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The weather seems to have changed quickly, and as the warm, sunny days of summer become a distant memory and the long, cold, dark, winter days seem to be slowly descending on us, many people wait in dread. These people are afflicted with seasonal affective disorder or SAD. Some know they have this mood disorder and others just know that they feel "blah" and "devoid of energy" and then "absolutely awful" the further they get into the winter months, but often they can't seem to pinpoint just why.
For those with SAD, or winter onset depression as it is sometimes called, it seems that the body's circadian rhythm, or internal clock, is set for the wrong time. This may result in sleep disturbance, lethargy, appetite disturbance, weight gain, a general lack of interest in and enjoyment of life, difficulty in focusing and concentrating on things, social isolation and other very unpleasant symptoms which in general look remarkably like depression. If they are lucky they may have a relatively mild case of the blues, but at its worst, there may be a sense of helplessness and hopelessness that may actually lead to a serious risk of suicide.
What makes SAD different from clinical depression is the cyclic or seasonal nature of the disorder. It rears its ugly head about the same time each year, if one were able to look for a pattern, and thankfully begins to improve as the weather starts to improve. More common in women than in men, for a diagnosis of SAD to be made, it must be of a cyclic duration of at least two years.
While most people think of SAD as winter related, there is a less common sister illness, summer onset depression, or reverse seasonal affective disorder, which starts as the weather gets warmer and ends as the cooler days of fall or winter arrive.
SAD usually begins in early adulthood and can seriously affect almost every aspect of daily life, resulting in the inability to attend work or go to school and lowering the desire to be with others.
While the actual etiology of SAD is unknown, it does seem to be related to a lack of bright light in the winter, which has an impact on natural circadian rhythms and results in a disruption in the sleep-wake cycle. A decrease in serotonin, a neurotransmitter found in the brain related to depression, has also been implicated in addition to melatonin, a naturally occurring hormone associated with sleep. As one might expect, SAD is more common the further one gets away from the equator, and in northern countries, places where there is less daylight, the nights are long, and interestingly, where there is less snow.
If you (or a loved one) have just started to feel down for seemingly no apparent reason, and remember that last year at this time you weren't feeling well either, you may want to check out whether you are suffering from SAD. The good news is that there are many things you can do on your own to keep things in check, help yourself and actually feel better. So, if you have had thoughts of hibernating, try and resist the temptation and instead get into a routine where you get up every morning, even when it may seem extremely difficult.
Find a partner and take yourself outside as often as you can, especially in the morning hours, and create an exercise routine that works for you. When you are at home, keep your shutters open during the day to let in as much natural sunlight as possible, and work to maintain a balanced and healthy diet devoid of sugary and high carbohydrate foods which may leave you feeling sluggish and unwell. Be aware of what some of your stressors are and see what you can do to reduce them.
If you still feel depressed after a few days and can't seem to shake it, make sure you speak to someone familiar with depression and get professional help. Treatment might include bright light therapy, melatonin hormone supplements, cognitive behavior therapy, relaxation, breathing and imagery techniques, psychotherapy and anti-depressant medication. As is seen in clinical depression, SAD can put tremendous strain on your relationships and on your family life, to the point that your family or partner may want to be included in treatment as well.
The writer is a licensed clinical psychologist in private practice in Ra'anana.
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