“Many people feel sluggish and down because of the weather, but seasonal affective disorder is not the same as the ‘winter blues,’” said Blake Casher, DO, psychiatrist and medical director of the geropsychiatric program at McLaren Greater Lansing. “The depression associated with SAD is often severe enough to require treatment.”
SAD is a psychological and physical condition — and a serious form of depression — that occurs in a seasonal pattern, usually recurring from fall through winter, and usually remitting in the spring.
“Those who are affected by SAD often don’t experience depression as severely at other times of the year,” said Dr. Casher.
SAD is caused by biological factors resulting from seasonal changes. As the days shorten, sunlight recedes, decreasing the amount of light that normally enters the retina. This change in light pattern disrupts the circadian rhythm, affecting the pineal gland, which regulates certain chemicals like serotonin, melatonin, dopamine and norepinephrine.
The disruption causes sufferers of SAD to exhibit symptoms typical of other clinical depressions like sadness, loss of interest, irritability and lethargy. Contrary to typical depression, however, sufferers of SAD will gain rather than lose weight, crave foods high in carbohydrates and sugar, and often oversleep.
In addition, SAD can cause somatic, or physical, symptoms like heart palpitations, decreased libido and dizziness. These symptoms can trigger academic problems for school children, difficulty for adults at work, and can strain interpersonal relationships with family, friends, spouses and colleagues.
“It’s important for those who have not experienced depression to understand they may have no idea how it affects another person. It’s both psychological and biological,” said Dr. Casher. “With SAD, it begins biologically and becomes both. Truly depressed individuals cannot think or will themselves out of depression, or make themselves not depressed by wishing or hoping. It’s more complicated than that.”
SAD can occur without warning, but risk factors can include a family or personal history of depression and/or substance abuse, with a higher rate of SAD occurring in women.
“People tend to eat more and drink more alcohol in the winter months. Weight gain can certainly add to depression and alcohol is a depressant, so consumption can compound the disorder. More than one drink per day should be avoided.”
To treat SAD, Dr. Casher prescribes phototherapy to “trick” the brain into correcting the abnormal phase delay in the sleep/wake process.
“We prescribe the use of a special type of light that has a specific brightness of 10,000 lux,” said Dr. Casher. “Every morning, the patient will sit and place the light within 18-24 inches of their vision for 45 to 60 minutes for maximum effect. There is no need to stare directly at the light, simply have it in front of the eyes to allow it to pass through the retina and simulate actual sunlight. Additionally, patients who are aware of their patterns will begin treatment in November or earlier in anticipation of the shorter days. They’ll often cease in spring when the days are lengthening and they feel they don’t need it anymore.”
Phototherapy treatment for SAD, according to Dr. Casher, has a success rate of 75 to 90 percent, does not require a prescription, but may be covered by insurance with a doctor’s order. If not covered by insurance, the phototherapy equipment is typically a one-time out-of-pocket cost of $200 to $300. Less expensive light treatments are available, but are less likely to be as effective as Dr. Casher’s recommended 10,000-lux light. Severe cases of SAD may require an additional prescription of antidepressants such as selective serotonin reuptake inhibitors (SSRIs), which can include Prozac, Zoloft, and Lexapro. Phototherapy is generally prescribed first due to its success rate and fewer side effects than antidepressants.
Suicidal ideation is always a risk with any form of depression, though it rarely presents with SAD. Dr. Casher advises to be aware of the potential growing severity of SAD, or any depression, and to immediately get help if you or a loved one exhibit suicidal warning signs. These include suicidal thoughts or visualizations like making specific plans or giving away personal items.