Feeling ‘SAD’ this Winter? It Could be More than Just a Temporary Emotion

SAD is a recognized mental health issue in Pakistan and around the world, especially among young women, and shows considerable geographical variation.

As the season changes from warm, sunlit days to cold, hazy skies, a lot of individuals experience brief periods when they feel down or unlike their usual active and joyful self.

These shifts in mood are mostly described as feelings of ‘sadness’ or the ‘winter blues’. Moreover, these feelings intensify as the days shorten in fall and winter, and they usually improve in spring when the longer daylight hours come back. In most cases this is normal - it’s cold and quiet, get’s dark quickly, and you’re mostly stuck indoors.

However, in certain cases, these shifts in mood can become more severe than just a temporary feeling and may negatively impact a person’s feelings, thoughts, and actions. If you’ve observed marked shifts in your mood and behavior with the changing seasons, you might be dealing with something called Seasonal Affective Disorder (SAD).

What is Seasonal Affective Disorder (SAD)?

Seasonal affective disorder, commonly referred to as SAD, is a type of depression. It is also known as winter depression or seasonal depression. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), this condition is categorized as a major depressive disorder with seasonal pattern.

As mentioned, individuals with SAD undergo shifts in mood and exhibit symptoms that typically appear in the fall and winter seasons when sunlight is low and generally get better at the beginning of spring. Generally, the hardest months for individuals with SAD are December, January, and February.

The symptoms of SAD may be upsetting and daunting and can disrupt everyday activities. The occurrence of SAD differs based on geographical latitude, age, and gender; however, it is more common in individuals living at higher latitudes.

Moreover, SAD is more frequently seen in individuals residing far from the equator, where winter daylight hours are limited. Younger individuals and females are also at elevated risk.

What Causes Seasonal Affective Disorder?

SAD cab begin at any age, but it typically starts when a person is between ages 18 and 30. Scientists are uncertain about the precise factors that lead to seasonal depression. A common reason stated is insufficient sunlight.

Other concepts proposed are as follows:

• Alteration of Biological Clock: With reduced sunlight, your biological clock adjusts. This internal timer controls your mood, sleep, and hormones. When it changes, you’re out of sync with the routine you’ve grown accustomed to and struggle to adapt to variations in daylight duration.

• Imbalance of Brain Chemicals: Neurotransmitters (brain chemicals) facilitate communication among nerves. The neurotransmitter serotonin plays a role in creating feelings of joy. If you’re susceptible to SAD, you might already have decreased serotonin activity. As sunlight aids in regulating serotonin, insufficient sunlight during winter can worsen the condition - serotonin levels may decrease even more, resulting in depression.

• Vitamin D Deficiency: Your serotonin levels are also elevated by vitamin D. As sunlight aids in vitamin D synthesis, reduced sunlight during winter can result in a vitamin D deficit. That alteration can influence your serotonin levels and your emotional state.

• Melatonin Increase: Melatonin is a substance that influences your sleep cycles and emotional state. The deficiency of sunlight can trigger an excessive production of melatonin in certain individuals. This may be why you might experience tiredness and drowsiness in the winter.

• Negative Thoughts: Individuals with SAD frequently experience stress, anxiety, and pessimistic thoughts in the winter. In certain cases, researchers aren’t sure whether these negative thoughts are a result or a trigger of seasonal depression.

Risk Factors

Seasonal Affective Disorder often begins in young adulthood, but susceptibility increases with age. Seniors are especially vulnerable due to reduced sunlight exposure, limited mobility, and chronic health issues. While young adults often experience severe anxiety and cognitive symptoms, older adults experience physical fatigue, sleep issues, and reduced interest in daily activities.

• Moreover, SAD occurs more frequently in individuals with depression or bipolar disorder, particularly in bipolar II disorder, characterized by recurring depressive episodes and hypomanic episodes that are milder than the manic episodes found in bipolar I disorder.

• Additionally, individuals with SAD often experience other mental health conditions, including attention-deficit/hyperactivity disorder, eating disorders, anxiety disorders, or panic disorders.

• SAD can also occasionally be hereditary and may occur more frequently in individuals who have family members with other mental health conditions, like depression or schizophrenia.

Seasonal Affective Disorder Stats in Pakistan

Although comprehensive national data is limited, research in Pakistan indicates that seasonal affective disorder is fairly prominent in the country. Studies have revealed notable changes in mood, stress, and anxiety.

Some main insights from SAD research in Pakistan include the following:

• A study indicated that 71% of undergraduate students were affected with SAD, with a higher impact on females. Another reported that 72% students surveyed showed symptoms of SAD.

• Winter depression was markedly greater in elevated Hunza (10.16%) compared to low-altitude Sargodha (2.15%).

• Research repeatedly indicates that women experience higher rates of SAD and winter blues than men.

• A long-term study identified elevated anxiety and depression in summer as well, while stress reached its highest level in autumn. This indicates that SAD is a diverse phenomenon with varied seasonal influences.

Can Seasonal Affective Disorder Occur in Summer?

As discussed, certain individuals experience a less common type of SAD referred to as ‘summer depression.’ It begins in late spring or early summer and ends in the autumn. It’s not as common as the seasonal affective disorder that usually occurs in winter, but cases have been reported.

While winter SAD causes low energy, hypersomnia (oversleeping), and carbohydrate cravings, summer SAD often brings insomnia, weight loss, and increased anxiety.

Main Variations of Seasonal Affective Disorder

| Category | Type | Timing | Symptoms | Causes | | --- | --- | --- | --- | --- | | Main Variation | Fall/Winter Seasonal Affective Disorder (Winter Pattern) | Starts in late fall or early winter and eases in spring | Fatigue, hypersomnia, weight gain, carbohydrate cravings, social withdrawal | Reduced sunlight disrupts circadian rhythms and increases melatonin production | | Main Variation | Spring/Summer Seasonal Affective Disorder (Summer Pattern) | Begins in late spring or early summer | Insomnia, decreased appetite, weight loss, increased anxiety or agitation | Long, hot days may affect sleep quality and reduce melatonin levels | | Related Condition | Subsyndromal SAD (S-SAD) | Typically occurs in winter months | Milder symptoms similar to winter SAD, often called “winter blues” | Less severe response to reduced sunlight | | Related Condition | Bipolar Disorder with Seasonal Pattern | Depressive episodes occur during specific seasons | Seasonal depressive episodes (may alternate with manic/hypomanic episodes) | Mood episodes triggered or influenced by seasonal changes |

What are the Symptoms of Seasonal Affective Disorder?

Symptoms of SAD typically resemble those of depression.

Symptoms of SAD can begin mildly and intensify as the season advances. They usually last approximately 4 to 5 months annually. The signs and symptoms of SAD include (and are quite similar to) those related to depression, along with specific symptoms that vary between winter-pattern and summer-pattern SAD.

Signs and symptoms of SAD may include:

• Feeling sad or down most of the day, nearly every day

• Losing interest in activities you once enjoyed

• Having low energy and feeling sluggish

• Having problems with sleeping too much

• Experiencing carbohydrate cravings, overeating, and weight gain

• Having difficulty concentrating

• Feeling hopeless, worthless or guilty

• Having thoughts of not wanting to live

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

• Oversleeping

• Appetite changes, especially a craving for foods high in carbohydrates

• Weight gain

• Tiredness or low energy

• Social withdrawal

Symptoms specific to summer-onset SAD, sometimes called summer depression, may include:

• Trouble sleeping (insomnia)

• Poor appetite

• Weight loss

• Agitation (aggravated behavior) or anxiety

• Increased irritability

How is Seasonal Affective Disorder Diagnosed?

If you or someone you know is exhibiting signs of SAD, consult a healthcare professional or a mental health expert right away. You might be asked to complete a questionnaire to assess whether your symptoms align with the criteria for SAD.

To be diagnosed with SAD, an individual must fulfill these criteria:

• Exhibiting the symptoms of depression or the specific symptoms of winter- or summer-pattern SAD mentioned above.

• Their depressive episodes happen in particular seasons (winter or summer) for a minimum of 2 consecutive years. However, not everyone with SAD shows symptoms each year.

• Their depressive episodes in that particular season occur more often than those felt at other times throughout the year.

How is Seasonal Affective Disorder Treated?

Treatment options for both winter- and summer-pattern SAD are classified into four primary categories that can be utilized individually or together. Individuals should discuss with a health care professional the possible advantages and disadvantages of various treatment choices and identify which option is most suitable for them.

Light Therapy

Since the 1980s, light therapy has been a frequent method for managing winter-pattern SAD. Its goal is to expose individuals with SAD to bright light to compensate for the reduced natural sunlight during the darker months.

For this therapy, the individual sits daily in front of a bright light box (10,000 lux) for approximately 30 to 45 minutes, typically in the morning, during the fall through spring. The light box, approximately 20 times brighter than standard indoor lighting, filters out potentially harmful UV rays, ensuring this treatment is safe for most individuals.

Nevertheless, individuals with specific eye conditions or those on medications that heighten sensitivity to sunlight might require alternative therapies or should receive light treatment under medical guidance.

Psychotherapy

Psychotherapy (often referred to as talk therapy or counseling) can assist individuals with SAD by helping them develop new patterns of thought and behavior while altering habits that lead to depression.

Cognitive behavioral therapy (CBT) is a form of psychotherapy designed to assist individuals in confronting and altering unproductive thoughts and behaviors to enhance their feelings of anxiety and depression. CBT has been modified for individuals with SAD (referred to as CBT-SAD).

CBT-SAD is usually carried out in two weekly group sessions over 6 weeks, emphasizing the replacement of negative seasonal thoughts, like those about winter’s darkness or summer’s heat, with more positive ones.

CBT-SAD incorporates a method known as behavioral activation, which assists individuals in recognizing and planning enjoyable, engaging activities, whether indoors or outdoors, to counteract the diminished interest they often feel during winter or summer.

Antidepressant Drugs

Antidepressants used for treating depression can be effective for SAD when administered alone or alongside talk therapy. Antidepressants function by altering the brain’s production or utilization of specific chemicals related to mood or stress.

Antidepressants require time, typically 4 to 8 weeks, to become effective. Issues with sleep, appetite, and focus typically get better before mood enhances. It is essential to allow a medication time to take effect before determining if it is suitable. Individuals might have to experiment with different medications to identify the one that suits them best.

Due to the link between SAD and disruptions in serotonin function, antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) are occasionally utilized to alleviate symptoms. These drugs can greatly improve an individual’s mood.

Moreover, the US Food and Drug Administration (FDA) has given the green light to an antidepressant known as Bupropion in an extended-release formulation intended to remain effective for a longer duration in the body. For numerous individuals, daily use of Bupropion from autumn to early spring can avert the return of seasonal depressive episodes.

Remember: every medication can produce side effects, so consult a healthcare professional prior to starting or discontinuing any medication.

Vitamin D

Since a lot of individuals with winter-pattern SAD suffer from vitamin D deficiency, taking vitamin D supplements might enhance symptoms. Nonetheless, research examining vitamin D as a remedy for SAD has yielded inconsistent outcomes, with certain studies suggesting it is comparably effective to light therapy, while others report no impact.

Can Seasonal Affective Disorder be Prevented?

Seasonal Affective Disorder may be prevented by taking the necessary steps before it’s onset.

Since the onset of SAD is highly foreseeable, individuals with a history of the condition can benefit from starting the aforementioned treatments prior to fall (for winter-pattern SAD) or spring (for summer-pattern SAD) to help prevent or lessen depressive symptoms.

So far, only a limited number of studies have examined the possibility of preventing SAD. So currently, discussing a tailored treatment plan with a healthcare professional is beneficial. They can assist you in determining not only the most suitable treatment option but also the ideal timing to help avert episodes of SAD depression.

Final Thoughts

Seasonal Affective Disorder is a major depressive disorder with a seasonal pattern, primarily affecting individuals during fall and winter when there is less sunlight. Symptoms include persistent sadness, loss of interest, low energy, changes in appetite, and difficulties in concentration. SAD is more prevalent at higher latitudes and predominantly affects younger individuals and women.

The precise causes of SAD remain unclear. Symptoms escalate from mild to severe over a typical 4 to 5-month period and vary between winter and summer patterns. Diagnosing SAD involves assessing symptoms over at least two consecutive years linked to specific seasons.

Treatment options include light therapy, psychotherapy (such as CBT-SAD), antidepressants, and vitamin D supplementation, addressing both biochemical and behavioral aspects of the disorder. Each treatment’s suitability varies, necessitating consultation with healthcare professionals.

Mindscape Global is dedicated to help you navigate your way through mental health challenges. Our experts provide the guidance and information you need to understand various mental health issues and how to address them. Our aim is to enlighten the society by spreading mental-health awareness, so that you or anyone suffering from conditions like SAD can understand what they’re going through and get the help they need.

References:

https://www.psychiatry.org/patients-families/seasonal-affective-disorder

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

Yasmin, H., Naveed Riaz, M., & Nasir, F. (2022). Epidemiological Study on the Prevalence of Winter Depression in Pakistan. Journal of Development and Social Sciences, 3(2), 655–662. https://doi.org/10.47205/jdss.2022(3-II)59

Sharif, A. & Riaz, . M. N. (2020) Longitudinal study on seasonal affective disorders in Pakistan. Rawal Medical Journal, 45 (2), 327-330

Yasmin , H, Riaz M N Nasir F . (2022). Epidemiological Study on the Prevalence of Winter Depression in Pakistan. Journal of Development and Social Sciences ,3(2),655-662, https://doi.org/10.47205/jdss.2022(3-II)59