Seasonal Affective Disorder: extreme winter blues

Written by Alexandra Gee

The winter months can be a difficult time. A drop in temperature can leave you vulnerable to a drop in mood. For most of us winter can trigger wanting to stay in bed, eat comfort food & not go out. When you add grief into the mix it can be even more dangerous.

Seasonal Affective Disorder (SAD) is a form of recurrent depression that affects people during the winter months. Depressive symptoms increase as winter approaches, temperatures drop & days are shorter & ease as spring arrives.

The difference between clinical depression and SAD is that SAD sufferers feel depressive symptoms solely or much more strongly during winter. They may feel fine during summer but as daylight hours reduce they don’t feel their normal self.

Winter can be difficult generally & most people don’t look forward to the cold, with winter blues a common issue in everyday Australians. Winter blues affects up to 14% of adults living in the US, while another 6% suffer from full-blown SAD, a more pronounced & severe form of winter blues.

The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) is the gold standard diagnostic criteria for mental disorders & the most common used in the western world. SAD has now been included as a recognised mental disorder in this manual & several studies have examined this condition & possible treatment methods.

SAD symptoms unfortunately may not be limited to just winter months, sometimes affecting four to five months of the year. A climate change can also affect the severity of symptoms. For example, a person who suffers from the winter blues may develop SAD if they move to a colder, darker climate. Alaska, for example, reports rates of 9.2% of the population, one of the highest ever recorded.

Symptoms of SAD are similar to depression but include a change in mood related to weather changes. Anhedonia, a common symptom of depression can be seen, which is an inability to look forward to or enjoy things that would normally make you feel happy. Suddenly instead of looking forward to Friday after work drinks, you may feel indifferent.

Sleeping patterns also change, sleeping more & have difficulty getting up in the morning. Energy levels are also lower, so everyday things might suddenly feel like a real effort, or that you just can’t be bothered anymore.

In relation to eating, due to the above changes in energy & excess sleep, you may crave simple carbohydrates such as bread, pasta & sweets. These give you a quick burst of energy which is short-lived, but seems beneficial when you feel tired & unmotivated. Unfortunately this kind of eating can lead to weight gain during winter, perpetuating the problem.

Trouble focussing is also a real problem during winter for SAD sufferers. Forgetfulness, absentmindedness & difficulty with tasks that require attention to detail can be a sign. Similarly to anhedonia, people suffering from SAD may feel more socially withdrawn during a low period. Feeling less like you want to see your friends or family is also a symptom of depression & SAD. This can also affect work and relationships & it is important if you are having problems to address them.

Experts are not sure what exactly causes SAD, however there are theories including something in the brain being triggered by the decrease in daylight hours, or the changes in the melatonin & serotonin hormones responsible for sleep-wake cycle creating an imbalance.

There are some studies that suggest a family history of depression increases the chances of a person developing SAD, as do life experiences. For that reason, you, readers, as people who have suffered terrible traumas by losing a sibling, are at higher risk of SAD & should be aware of these symptoms, paying particular attention to the timing of them.

Serotonin & melatonin are hormones that regulate the sleep-wake cycle, with melatonin being responsible for sleep, with higher levels seen during winter. Putting it simply, winter makes us want to stay in bed!

In one study, melatonin levels were different in people diagnosed with SAD during winter than the healthy control group. While this doesn’t show that melatonin changes is the cause for SAD, it does increase weight for this theory.

Unfortunately sleeping more & having less energy creates an environment that can allow depression to increase, particularly as serotonin can decrease during this time. Serotonin is a feel-good hormone & is well-known in relation to anti-depressants. SSRIs (selective serotonin reuptake inhibitor) are a common range of anti-depressants that increase the levels of serotonin in the brain by reducing the rate at which the body removes it.

Think about the illegal drug ecstasy: the reason it gives people a sense of extreme elation & energy is due to a sudden release of serotonin in the brain. Afterwards, users face a ‘comedown’ where serotonin levels are depleted & they feel depressed & fatigued. This is an extreme example of the importance of serotonin levels in the brain.

What can you do?

Several studies have shown that light therapy can improve symptoms related to winter & sunlight. It involves using a bright artificial fluorescent white light for 30 to 90 minutes a day, depending on the severity of SAD symptoms, and is most beneficial in the mornings, as it helps a person to wake up & feel energised for the day. Treatment can, however, be divided throughout the day. There is a lot of information available about light therapy, however speaking to a GP is a good way to get an idea if this could help you.

In terms of medication, SSRIs in some people improve their serotonin levels, increasing energy & mood. However they can also have serious side effects & should never be assumed to be the best or first option. If depression, or even SAD is affecting you, it’s best to speak to a doctor or get a referral to a psychiatrist who can discuss medication possibilities & their suitability to your situation.

Other alternatives include managing stress, which can include psychotherapy to help incorporate coping strategies to everyday situations that can overwhelming & learning how to best approach & deal with life’s hiccups.

Regular exercise is also very useful in reducing SAD as it releases endorphins which are also feel-good hormones that reduce pain & give a natural high. Exercising outdoors gives the added bonus of having sunlight, a form of light therapy, although this can be difficult during winter.

Exercise is more difficult in winter, with safety being an issue for exercising outdoors as it’s dark before & after work for most people, so maybe switching to a lunch time workout, social walk, or taking up a class can also help. Aches & pains are usually worse during winter, so taking up a sport like swimming, which is not only warm but low impact, is a good option.

Coping tips in the winter months

I may sound like a broken record, but please do get enough Omega-3 fatty acids during this period. You may not eat much fish during winter & if you’re not getting enough from your diet a supplement can help. Improving mental function helps us to deal with stress & improves concentration & productivity.

While you may feel like you want to hibernate during winter, keeping in touch with family & friends helps you to feel connected. Making the effort might feel like a struggle, but once you are out of the house & in the company of people who love you, it is worth it.

Personally, I find snuggling up in bed with my dogs the best way to warm up & feel better. Also, a warm cup of tea & a good tv show always makes the cold days feel easier to cope with.

If you have any suggestions or tips on how you like to beat the winter blues please write in, we always love to hear from readers.

References:

Booker, J.M., Hellekson, C.J. Prevalence of seasonal affective disorder in Alaska. Am. J. Psychiatry 1992; 149:1176–1182

Partonen T, Lonnqvist J. Seasonal affective disorder. Lancet 1998; 352:1369-74.

Rosen LN, Targum SD, Terman M, Bryant MJ, Hoffman H, Kasper SF, Hermit JR, Docherty JP, Welch B, Rosenthal NE. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res. 1990; 31:131-144.

Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984; 41:72-80

Wehr TA, Duncan WC, Jr, Sher L, Aeschbach D, Schwartz PJ, Turner EH, Postolache TT, Rosenthal NE. A circadian signal of change of season in patients with seasonal affective disorder. Arch Gen Psychiatry. 2001; 58:1108–1114.