January 29, 2019

Seasonal Affective Disorder

Psychologists and other professionals have come to know quite a lot about the kind of depression that grips a significant number of Americans. It is estimated that nearly 7% of U.S. adults—that’s over 16 million of us—have experienced a major depressive episode in the last year. People with major depression suffer depressed mood of course, but also experience loss of interest in normal activities and big changes in their sleep patterns, their ordinary energy and concentration, and they experience a drop in self-image that may reduce the ability to meet daily responsibilities.

Quite a few of us recognize some or most of these symptoms recurring, but only during the winter months.  The phenomenon has come to known popularly as Seasonal Affective Disorder (SAD), identified in the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association as Major Depressive Disorder with Seasonal Pattern.  Studies show that most sufferers are able to recognize this cyclic pattern in themselves even without the help of a professional, and that it’s certainly not uncommon, since between 1% and 10% of the population experience some or all of the symptoms associated with this disorder. But the prevalence of SAD is clearly related to latitude.

What to do about the disappearance of energy, the loss of interest and tendency to prefer carbohydrates and avoid social activities? The treatments under consideration by researchers focus on three separate mechanisms for addressing the symptoms of SAD. 

1. Let there be light! Because the shorter days of winter offer less light, and this disorder is more prevalent in northern latitudes where the dark, gray days are commonplace, light therapy is being studied as a treatment. This involves the use of special (often expensive) lamps or fixtures to alter rhythms driven by the biological clock. There is research showing this can be useful for those whose symptoms are serious enough to consider the consistent regimen of wakefulness and light exposure needed to make a measurable difference. Most of the research being done has focused on delivering the specific light at “retina level” but other investigators believe that light can be transported to the brain by way of red blood cells, and are experimenting with shining light at the back of the knees where large blood vessels run near the surface. 

2. Medication: There is widespread use of medication in the treatment of major depressive symptoms, and many physicians turn to the same drugs for their patients complaining of seasonal patterns of depression, and signs of “winter blahs”. While I’m not a prescriber myself, I sometimes refer patients to a psychiatrist or primary care doctor for evaluation of symptoms that might be improved by a medication. When it comes to a seasonal pattern of symptoms though, I would be very slow to suggest that medications are an answer. In general, the medications for depression take a fairly long time to become effective—often a month or so before substantial improvement is noted. If a patient seeks medication after spending a month gathering symptoms and getting an appointment, and a particular medication takes about a month to become noticeably effective, and a seasonal low is expected to last only two or three months, I wonder whether the risks and side effects will be worth the marginal improvement experienced in that final month of SAD. And the side effects can be substantial: Drowsiness, nausea, dry mouth, insomnia, diarrhea, agitation, dizziness, and sexual problems. 

A further concern about medications—though absolutely useful in particular cases—it may be difficult to discontinue them when spring returns. Because of that, some physicians may recommend remaining on the medication in order to prevent future depressive episodes, and that could be warranted for some, but when I look over the list of side effects, I have trouble balancing the negatives with any absolute gains to be had.

3. Cognitive Behavioral Therapy (CBT): Because CBT is what I do, it may sound self-serving to note that it has been shown as effective as either of the other options. While either light therapy or medication might be the treatment of choice for a particular patient, it has always been my preference to use “skills rather than pills”. By changing our cognitions (thinking patterns) and our behaviors, each of us can more easily manage all kinds of negative circumstances, including the symptoms of Seasonal Affective Disorder. Moreover, in my experience, we can take CBT many steps further by employing strategies from the emerging science of Positive Psychology. As those who have been reading my blogs all along will surely recognize, this has nothing to do with becoming a “Pollyanna” and everything to do with changing one’s approach to the challenges we face. Future blogs will offer connections to resources related to CBT and Positive Psychology. Stay tuned!

Posted in: General @ 3:41 pm