Don't Be SAD! - Seasonal Affective Disorder

Brenda F. Johnson, MSN

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.