When I was young, every year right after Thanksgiving my dad would suffer a complete personality change.
From his usual vibrant, happy and optimistic self, he would become irritable, fatigued and just depressed enough to let everyone know how miserable he was and that he hated the winter.
It was like Dr. Jekyll transforming into Mr. Hyde. Hyde usually stayed around until the end of winter.
Just like the Christmas season was coming, we knew his personality change season was coming.
And it didn’t have anything to do with past bad holiday experiences or with financial matters. It just happened.
But then around Valentine’s Day, he’d completely snap out of it and become his old self. It was unbelievable.
At the time, nobody knew why it happened. It was just something we knew was going to happen, and we tried to deal with it the best we could.
Today, however, there is an answer for it.
It is suspected that people who become depressed during the winter months for no explicable reason, only to see that depression leave in the spring or summer, may be affected by what is called seasonal affective disorder (SAD).
SAD is a seasonal depressive disorder that affects millions of Americans every year. Those who live in more northern regions of the country are particularly prone to SAD.
However, tens of millions more people also suffer from a milder form of SAD known as the “winter blues”.
I suspect my dad had something in between the two. He didn’t just get bluesy. He got down right ornery.
If you suffer from SAD or just get those winter blues, there’s good news.
There are several actions experts recommend you take that can make the winter season a lot easier to cope with and can perhaps make you a more content and productive person.
Let’s take a closer look at SAD.
What Is Seasonal Affective Disorder (SAD)?
SAD is classified as a major depressive disorder that seems to follow the seasons.
Most people who suffer from SAD experience it during the winter months. However, a lesser number of people can experience SAD during the spring and summer.
It’s mainly an adult disorder, but there have been some reported cases of children having it.
The typical onset for SAD is early adulthood with women being more affected than men.
Researchers believe that there may be a genetic component involved, but they haven’t discovered a link.
In order to be considered SAD, a person must experience symptoms for at least two consecutive years.
What Are The Symptoms Of SAD?
Some of the symptoms of fall-winter SAD listed by the Mayo Clinic include:
- Tiredness or low energy
- Problems getting along with other people
- Hypersensitivity to rejection
- Heavy, “leaden” feeling in the arms or legs
- Appetite changes, especially a craving for foods high in carbohydrates
- Weight gain
The severity of the symptoms of SAD can vary widely.
Some can suffer severe depression that might require a doctor’s attention or even hospitalization.
Others suffer from a milder form of SAD known as subsyndromal seasonal affective disorder (SSAD). SSAD is also termed the “winter blues”.
People with SSAD often suffer the same symptoms as SAD but to a much lesser degree.
For example, people with SAD report sleeping an average of 2.5 hours more in winter than in the summer, whereas people with winter blues sleep 1.7 hours. more. The general population sleeps about 0.7 hours more in the winter. See here.
(NB: These statistics are from SAD expert Dr. Norman Rosenthal. Unfortunately, he doesn’t specify whether these hours are per day or week.)
Depending on the severity of the symptoms of SAD, it is quite easy to see how it can severely affect productivity in work or school and may affect interpersonal relationships.
My dad got what he called a “fluey”, tired feeling every winter without any other symptoms and was extremely difficult to get along with.
How Many People Get SAD?
The reported prevalence of SAD amongst the general population varies greatly.
Since SAD is primarily an adult disorder, I believe these statistics apply to adults.
The Cleveland Clinic reports that approximately 500,000 Americans suffer from SAD.
However, Dr. Norman Rosenthal, Clinical Professor of Psychiatry at Georgetown University Medical School and expert in SAD research, estimates that six percent of the US population is affected by SAD in its most marked form.
This would mean that approximately 14 million people have SAD.
However, Psychology Today states that seasonal affective disorder is estimated to affect 10 million Americans. That’s about 4 percent of the adult population.
I suspect the discrepancy between the numbers has to do with the fact that people can suffer from varying degrees of severity of symptoms.
It’s possible that the Cleveland Clinic’s statistic represents the severest form of the disorder where people need professional help because of severe depression.
Psychology Today reports that 6% of SAD sufferers need hospitalization. That would be about 600,000 people.
This would then be in line with Cleveland Clinic’s reported number of people with SAD.
However, that would still leave between 9 – 13 million people with SAD.
Now consider this.
Most experts (including the Cleveland Clinic) seem to agree that the milder form of SAD (SSAD) affects an additional 10-20% percent of the adult US population.
If we use an average of 15%, that means that another 36 million adult Americans suffer from SSAD.
So if Dr. Rosenthal and Psychology Today are correct, then there are somewhere between 46 – 60 million adult Americans suffering from some form of SAD or SSAD.
That means that there is a significant portion of the population who are to some degree psychologically or physically negatively impacted by the winter season.
The Geographic Distribution of SAD
SAD primarily affects people who live in northern latitudes or geographic locations farther away from the equator.
Why Do People Get SAD?
The exact cause of SAD is unclear. However, the fact that it is more prevalent in areas where available sunlight decreases in the winter months has led researchers to pose some theories.
1. Lack of Serotonin
Serotonin is a neurotransmitter manufactured in the brain but also found in the digestive tract.
Some of the functions of serotonin include the proper regulation of mood, appetite, and sleep.
A number of researchers believe that a decrease of serotonin in the brain could be responsible for SAD.
A recent study found that people who suffer from SAD have a 5% increase in a compound called serotonin transporter protein (SERT) in the winter months as opposed to the summer.
SERT is responsible for the travel of serotonin from the brain back into nerve cells where it is not active. Therefore the higher the level of SERT activity, the lower the activity of serotonin.
Lead researcher Brenda McMahon, MD, from the Neurobiology Research Unit at Copenhagen University Hospital notes,
“Sunlight keeps this setting naturally low, but when the nights grow longer during the autumn, the SERT levels increase, resulting in diminishing active serotonin levels.”
Therefore lower levels of brain serotonin could be responsible for the symptoms associated with SAD.
2. Melatonin Overproduction
Melatonin is a hormone responsible for regulating sleep and wakefulness.
It’s also important for the synchronization of the circadian rhythm and sleep-wake timing.
When you are exposed to darkness, the pineal gland in the brain produces melatonin which causes you to feel sleepy.
The production of melatonin stops when light causes your pineal gland to stop making melatonin. This causes you to wake up.
It seems that people with SAD may have a problem with the overproduction of melatonin.
As winter days become darker, melatonin production increases. In response, those with SAD feel sleepy and lethargic.
Although researchers believe melatonin plays a role in SAD, they don’t believe it’s over production alone can account for symptoms.
3. Disruption Of Circadian Rhythms
A circadian rhythm or “body clock” is a roughly 24-hour cycle in the physiological processes of living beings.
The illustration below presents what a normal 24-hour human circadian rhythm should look like.
This cycle is generated from within your body. However, it can be affected by external factors like light and darkness.
Normally the circadian rhythm should be synchronized to daily light–dark changes and also to those that occur throughout the seasons.
However, it has been shown that people who have SAD become depressed in the winter because their circadian rhythm with respect to the sleep – wake cycle has been disrupted.
Researchers are not sure why this happens, but it may be due to the combination of decreased serotonin and increased melatonin impacting circadian rhythms.
4. The Importance Of Vitamin D
Decreased vitamin D levels have long been associated with SAD leading some researchers to suggest that decreased levels of vitamin D might be a risk factor in SAD.
Low vitamin D has also been linked to depression
It’s possible that decreased outdoor sun exposure in the winter could be the reason for inadequate vitamin D.
These are the main theories as to why people get SAD. Let’s take a look at how it’s treated.
How To Treat SAD
Of course, if you have any of the symptoms of SAD, you should see your health practitioner.
For those with milder forms of SAD, there are a number of things recommended by healthcare professionals to alleviate some of the symptoms. These include:
1. Light Therapy
The primary treatment for SAD is light therapy. This makes sense since we have seen that the lack of daylight is thought to be instrumental in causing SAD.
Dr. Rosenthal reports that sixty to eighty percent of SAD sufferers benefit from light therapy.
These units produce 10,000 LUX of light while blocking 99.3% of UV light.
Rosenthal states that most SAD sufferers need between 30 and 90 minutes a day. Mornings appear to be the best time for therapy to work.
He added that people experience results within 2 -4 days of starting treatment.
Here is the Mayo Clinic’s recommendation for light box therapy.
2. Blue Light Therapy
There is some question on prolonged exposure to blue light on eye health. However, studies so far have been inconclusive.
If you suffer from an eye disease, consult your physician before using a blue light.
I don’t have SAD or get the “winter blues”, but I do use a blue light because of its positive effect on mood and as a preventative measure because I do have a family history of SAD.
This is the one I use.
Here is an article by sad.org.uk on whether you should choose a blue light or white light for SAD treatment.
3. Get Regular Exercise
Research has shown that exercise is beneficial in those suffering from depression.
It is recommended that someone with SAD not exercise late at night as this could have an effect on melatonin secretion and possibly shift the circadian rhythm.
4. Maintain Adequate Vitamin D Levels
It is recommended that those who have SAD or depression make sure that their vitamin D levels are within normal limits. If they are low, your doctor may prescribe a supplement.
There seems to be some controversy on proper levels of vitamin D. See here.
Diet is one natural way of increasing vitamin D levels. Salmon, herring, and sardines are excellent sources of vitamin D.
Spending time outdoors can also raise vitamin D levels. But, of course, in the winter this may be difficult.
5. Maintain A Proper Diet
Recent evidence has shown the importance of good dietary habits on mood and depression.
Refined sugar and processed fructose, in particular, are known to have a very detrimental impact on your brain function and mental health in general. Everybody should avoid these.
To optimize your gut microbiome, eat real food, as well as fermented foods such as fermented vegetables, raw milk kefir, kombucha, and yogurt.
Some research has also shown that optimizing your intake of omega-3 fatty acids can have a positive effect on depression.
6. Conventional Antidepressants
Some practitioners may prescribe antidepressants for extreme depression in SAD. However, the side effects of these medications must be measured against their potential benefits.
7. Cognitive-behavioral therapy (CBT)
Finally, some research has shown that Cognitive-behavioral therapy (CBT) may be effective in treating SAD.
However, this 2009 study showed a combination therapy was even more effective.
CBT could be used to replace medications as a treatment for severe cases of SAD.
How Do You Know If You Have SAD?
Here is the million-dollar question you have been waiting for: How do you know if you have SAD?
Dr. Rosenthal has written an excellent article here on how to determine if you have SAD or SSAD.
It includes a self-assessment checklist from the Seasonal Pattern Assessment Questionnaire.
However as Rosenthal notes in his article,
A self-assessment checklist can never substitute for a clinical evaluation, so if you think you are affected, especially to a major degree, you would be best off checking in with your doctor for further guidance.
The Take Away
Whether you have SAD, SSAD, or just don’t like the dark, cold winter days, some core principles hold.
Get outside and get some sun if possible. Exercise regularly. When inside, get some morning exposure to a light box. Stay away from blue light at night. Eat well and make sure your vitamin D levels are adequate.
And take heart. Spring is coming.
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