Don't Be SAD! - Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) that is more than winter blues. For most of us, cold weather is here or will be soon. Days of snow, rain and overcast skies can create mood disorders in some people. There is a legitimate disorder called Seasonal Nurses General Nursing Article

Don't Be SAD! - Seasonal Affective Disorder

Defining SAD

As it's name states, SAD is related to the fall and winter seasons. The Mayo Clinic defines SAD in their article, "Seasonal Affective Disorder (SAD)", as a type of depression that saps energy and makes one feel moody. Possibly SAD is related to a messed up circadian rhythm,( a faulty body clock), as well as living far from the equator due to less sunlight exposure during the winter.

It is thought that the darker days and less sunlight along with miserable weather can trigger a form of depression. Honor Whiteman tells us in her article, "Seasonal Affective Disorder: could you spot the signs?", that SAD was first defined by a US doctor, Dr. Norman Rosenthal in 1984. SAD is also called seasonal adjustment disorder, with most patients showing symptoms in the winter.

The exact cause of SAD is not yet known, but it is believed to be related to the amount of light that reaches the retina. As light reaches the retina, the hypothalamus receives signals that translate to the brain controlling appetite, sex drive, sleep, mood and activity.

Also, the neurotransmitter, serotonin (affects the mood) is thought to play a part in SAD. Low levels of serotonin can be found in those with depression, especially during winter. Furthermore, higher levels of melatonin are found in SAD patients, the hormone that makes us sleep.

Many people go for years without being diagnosed, making it difficult to really know how many actually suffer from it. It is estimated that 500,000 people in the U.S. suffer from SAD according to the Cleveland Clinic.

If someone has bipolar disorder, spring and summer can produce a mania, while fall and winter brings depression. So for those with mood disorders already, SAD can exacerbate things for them.

Signs and Symptoms

Although age is not a definer of SAD, most patients exhibit signs before the age of 20 with three out of four sufferers being women, and geographic location playing a factor. Whiteman presents a patient case of a young woman named Helen who displayed symptoms at the age of 13.

Quote
I probably had sub-syndromal SAD, as did my mother, for most of my adult life. But it showed up as an inability to get up on winter mornings, a deep dislike of November and December and general feelings of despair which I did not recognize as seasonal.

As a teenager, she was prescribed antidepressants that helped some, but as an adult in her 30s she tried self help remedies but they did not decrease her symptoms.

Quote
I knew that I hated darkness and dull weather but didn't make the connection because I didn't know there was one. Eventually, I saw a new doctor and she spotted a pattern. She pointed me towards SADA. I went to their annual general meeting and realized with huge relief that I was amongst fellow sufferers and that we all had something with a name. I was not mad after all.

Fall and Winter SAD symptoms

  • Irritability
  • Tiredness
  • Problems getting along with others
  • Craving carbohydrates, weight gain
  • Heavy feeling in arms and legs
  • Oversleeping
  • Depression
  • Insomnia
  • Weight loss
  • Poor appetite
  • Agitation/Anxiety

Treatment for SAD

Mental Health America reports that 85% of SAD patients get better with light therapy, light up to ten times brighter than domestic light. The key is to get help before symptoms get severe. Instruct patients to be ready to answer their doctors questions to help in their diagnosis, such as: what are your symptoms? When did they first begin? Are the symptoms continuous or occasional? How severe are they? What makes them better/worse? Do you use drugs or alcohol? Any family members suffer from SAD? etc. Being prepared will help the doctor in making a diagnosis.

The doctor may do blood work, physical exam, and psychological evaluation to get the full picture of the patient. As mentioned before, light therapy is used in treating SAD. Medication such as Wellbutrin and Aplenzin may be subscribed along with psychotherapy to manage symptoms. Getting outside helps, even if it is cold, taking a walk in outdoor light decreases depression. Exercising helps relieve stress and anxiety and can benefit SAD patients.

Conclusion

Nurses see firsthand how weather, environment, and stress can affect our patients, understanding that there can be an exacerbation during the dark days of winter helps in understanding our patients. There are simple things we can do to help our patients feel better, such as letting in sunlight into the patient's room during the day, engaging them in conversation as much as possible, letting them have as much control in their care as is safe, and discussing concerns with their doctor for further treatment if needed. There is a group that is there to help;

Society for Light Treatment and Biological Rhythm

P.O. Box 591687

174 Cook Street

San Francisco, CA 94159-1687

www.websciences.org/sltbr

Do you suffer from SAD, or know someone who does? Please share with us your story.


References

Mayo Clinic Staff. "Seasonal Affective Disorder (SAD)". Sept. 12, 2014. Mayo Clinic. 7 December, 2015. Web.

"Seasonal Affective Disorder (SAD)". Feb. 2002. Mental Health America. 7 December, 2015. Web.

Whiteman, Honor. "Seasonal Affective Disorder - Could You Spot the Signs?". Thursday 3 December 2015. Medical News Today. 3 December, 2015. Web.

Gastrointestinal Columnist

Brenda F. Johnson, BSN, RN Specialty: 25 years of experience in Gastrointestinal Nursing

61 Articles   326 Posts

Share this post


Share on other sites

Julie Reyes, DNP, RN

14 Articles; 260 Posts

Specializes in pediatrics, occupational health.

This is great! One of the surgeons at my hospital said taking daily doses of Vitamin D will also help. Has anyone ever heard of this as a treatment? It makes complete sense to me....!

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

22 Articles; 9,987 Posts

Specializes in LTC, assisted living, med-surg, psych.

I have SAD along with bipolar disorder, so I have to be careful using a light box lest it throw me into mania. Living in the Pacific NW where it's cloudy and wet all winter (and much of the spring and fall as well), I need the artificial light but use it for only 30 minutes a day and not at all on the rare sunny days.

While I'm doing reasonably well, I noticed a definite improvement in mood on my recent trip to the Caribbean. I really should live in a warmer and sunnier clime. :)

verene, MSN

1,790 Posts

Specializes in mental health / psychiatic nursing.

I have SAD. I wasn't diagnosed until my mid-twenties, but I had spent much of my life in a sunnier (though colder) winter climate. I Find the combination of using a SAD light for 30 minutes a day in the mornings and vitamin d supplements make a huge difference to my energy and mood. On really dark days I'll use my light for a full hour.

Dogen

897 Posts

Specializes in Behavioral Health.
This is great! One of the surgeons at my hospital said taking daily doses of Vitamin D will also help. Has anyone ever heard of this as a treatment? It makes complete sense to me....!

There's some good correlational data on vitamin D levels being predictors of depressive symptoms, however the link is not as strong as people tend to believe. The lead author of the linked study cautions that the effects of vitamin D supplementation are likely to be small, but that it has no down side (supplements are generally cheap, safe, and well tolerated), so it's worth using. It's worth noting that a review published last year found no evidence that supplementation was beneficial, but that the included studies generally lacked good data to begin with. Many of them didn't even include patients with depression at baseline. So, the question of whether supplementation actually helps is still up for debate.

ETA: Wellbutrin is bupropion hydrochloride, Aplenzin is buproprion hydrobromide... not that your prescriber couldn't prescribe either of those for SAD, it's just odd to me that the two mentioned treatments are buproprion salts.

Specializes in Med nurse in med-surg., float, HH, and PDN.

ETA: Wellbutrin is bupropion hydrochloride, Aplenzin is buproprion hydrobromide... not that your prescriber couldn't prescribe either of those for SAD, it's just odd to me that the two mentioned treatments are buproprion salts.

Why?

Not as a challenge, but because I don't know why it is odd to prescribe one of them as an adjunct to the 'regular' med for depression. I don't know the significance of the salts as opposed to another type of treatment. Can you nutshell it for me, please? Thanks in advance!

Dogen

897 Posts

Specializes in Behavioral Health.
Why?

Not as a challenge, but because I don't know why it is odd to prescribe one of them as an adjunct to the 'regular' med for depression. I don't know the significance of the salts as opposed to another type of treatment. Can you nutshell it for me, please? Thanks in advance!

There are multiple things going on in my head. The first is that depression is a symptom, and you treat the symptom of depression generally the same regardless of the cause. Someone with SAD can use the same medications as someone with Major Depressive Disorder, depression secondary to PTSD, etc. So, there are actually a lot of treatment options: all of the antidepressants (SSRIs, SNRIs, TCAs, MAOis, aminoketones...).

Another thing, though, is that Wellbutrin and Aplenzin are the only FDA approved treatments for SAD. That means very little to me, but may be important to the author/AN for legal reasons. I can't fault them for not wanting to run afoul of the FDA, since advertising medications for off-label purposes can get you fined. FDA approval is a legal and financial hurdle, though, and it's common to prescribe off label when the literature supports the use. Sertraline (Zoloft) is approved for the treatment of PTSD while escitalopram (Lexapro) and mirtazapine (Remeron) aren't, but that doesn't stop anyone from prescribing them if they seem appropriate.

Which brings to mind Sarafem, which is Prozac made into a purple pill and sold for premenstrual dysphoric disorder. They're even more closely related than Wellbutrin and Aplenzin - Sarafem and Prozac are the exact same drug. Sarafem is just a new name (Prozac has baggage), with a new effeminate color scheme to appeal to the market. So, I'm often leery of things like Aplenzin (a drug closely related to another drug that's now generic, marketed for a disorder that's new enough that most older drugs in the same class won't have FDA approval). But, that's my own baggage. :)

Specializes in pediatrics; PICU; NICU.

I have SAD in the summer along with my bipolar 2. My psychiatrist usually just tweaks whatever antidepressant I'm already taking to get me through it. I almost never have SAD in the colder months.

I also take vitamin D3 because my vitamin D level has been low for a long time. I've been taking it for about 5 years & have not noticed any difference with my symptoms.

Farawyn

12,646 Posts

*following*

Specializes in Med nurse in med-surg., float, HH, and PDN.

Thanks, Dogen! I had to read parts of your response to my question about 3 times before it began to sink in.

Sounds like a marketing ploy by Big Pharma, so instead of having your Wellbutrin dose bumped up a bit by your doc, they'd rather you get another prescription for 'something else' to bump up their bottom-line.

I take Paxil 40 mg. qAM. Seems like all my SAD symptoms bloom every November. Anyway, I take Wellbutrin from about Nov/Dec until Apr/May. Otherwise I'd be feeling overwhelmed and would be surrounded by used, soggy tissues. Seems to help with my Equanimity Scale Rating. (I don't think there is such a thing, or at least one by that name. Personally I think I just made it up, but I wouldn't be surprised to find I didn't. Make it up, that is.)

Farawyn

12,646 Posts

I have SAD. I never got officially diagnosed.

I do the soggy tissue thing and my friends all know NOT to hug me from Thanksgiving through St. Patrick's Day.

This is all very interesting to read.

Dogen

897 Posts

Specializes in Behavioral Health.
Thanks, Dogen! I had to read parts of your response to my question about 3 times before it began to sink in.

Sorry. :( Sometimes I ramble...

Sounds like a marketing ploy by Big Pharma, so instead of having your Wellbutrin dose bumped up a bit by your doc, they'd rather you get another prescription for 'something else' to bump up their bottom-line.

Yes and no. I'm pretty sure AN is more interested in not getting in trouble than pushing the Big Pharma agenda, so I think the OP is tying to be helpful within the limits of the law. Big Pharma, though, would like you to go into your doctor and ask about Aplenzin, which costs $1,000/month before insurance. You're unlikely to be on both Wellbutrin and Aplenzin (d/t increased risk of seizures and serotonin syndrome), so if you go in asking about Aplenzin you're more likely to walk out with a prescription for that. Compare that to generic Wellbutrin, which runs about $100/month before insurance.

I take Paxil 40 mg. qAM. Seems like all my SAD symptoms bloom every November. Anyway, I take Wellbutrin from about Nov/Dec until Apr/May. Otherwise I'd be feeling overwhelmed and would be surrounded by used, soggy tissues. Seems to help with my Equanimity Scale Rating. (I don't think there is such a thing, or at least one by that name. Personally I think I just made it up, but I wouldn't be surprised to find I didn't. Make it up, that is.)

I don't want to detract from the importance of people recognizing how their mood changes with the season by making this all about medication. I'm glad OP brought it up, and that people are starting to notice it. I was initially amazed how many of my patients loathe the holiday season because it brings with it things like a low mood, low energy, and a short temper. I'm glad so many people have gotten treatment that works for them, yourself included. :)