Defying the Darkness
“What makes night within us may leave stars.” - Victor Hugo
Growing up, no one in her family wanted to wake up my friend. She could make a lion’s paw’s swipe feel like butterfly kisses. As winter approached, the mood always grew darker and the snarls louder. I too sometimes would feel the bite, as she and I walked to the bus stop every day during high school. Moving to Michigan did not do my friend any favors. In that strange land of East Coast time zone Michigan, while the summers are luxuriously full of daylight, the winters are gloomier, longer. Only well into her thirties did my friend understand she suffered from seasonal affective disorder (SAD).
As winter approaches, many people go through episodes of feeling sluggish or down. SAD, however, is a type of clinical depression characterized by a recurrent pattern that can last as long as five months. According to the National Institutes of Health, while the disorder can occur in warmer months, close to 90 percent of cases are diagnosed during the winter months, with an increased likelihood the further one moves away from the equator. In addition, although SAD is marked by a recurrent pattern, 30-50 percent of those diagnosed may not show symptoms in consecutive winters. Women are overwhelmingly more likely to be diagnosed than men.
Individuals diagnosed with SAD can exhibit a variety of symptoms such as decreased energy, difficulty concentrating, or changes in sleeping or eating routines. Individuals may express feelings of guilt, irritability, or hopelessness. Thoughts of death or suicide are not uncommon. Moreover, those with SAD often are diagnosed with other mental health issues including a panic or anxiety disorder, an eating disorder, or attention-deficit/hyperactivity disorder.
SAD occurs in up to three percent of the general population, although researchers believe an additional 10 percent likely experience mild symptoms that go undiagnosed. For those with other mental health issues, the percentages of SAD are even higher: up to 20 percent of those diagnosed with major depressive disorder and up to 25 percent with bipolar disorder also suffer from SAD.
The causes of SAD are complex and not fully understood. Several studies indicate those with SAD, particularly winter-time SAD, have reduced levels of serotonin, which helps regulate mood. Shorter daylight hours and lower vitamin D levels also contribute to lower serotonin production. In addition, fluctuating estrogen levels impact serotonin production, which helps explain the preponderance of women being diagnosed with the disorder.
Certain gene variants have been identified as associated with SAD, all of which thus far are related to circadian rhythm functioning. According to Harvard Medical researchers, circadian rhythms are controlled by multiple genes and are responsible for several important daily fluctuations, including body temperature, metabolism, digestion, and wakefulness. Individuals with SAD seem to have a disrupted sleep-wake cycle, resulting in sleep, mood, and behavior changes.
A 2017 meta-analysis of observational studies of shift workers indicates up to 40 percent of shift workers were more likely to develop major depression than their daytime counterparts. In addition, regardless of type of work, those who wake up and go to sleep without routine exposure to sunlight are more likely to develop SAD.
Since the 1980s, the cornerstone treatment for SAD has been phototherapy. Light therapy is recommended daily, preferably in the morning to maximize its effect on melatonin production, which is involved in regulating sleep. Light therapy is also thought to enhance serotonin production. In conjunction with light therapy, monitoring vitamin D levels and supplementing if deficient can prove helpful.
With or without light therapy, researchers indicate regular periods outdoors are beneficial not only from a light perspective, but exercise is also shown to boost mood and modulate circadian rhythm. Psychotherapy or counseling can help those with SAD rethink and change behavior contributing to depression. Specifically, cognitive behavior therapy has been shown to mitigate unhelpful behaviors associated with depression. Finally, short term antidepressant use, with or without psychotherapy, has proven useful for some individuals.
Because SAD is a recurring disorder, preventive measures may prove useful over time. Introducing proven therapies early may lessen future episodes. In addition, focusing on thankfulness practices—journals, meditation, stress management—can help maintain a more positive outlook. Keeping up with social connections is beneficial for your overall mental health. Start a new hobby that involves others. Keep in regular contact with family and friends. Not only can they provide support, but they also may be key to recognizing if a depressive state is dangerous. Other generalized winter health tips also are recommended for those with SAD, including staying hydrated, avoiding alcohol and simple carbohydrates, and maintaining a routine sleep cycle.
As we enter this season of lights, some will only see darkness. They say without darkness we would never see the stars. The trick then for those with SAD is to focus not on the gloom of night, but the stars, with their infinite possibilities. ▼
Sharon A. Morgan is a retired advanced practice nurse with over 30 years of clinical and healthcare policy background.