eNewsletter - February 2020

Behavioral Health Partners



Identifying and Treating Seasonal Affective Disorder 

Living in the Midwest in the late winter months is challenging. Slugging through slush-filled parking lots and dealing with sudden temperature drops and gale force winds can make it hard to stay upbeat. But for nearly 10 million Americans, the depressive symptoms that accompany the winter months are much more than weather-related blues. They may actually indicate Seasonal Affective Disorder (SAD), a subtype of unipolar major depressive disorder, bipolar I disorder or bipolar II disorder.

It is believed an additional 10 to 20 percent of the population may experience a mild form of SAD. While most patients experience SAD in winter months, the condition can have a spring-summer onset as well. Women are four times more likely to experience SAD.

Identifying Seasonal Affective Disorder. As behavioral health providers, it’s essential to determine severity and effective treatments for SAD, as preventive measures can be particularly successful at warding off symptoms in subsequent seasons. In general, SAD presents similarly to other forms of depression and, according to the DSM-5, can include symptoms of:

  • Feelings of hopelessness and sadness
  • Thoughts of suicide
  • Hypersomnia or a tendency to oversleep
  • A change in appetite, especially a craving for sweet or starchy foods
  • Weight gain
  • A heavy feeling in the arms or legs
  • A drop in energy level
  • Decreased physical activity
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Increased sensitivity to social rejection
  • Avoidance of social situations

Symptoms of summer SAD may include

  • Poor appetite
  • Weight loss
  • Insomnia
  • Agitation and anxiety 

Regardless of the affected season, SAD symptoms may also include those of major depression such as guilt, loss of interest or pleasure in previously enjoyable activities, hopelessness or helplessness, as well as physical symptoms like stomach aches or headaches.

Treating Seasonal Affective Disorder. Treatment options may include a combination of lifestyle changes, light therapy, supplementation of vitamin D, counseling and medications.

  • Utilize light therapy. Using a light box or light visor, patients sit for 30 to 60 minutes each day during the depressive season for exposure to artificial light. If improvement doesn’t occur within a few days, other treatments can be added to increase effectiveness. Ending treatment too early can result in the return of symptoms.

  • Recommend increased intake of vitamin D. Studies suggest SAD patients may make less vitamin D, which is believed to play a role in serotonin activity. Supplementation may help ward off symptoms of depression.

  • Suggest regular counseling. Research shows that Cognitive Behavioral Therapy (CBT) for SAD is effective for winter depression in particular, specifically with helping patients to learn to challenge problematic thoughts and behaviors.

  • Consider antidepressant medication. Seasonal or continuous pharmacotherapy may be helpful depending on patient history and preference. Continuous therapy is warranted in more severe cases.

  • Encourage healthy choices and self-care. Patients should be empowered to create a routine that includes daily exposure to natural light via outdoor walks, aerobic exercise, enhanced indoor lighting, dawn simulation and good sleep hygiene. The most important component of self-care involves planning preventive action steps in advance of problematic seasons to offset severity or prevent recurrence of the disorder.

Finding more SAD resources for patients. Linden Oaks has behavioral health professionals available for consult who specialize in identifying and treating depression or anxiety related to SAD. For more information on treatment, contact Linden Oaks Help Line 24 hours a day at (630) 305-5027 and one of our assessment professionals can assist.

References:

https://www.uptodate.com/contents/seasonal-affective-disorder-treatment#H89640513

https://www.psychologytoday.com/us/conditions/seasonal-affective-disorder

http://www.sleepreviewmag.com/2016/05/light-dawn-simulation/