Seasonal depression is often referred to as seasonal affective disorder (SAD). With the arrival of the first cold days of autumn, the days become shorter and the sky becomes cloudy. This seasonal disorder is also known as winter/holiday blues. However, it is important to distinguish whether the low mood is a temporary autumn blues associated with less sunlight and rainy weather, or a more serious problem. It can be a complex disorder causing many symptoms, such as lethargy, anxiety, and insomnia. It can range from mild to debilitating and require professional help. What is seasonal depression, what are its causes and symptoms, and how can it best be treated?
Affective disorder. What is depression?
Depression is a commonly used term for an affective disorder, i.e., a mood disorder whose main symptom is a prolonged low mood associated with an overwhelming feeling of sadness and despondency. The basic symptoms of depression include: loss of ability to enjoy activities that were previously enjoyable, decreased energy, increased fatigue, and difficulty performing basic tasks, even if they are relatively simple. For this condition to be considered long-term, it must last at least two weeks, and the symptoms must be present most of the time. In addition, depression is often associated with sleep disturbances, especially insomnia, appetite disturbances, reduced concentration, and persistent feelings of guilt. In addition, a person suffering from depression struggles with low self-esteem, pessimistic visions of the future, and in the worst cases, suicidal thoughts and tendencies. Depression is generally recurrent, meaning that after one episode, usually lasting several weeks, there is a long period of remission, which can interfere with daily functioning, followed by another episode of depression.
Beck’s triad of depression
The negative cognitive triad provides a clear understanding of the mechanism of depression. The triad was developed by Aron Beck (one of the most prominent authors of cognitive therapy) and is based on the fact that depression affects the cognitive sphere.
The triad is characterized by three main, basic negative assumptions (cognitive beliefs) about oneself, other people, and the future. During depression, people think negatively about themselves—they believe that they are flawed, inadequate, and worthless. In depression, people are dissatisfied with their current life situation and believe that the world places unreasonable demands on them. Thoughts about others are related to their unkindness, lack of understanding, and lack of support. Judgments about the future are extremely negative and hopeless. When depressed, people are pessimistic about their ability to achieve desired results.
The negative cognitive triad assumes that beliefs are the main feature of all types of mood disorders. This means that other aspects of depression, such as somatic (e.g., sleep problems), motivational (e.g., passivity and withdrawal), and affective (e.g., intense sadness) disorders, are the result of negative assumptions made by people suffering from depression.
Autumn sadness. What is seasonal depression?
Seasonal affectivedisorder (SAD) is a subtype of affective depressive disorder, i.e., one of the types of depression. It is characterized by a cyclical, seasonally recurrent course, which means that the first depressive episodes usually occur in late fall or early winter and last until spring, when there is an improvement in mood and general condition. In some very rare cases, the symptoms of the disease appear in spring and summer, while remission occurs in fall and winter.
How common is seasonal depression?
It is assumed that autumn or winter depression is a relatively common disease. Its frequency varies among populations depending on geographical latitude. The highest prevalence of SAD has been observed at higher latitudes. According to estimates, seasonal affective disorder affects 4% of the population in temperate zones, and in areas with greater sunlight deficiency, this percentage increases to as much as 10%. What is more, the risk of developing the disorder is higher in people who migrate from lower to higher altitudes. In addition, women are four times more likely than men to suffer from seasonal affective disorder. The incidence of SAD seems to decrease with age.
What causes seasonal affective disorder (SAD)?
The main causes of depression are considered to be cyclical changes in the length of day and night and the intensity of sunlight, which is why recurrences are observed at specific times of the year. To some extent, genetic factors may also contribute to the onset of SAD, but so far no gene has been identified whose mutation would have a direct impact on the development of the disease. As with typical depression, SAD is associated with a decrease in serotonin levels in the brain and disturbances in other neurotransmitters such as norepinephrine, dopamine, and melatonin. Serotonin and melatonin are responsible for maintaining the body’s daily rhythm related to the seasonal night-day cycle. People suffering from seasonal depression struggle with changes in their concentration, which disrupts their normal sleep-wake cycle. This, in turn, leads to difficulties in adapting to seasonal changes in the length of the day, as well as sleep, mood, and behavioral disorders. It is also worth mentioning the role of vitamin D, whose deficiency, although not the most important factor in the development of depression, can worsen its course and the response to possible treatment. Vitamin D is considered important for promoting serotonin activity. In addition to vitamin D consumed in food, the body produces it as a result of exposure to sunlight on the skin. When there is less daylight, people with SAD may have lower levels of this vitamin in their bodies, which further impedes serotonin activity.
Seasonal affective disorder. Symptoms of seasonal depression
The symptoms of seasonal depression do not differ significantly from those observed in typical depression. However, in SAD with episodes in the fall and winter, social withdrawal, known as “social hibernation,” is more common, as are atypical symptoms such as increased sleepiness, increased appetite (especially for sweet foods), and, consequently, weight gain. In the case of less frequent episodes in the spring and summer, insomnia, decreased appetite and weight loss, anxiety, restlessness and agitation, and a tendency toward aggressive behavior are characteristic. Possible somatic symptoms of seasonal depression include drowsiness, constant fatigue, and difficulty concentrating.
How to recognize seasonal depression?
There is no single universal test for diagnosing seasonal depression. In order to make a diagnosis, the patient must meet the criteria characteristic of recurrent depressive disorders. These symptoms must also appear cyclically in the fall-winter or spring-summer season. It is worth mentioning that the symptoms do not have to appear every year, although this is most often the case. The doctor may ask the patient two questions as a screening test:
- Have you experienced a decrease in interest or pleasure in the last month?
- Have you felt sad, depressed, or hopeless in the last month?
If the answer to at least one of the questions is yes, the diagnosis should be further investigated and it is best to recommend that the patient consult a psychiatrist or psychotherapist. The Beck scale mentioned above is the most commonly used. However, tests cannot replace a thorough psychological examination, which must consist mainly of talking to the patient and observing their behavior during the visit. The final diagnosis is made if at least two of the three symptoms are present for a minimum of two weeks, including: depressed mood, anhedonia, i.e., the aforementioned inability to enjoy what was previously a source of joy, and decreased energy. In addition, at least two of the following symptoms must be present: difficulty concentrating and paying attention, low self-esteem, feelings of guilt, a pessimistic outlook on the future, suicidal thoughts and behavior, various types of sleep disorders, and various types of appetite disorders. An important factor in the diagnosis of recurrent depression is the occurrence of at least two-month breaks between episodes of mood disorders. In the case of seasonal depression, this criterion is automatically met, as the symptoms only appear at a specific time of year.
What is the treatment for seasonal depression? Psychotherapy and phototherapy
Once the correct diagnosis has been made, the patient should learnhow to cope with seasonal depression. Due to the fact that the most likely cause of such disorders is the reduction in sunlight that occurs in the fall and winter, phototherapy is a recognized and recommended method of treating SAD and improving well-being. This method has been used since the 1980s. It involves daily or every other day exposure to light with an intensity of 2,500 to 10,000 lux in the morning. At the lowest intensity values, the exposure time should be approximately 2 hours, while at the highest values – half an hour. It is important that the phototherapy lamp is at the patient’s eye level. Such therapy usually lasts between 2 and 3 weeks. Its effect is to reduce the concentration of a substance considered to be depressogenic, namely melatonin. Phototherapy is considered a safe method, but in the case of people diagnosed with eye diseases, it is important to consult an ophthalmologist beforehand to rule out any contraindications to the use of strong light directly on the eyes. It should also be remembered that people taking medications that increase sensitivity to sunlight may require alternative treatments or therapy under the supervision of a specialist. In other cases, a phototherapy lamp can be purchased to perform the treatment at home.
Another method of treating seasonal depression is psychotherapy. In this case, cognitive behavioral therapy(CBT) is considered the most effective. Its role is to help patients learn to cope with difficult situations. A special form of CBT has even been developed for people diagnosed with seasonal depression (CBT-SAD). Most often, sessions take place twice a week for six weeks. During these sessions, the therapist focuses on replacing the patient’s negative thoughts associated with the fall and winter seasons with more positive ones. CBT-SAD also uses a process called behavioral activation to help patients plan enjoyable and engaging activities during the day. According to research, both of the above-mentioned treatment methods are effective in alleviating the symptoms of seasonal depression. Faster results can be observed with phototherapy, while psychotherapy brings more long-lasting benefits. These methods can be combined without any concerns.
In SAD, as in other types of depression, there are disturbances in serotonin activity. Therefore, antidepressants called selective serotonin reuptake inhibitors, or SSRIs, are used to treat seasonal depression . Commonly used drugs include fluoxetine, citalopram, sertraline, paroxetine, andescitalopram. However, in the case of SAD, bupropion is considered the most effective agent, which is used not only to treat symptoms but also to prevent recurrence of episodes. Bupropion is an inhibitor of norepinephrine and dopamine reuptake in the central nervous system, so taking it increases the levels of these neurotransmitters in the brain. It is considered a safe substance, but as with antidepressants, patients must be aware of the possibility of side effects.
Given the above-mentioned role of vitamin D, supplementation with a dose of 800–2000 IU/day is recommended between October and April, depending on body weight and diet. It is found in food primarily in yeast, mushrooms, fatty sea fish, fish oils, eggs, and liver.
People suffering from seasonal depression should receive support from their loved ones. The sufferer has a constant feeling of hopelessness and helplessness, and a lack of understanding worsens their condition. They blame themselves for not being able to perform simple tasks, which intensifies the negative vicious circle and increases their feelings of guilt. That is why it is so important to ensure that the person has enough social interaction and empathy so that they do not feel lonely. Additional steps that are worth taking in the case of seasonal depression include physical activity, meditation, relaxation techniques, aromatherapy, avoiding dark rooms, and going for walks on sunny days. However, these methods can only support treatment and are not a substitute for medical consultation, which should be the first choice in the event of worrying symptoms.
Can seasonal depression be completely cured?
Considering that seasonal depression is a subtype of recurrent depressive disorders with a chronic, relapsing course, a complete cure is extremely rare. The best thing a patient can do is to ensure that they receive the right treatment, follow their doctor’s recommendations, and maintain a healthy lifestyle. These factors can help them function at a decent level. SAD is a specific condition whose onset can be predicted, so it is worth taking preventive measures during the expected period of relapse. It is worth starting psychotherapy, which will contribute to a significant improvement in quality of life and reduce the risk of relapse.