Winter Depression or Seasonal Affective Disorder

“ye wande shikas chu mae kharaan; wandas manz chu mae souri kharaan”

Isha Malik

WHEN the long dark days of winter approach, do you feel slowed down? Does it feel more difficult to wake up early in the morning? Do you face difficulty in concentrating on work; feel demotivated and sad for most part of the day?

You may be one of the many people who get psychologically affected by change in the season. This condition is known as SAD- seasonal affective disorder. Though most of the people with this condition never seek professional help but they complain about feeling less cheerful, creative, energetic and productive during the winter season compared to the rest of the year.

In Kashmir, the cold weather lasts for more than six months, which leads to most of the people having significantly low levels of vitamin D due to less exposure to sunlight.  A number of studies have shown a relationship between Vit D levels and depression, which to some extent explains why people living in cold regions have a higher risk of developing seasonal affective disorder. You might have heard many people around you saying

“ye wande shikas chu mae kharaan; wandas manz chu mae souri kharaan, beh chus/ches na hekaan kih thi karith; mae chu nebar wuchun tuth kharaan, souri chu manhoos baasaan”

What is Seasonal Affective Disorder?

As per APA- American Psychological Association

Seasonal affective disorder is a form of depression also known as SAD, seasonal depression, or winter depression. In the Diagnostic Manual of Mental Disorders (DSM-5), this disorder is identified as a type of depression – Major Depressive Disorder with Seasonal Pattern.

Seasonal affective disorder (SAD) was first described as a syndrome of recurrent episodes of depression that occur annually (usually in the winter season at same time each year) by Rosenthal et al. in 1984.

People with SAD experience mood changes and symptoms similar to depression. The symptoms usually occur during the fall and winter months when there is less sunlight and usually improve with the arrival of spring. The most difficult months for people with SAD tend to be January and February. While it is much less common, some people experience SAD in the summer as well.

SAD is more than just “winter blues.” The symptoms can be distressing and overwhelming and can interfere with daily functioning. However, it can be treated. It is more common among women than men. SAD may begin at any age, but it typically starts when a person is between ages 18 and 30.

SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. As seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. SAD is more common in people living far from the equator where there are fewer daylight hours in the winter.

Symptoms and Diagnosis 

Common symptoms of SAD include fatigue, even with too much sleep, and weight gain associated with overeating and carbohydrate cravings. SAD symptoms can vary from mild to severe and can include many symptoms similar to major depression, such as:

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed.
• Changes in appetite; usually eating more, craving carbohydrates.
• Change in sleep; usually sleeping too much.
• Loss of energy or increased fatigue despite increased sleep hours
• Social withdrawal (feeling like “hibernating”)
• Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable to others).
• Feeling worthless or guilty
• Difficulty thinking, concentrating, or making decisions.
• Thoughts of death or suicide   (APA)

Remember that the symptoms associated with SAD could be a result of some other underlying medical causes. Physical examination and some blood tests can help to confirm the diagnosis and rule out the presence of any other causal factor. Some specific illnesses that need to be considered are:

Hypothyroidism, hypoglycaemia, chronic viral illnesses, chronic fatigue syndrome etc.

How is SAD diagnosed? 

If you think you may be suffering from SAD, talk to your family doctor or a mental health professional. To be diagnosed with SAD, an individual must meet the following criteria:

• They must have symptoms of depression (as mentioned in list above)
• The depressive episodes must occur during specific seasons (i.e., only during the winter months or the summer months) for at least 2 consecutive years. This means there must be a temporal relationship between the onset of the symptoms and a particular time of the year.
• Full remissions also occur at a characteristic time of the year (e.g., depression disappears in spring).

Causes of SAD:

The exact cause of SAD has not been fully understood yet, but it’s often linked to- reduced exposure to sunlight during short winter days.

Lack of sunlight might stop a part of the brain called the hypothalamus from working properly; this may in turn affect-

• Production of melatonin – melatonin is a hormone that makes you feel sleepy; in people with SAD, the body may produce it in higher than normal levels
• Production of serotonin – serotonin is a hormone that affects your mood, appetite and sleep; a lack of sunlight may lead to lower serotonin levels, which is linked to symptoms of depression.
• Body’s internal clock (circadian rhythm) – your  body uses sunlight to time various important functions, such as when you wake up, so lower light levels during the winter may disrupt your body clock and lead to symptoms of SAD

It’s also possible that some people are more vulnerable to SAD as a result of their genetic predisposition, as mood disorders appear to run in families.

Who is at more risk?

• Females
• Young adults
• Individuals living in cold regions with long winter season.
• Individuals with personal or family history of depression.
• Individuals diagnosed with depression or bipolar disorder.
• Females in post-partum phase

Treatment:

SAD can be effectively treated in several ways which includes- light therapy, antidepressant medications, talk therapy or some combination of these. Although symptoms generally improve with the change of season, symptoms can improve more quickly with proper treatment.

The main treatments are:

• Making lifestyle changes –getting natural sunlight, eat a healthy and balanced diet, and paying extra attention to stress management. Keeping yourself engaged in pleasurable activities and doing physical exercise for at least 30minutes- 3-4 times a week can prove to be quite helpful. Regulation of your sleep cycle is also important. Taking vacations in sunnier regions can also help one cope with SAD.
• Light therapy – where a special lamp called a light box is used to simulate exposure to sunlight.  It usually requires 20 minutes or more per day, typically first thing in the morning, during the winter months. Most people see some improvements from light therapy within one or two weeks of beginning treatment. To maintain the benefits and prevent relapse, treatment is usually continued through the winter. Because of the anticipated return of symptoms in late fall, some people may begin light therapy in early fall to prevent symptoms.
• Consulting a Clinical Psychologist (for CBT sessions) or a Psychiatrist, who will prescribe some antidepressant medicine– such as selective serotonin reuptake inhibitors (SSRIs).

• For more on various Addiction Treatment Programmes visit Rehab Recovery

Views expressed in the articles are the author’s own responsibility. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is strictly for educational/informative purposes only

• The author is a Clinical Psychologist at G.B.Panth Hospital 

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