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Seasonal Depression

smcopywrite | Oct 10, 2011 |

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Have you noticed how rainy, gray, overcast days can zap your energy and make you feel as if your body is overly tired and it can be a struggle to do even the smallest things? Believe it or not there is a scientific reason why your body and mind feel as if you are moving through a fog; it’s called seasonal depression or seasonal affective disorder (SAD).

Low or insufficient exposure to sunlight has been confirmed to have a connection to low levels of chemicals located in our body called melatonin and serotonin. Melatonin and serotonin are also found in decreased levels for those individuals plagued by depression. In addition to lowering the levels of these two chemicals, overcast and low to no sunshine days will increase our bodies cravings for carbohydrates, we experience weight gain and sleep disturbance.

Some people will identify a fluctuation in mood or feelings of depression in the winter months of the year. After reviewing a calendar you can certainly see why. Every year on June 21

st we encounter the summer solstice which is the longest day of the year. We encounter our longest hours of sunshine during the middle of each summer which accounts for why we are happier during this time of year. Following the summer solstice, days will begin to get shorter and shorter. Each consecutive day has less sunshine until we reach the winter solstice on December 21^st which is the shortest day of the year. Winter months are when our happy moods shift to the darker side.

It certainly is no accident that most of us are moody and not quite as chipper on December 21^st as we are on June 21^st. With low levels of serotonin and melatonin, cravings for carbs, sleep disturbances and the overall stress that comes with trying to create the perfect family holidays many people will find themselves in an acute episode of seasonal depression.

Symptoms of seasonal depression

The symptoms of seasonal depression occur at regular intervals and typically return each year during winter months. Symptoms have a tendency to be atypical of depression. They include;

A heavy, lead feeling in the arms and legs
Irritability or short tempered
Weight gain
Increased appetite and increased cravings for carbohydrates
Weight gain
Difficulties with interpersonal relationships

Causes of seasonal depression

Seasonal depression is believed to be caused by a disturbance with the body’s circadian or night and day rhythm. Light that enters our body through the eyes influences this rhythm. When it’s dark the body’s pineal gland creates a substance called melatonin which is responsible for the feelings of drowsiness we experience. Light entering our eyes will shut off the production of melatonin.

Many people working in offices during the winter months leave their house before daylight and return home after sunset while sitting in an office with little or no windows all day long causing levels of melatonin to become disrupted. Even if you don’t find yourself in an office building all day during the winter months you can still experience exposure to little or no sunlight levels. Certainly you won’t get anywhere close to the sunlight provided in the summer months during the daylight hours. A disruption in the melatonin levels will create symptoms of seasonal depression.

Seasonal depression is also associated with decreased levels of serotonin. Serotonin is a neurotransmitter or “feel good” substance used in anti-depressants called SSRIs or serotonin reuptake inhibitors. Decreased levels of this particular neurotransmitter may be responsible for symptoms of seasonal depression such as the feelings of depression and carbohydrate cravings.

Diagnosis of seasonal depression

There is no laboratory test for seasonal depression. In order to diagnosis seasonal depression your physician will typically do a physical examination to rule out any other medical conditions and make do an assessment of a patient’s symptom history using the criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-IV doesn’t consider seasonal depression as a separate disorder by itself. Instead the DSM-IV ties seasonal depression to Major Depression and identifies it as an indicator for the condition. Consecutively to be diagnosed with seasonal depression a patient must first meet the criteria for Major Depression or a Major Depression Episode;

A minimum of five of the following symptoms need to be present nearly every day for a two week period and represent a change from previous functioning. At least one of the symptoms must be (1) depressed mood or (2) loss of interest

Symptoms clearly a result of a medical condition or mood congruent delusions or hallucinations

Depressed mood or irritability in children and adolescents
Marked diminished interest or pleasure in all, almost all activities
Significant weight loss or gain along with or increase or decrease in appetite
Hyperinsominia or insomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate or indecisiveness
Recurrent thoughts of death or suicide ideation without a specific plan or a suicide attempt or a specific plan for suicide
The symptoms are not better accounted for by a mood disorder due to a general medical condition, substance induced mood disorder or bereavement (normal reaction to the death of a loved one)
Symptoms are not better accounted for by a psychotic disorder like schizoaffective disorder

If these criteria fit, the following criteria would also need to be met to obtain a seasonal pattern indicator

Regular temporal relationship between the onset of major depressive episodes and particular time of the year (unrelated to obvious season-related psychological stressors)
Full remissions or a change from depression to mania or hypomania also occur at a characteristic time of the year
Two major depressive episodes meeting criteria A and B in last two years and no non seasonal episodes in the same period
Seasonal major depressive episodes substantially outnumber the non-seasonal episodes over the individuals lifetime

Treatment for seasonal depression

Light therapy

Light therapy has been touted as one of the best treatments for seasonal depression. Light therapy uses a device that provides a bright white light.

During the fall of 1998 a group of 13 Canadian specialists issued a collection of professional consensus guidelines for the treatment of seasonal depression. The specialists produced the following set of guidelines for light guidelines;

The starting dose for light therapy should be 30 minutes per day with a fluorescent light bulb emitting approximately 10,000 lux
Light boxes emitting 2500 lux will require 2 hours of therapy per day
Light therapy should begin first thing in the morning to maximize response to treatment
Most patients will respond to light therapy in approximately one week of treatment. However, some patients may not show a response for up to four weeks of treatment
Common side effects of light therapy are eyestrain, headache, nausea and agitation. Side effects are generally mild and temporary and will disappear with reduction in the dose of light used for therapy.

Doctor Michael Terman, head of the Winter Depression Program at Columbia-Presbyterian University, has indicated the consensus in America is that post awakening bright light therapy is the first line if intervention for light therapy. The bright light should be a broad spectrum white light source at 10,000 lux. Drugs should be used as a support for white light therapy when it isn’t sufficient. Optimum dosing of light is crucial. If light therapy dosing isn’t performed correctly there will be no improvement for the patient, partial improvement or even worsening of the symptoms for some patients.

Drug therapy

Treatment of seasonal depression using prescription drugs is an option. Wellbutrion XL became the first drug in America approved specifically for seasonal depression in 2006.

Seasonal depression is a recognized disorder that effects millions of people every year. There is treatment for the disorder with light therapy or the use of prescription medication. If you feel you have seasonal depression, please visit with a physician to diagnosis and select the treatment that works best for you.

Sources;

American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 4^th ed. Washington , D.C.: American Psychiatric Association, 1994

FDA News. FDA Approves the First Drug for Seasonal Depression. June 12, 2006.

Lam, R.W. and A.J. Levitt. Canadian consensus guidelines for the treatment of seasonal affective disorder; a summary of the report of the Canadian Consensus Group on SAD. Canadian Journal of Diagnosis 15 suppl. (1998): s1-s15