UNDERSTANDING SEASONAL DEPRESSION: SYMPTOMS, CAUSES AND TREATMENT

Seasonal depression, also known as seasonal affective disorder (SAD), is a mental health condition that affects many worldwide. As the seasons change, so too can our mood, energy levels, and overall well-being. Common experiences resulting from SAD include feelings of depression, sadness, depleted energy, and low mood, all of which can lead to an inability to carry out normal daily activities. By understanding the symptoms, causes, and treatment options for seasonal depression, we can empower ourselves and others to take control of our mental health and navigate through difficult days with resilience and hope.

Symptoms of Seasonal Depression

Symptoms can occur at the beginning of a particular season in mild forms and can exacerbate throughout the season. The most common symptoms that affect an individual with seasonal depression include:

• Feeling sad or having a depressed mood
• Feeling lethargic, lazy, and unwilling to get out of bed
• Loss of passion and interest in activities that were once enjoyed
• Feelings of lack of will and worthlessness in life
• Lack of focus
• Changes in sleep patterns
• Difficulty thinking, concentrating, or making decisions
• Excessive desire to eat food, especially starches and sugars
• Changes in weight
• Feelings of guilt

If a person experiences one or more of the above symptoms at the beginning of a particular season and the symptoms persist throughout the day for several days, the person should consider consulting a healthcare provider to get help managing these symptoms.

Can seasonal depression be any season?

Yes, seasonal depression can be any season. Seasonal Affective Disorder typically occurs in the winter or summer but can occur during other seasons as well. Symptoms of SAD will occur at the same time every year and can vary depending on the individual and the season.

Winter Depression

Winter depression, a subtype of seasonal depression, typically occurs during the late fall and early winter months and can cause various symptoms, including trouble sleeping. Individuals may experience feeling down for extended periods, decreased motivation, alterations in sleep and appetite, increased alcohol consumption, and even suicidal ideation.

The exact cause of winter depression is yet to be determined, but it is speculated that it is related to shifts in the amount of sunlight and its impact on the body's circadian rhythm. Often, the cycle of the depressive symptoms is broken during warmer months, when individuals are able to enjoy more sunlight and engage in outdoor activities again. With the lack of the latter in the winter months, individuals with winter-onset SAD often:

• Oversleep
• Experience appetite changes, craving more foods high in carbohydrates
• Gain weight
• Exhibit tiredness or low levels of energy

It is estimated that approximately 10% to 20% of individuals in America may experience a milder form of the winter blues. Recognising the symptoms and prevalence of winter depression is essential, as it can significantly impact an individual's life, prompting the need for assistance and support.

Summer Depression

While SAD is often associated with populations living in regions far from the equator where daylight hours are shorter in the winter, it is also common in countries that experience extreme summers, such as those in the MECA - Middle East and Central Asia - region. It is estimated that up to 10% of the population in MECA suffer from SAD, with symptoms ranging from fatigue and low energy to difficulty concentrating and changes in appetite. Summer depression generally begins in the spring and summer months and ends in the fall, occurring around the same time each year.

This lesser known variety of seasonal depression affects individuals in similar ways, such that individuals often spend more time indoors due to the intolerable heat of the summer months. As people withdraw from the sun and isolate themselves during these warm months, individuals can develop feelings of depression.

Symptoms specific to summer-onset seasonal affective disorder may include:

• Trouble sleeping (insomnia)
• Poor appetite
• Weight loss
• Agitation or anxiety
• Increased irritability

Causes of Seasonal Depression

Negative thoughts and feelings about seasonal changes can play a role in the development of SAD. While the main cause of seasonal depression is not known, factors that increase the likelihood of developing it include:

Change in serotonin levels

Serotonin is a brain chemical that affects a person's mood. With the change in levels of sunlight and engagement in activities, the transport of this substance throughout the brain can be affected, leading to feelings of depression. More specifically, research on the effects of sunlight on serotonin levels found that less exposure to sunlight influences the activity of a transporter protein called SERT in the brain. As levels of SERT increase, serotonin activity decreases, leading to lower mood and increased feelings of depression.

Disturbance in the level of melatonin

Melatonin, a hormone secreted by a gland in the brain, is responsible for regulating the vital processes carried out by the body. The hormone responds to darkness and causes feelings of sleepiness. In winter-onset SAD, darker days promote the production of melatonin, leaving people to feel increasingly lethargic. While melatonin plays a role in impacting the symptoms of SAD, it cannot account by itself for these phenomena. In summer-onset depression, longer days and shorter nights often result in a decrease in melatonin production, leading to an increased likelihood of insomnia.

Changes the body's biological clock

It is known that the body has a biological clock that largely impacts, among other things, the sleep/wake schedule. Fluctuations in the amount of daylight when seasons change, as well as changes in serotonin and melatonin levels, cause disruptions in the body's internal clock, leading people to be out of step with their daily schedule and experience changes in sleep, mood, and behaviour.

Other types of depression

There are many types of depression, and people who have other types of depression, such as major depression, chronic depression or bipolar disorder, are more likely to develop seasonal depression.

Family history

People with a family history of seasonal depression as well as other forms of depression, are more likely to develop seasonal depression throughout their lifetimes.

Vitamin D deficiency

Vitamin D plays a vital role in the human body and is indirectly responsible for human mood. Vitamin D is largely created by the action of the sun's ultraviolet rays on the skin. As people spend more time indoors during specific seasons, they get less exposure to sunlight, leading them to produce less vitamin D. This reduction in vitamin D levels leads to mood changes, including feelings of depression, which can often lead to social withdrawal - further exacerbating the SAD symptoms. While vitamin D supplements do exist, individuals often need more than the recommended dosage in order to reap any benefits on mood. As such, light therapy is a therapeutic approach that mimics sunlight effectively to help promote the production of vitamin D.

Diagnosing Seasonal Depression

It can be difficult to diagnose seasonal affective disorder because of its similarity with symptoms of other types of depression and mental disorders. With the help of a mental health professional, individuals can complete questionnaires to assess symptoms, thoughts, feelings, and behavioural patterns. A professional may also recommend a physical exam as, in some cases, SAD may be misdiagnosed in the presence of other health problems such as thyroid disorders, hypoglycemia, and some viral infections.

If you suspect that you are experiencing symptoms of seasonal depression or any other mood disorder, it is recommended to seek the advice of a healthcare provider or mental health professional.

Treatment Options for Seasonal Depression

Various treatment options are available for seasonal depression, including light therapy, psychotherapy, medications, vitamin D supplements, and lifestyle modifications.

Light Therapy

Light therapy involves sitting in front of a lamp that emits a very bright light (and filters out harmful ultraviolet (UV) rays) that mimics sunlight. It usually requires 20 minutes or more per day, typically first thing in the morning. Most people see some improvements from light therapy within one or two weeks of beginning treatment, and it appears to be effective for most people in relieving symptoms of seasonal affective disorder. To maintain the benefits and prevent relapse, treatment is usually continued through the winter. Because of the anticipated return of symptoms as the seasons change, some people may begin light therapy before the shift in season to help prevent symptoms.

Light therapy is usually thought to be safe. However, people with certain eye conditions or those taking medications that make them more sensitive to the sun may need another treatment option. They should use light therapy only with medical supervision.

Psychotherapy

Psychotherapy, such as cognitive behavioural therapy for seasonal affective disorder (CBT-SAD), is a form of talk therapy that involves individual or group sessions in which individuals can learn how to replace negative thoughts with positive ones and identify and engage in enjoyable activities. Studies have indicated that both CBT-SAD and light therapy are equally effective in improving SAD symptoms. While light therapy may produce faster initial results, CBT appears to provide longer-lasting benefits. A combination of both is ideal for helping treat SAD in most individuals. CBT-SAD also involves a process called behavioural activation, which individuals can practise in their daily lives outside of therapy sessions. This process involves the identification and planning of engaging activities to help the individual combat the depressive feelings and apathy they experience with SAD.

Medications

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are an effective treatment for many cases of seasonal affective disorder, helping improve moods and preventing the reoccurrence of depressive episodes, especially if symptoms are severe. It is important to note that all medications can have side effects, and it is therefore recommended to discuss the potential risks of using these medications with a doctor or health care provider.

Lifestyle Changes

Adopting a healthy diet and engaging in regular exercise can be advantageous for individuals with SAD. Consuming a balanced diet with an abundance of fruits and vegetables can help to enhance mood and energy levels. Individuals can also incorporate more exercise into their daily routines. Physical exercise helps trigger the release of endorphins, which help towards enhancing mood and reducing feelings of stress and anxiety. Normalising sleep patterns can also help individuals maintain a normal circadian rhythm, helping protect against symptoms of SAD. Abstaining from alcohol and drugs is also recommended when managing SAD, as they can exacerbate symptoms and obstruct the treatment.

Prevention and Management

Addressing early symptoms of seasonal depression and seeking treatment may help prevent further deterioration and worsening of the condition. To help prevent the development of seasonal affective disorder, individuals can psychologically prepare for the seasons. In mentally preparing for the season in which you usually get depressive symptoms, you can determine sleep schedules and organise dates for specific activities which bring feelings of joy. Engagement in these activities can also decrease feelings of social isolation in individuals with seasonal depression.

Individuals can also try to bring light into their homes throughout the day, helping get direct exposure despite spending more hours indoors than usual. Exposure to sunlight in the morning can help reset the body's internal clock, help boost mood, trigger the production of vitamin D, and also improve immune system functioning.

Ongoing treatment, such as light therapy, psychotherapy, medications, and vitamin D supplements, may be essential for managing seasonal depression effectively and preventing relapses. Get in touch with a healthcare provider to find out which is best for you.

How do we treat seasonal depression at The Kusnacht Practice?

Seasonal depression affects an individual's physical and mental well-being, as well as their ability to function normally in daily life. Without proper recognition and treatment, the symptoms of seasonal depression can become more severe and even lead to more serious health concerns. Remember that help is available, and by seeking support and exploring various strategies, we can overcome seasonal depression and live a more fulfilling life.

The Kusnacht Practice is equipped to treat seasonal affective disorder and ensures health and care excellence, providing an array of specialised mental health therapies and treatments suited to each individual with Psychotherapeutic care, Medical treatment and care, Biomolecular Restoration (BIO-R®) and Family systems therapy. Our psychiatric and medical teams are dedicated to your well-being, providing personalised therapies tailored to your individual needs and goals. Whether it be to help manage symptoms of SAD or other mental health concerns, our team is there to support you.

If you or a loved one is experiencing SAD or symptoms of SAD, consider reaching out to find out how we can help.