Seasonal Affective Disorder

As it comes into Winter, it is probably a good time to consider conditions that are more likely to require treatment during this season.

If you think of Winter, you may at first associate it with the flu, colds, or respiratory complications such as pneumonia. However, in the cooler months, seasonal affective disorder (SAD) may be often overlooked as a simple case of the ‘winter blues’ (Healthdirect 2016).

SAD is a mood disorder that takes trend in the form of a seasonal depression, each year (Healthdirect 2016), with the condition generally concluding  in Spring or Summer (the warmer seasons) (Healthdirect 2016). However, some people can even suffer SAD through Spring and Summer too (MayoClinic 2017).

Signs of Seasonal Affective Disorder

Autumn to Winter

Some of the SAD signs to watch for in Autumn and Winter can include:

• Tiredness,
• Excessive sleeping,
• Increased weight,
• Increased appetite,
• Craving carbohydrates.

(Healthdirect 2016; MayoClinic 2017)

Spring to Summer

Some of the SAD signs to watch for in Spring and Summer:

• Agitation,
• Anxiety,
• Low appetite,
• Weight loss,
• Insomnia.

(MayoClinic 2017)

Additional Seasonal Affective Disorder Symptoms:

• Feeling depressed the majority of the day on most days.
• Lack of enjoyment for activities that are usually enjoyable.
• Poor concentration.
• Depressed, negative thoughts.

(MayoClinic 2017)

Who Gets Seasonal Affective Disorder?

Nussbaumer et al. (2015) state that many people living in northern latitudes commonly experience a ‘Winter blues’. However, for some people, these ‘Winter blues’ eventuate into clinical depression.

Strikingly, up to 75% of people with seasonal affective disorder are female (Kaminski-Hartenthaler et al. 2015).

For most (up to 2 in 3) people with Winter-SAD, they can expect to suffer it every year (Fornasier et al. 2015; Nussbaumer et al. 2015). Forneris et al. (2015) acknowledge that one benefit of this is that its predictability could help to implement prevention or intervention strategies.

Can A Change of Scenery Help?

According to research by Forneris et al. (2015) ‘the prevalence of SAD ranges from 1.5% to 9%’, with the variance due to a difference in geographical latitude.

Living further away from the equator appears to increase the risk of SAD. This is quite possibly due to the limited sunlight in Winter months and longer Summer days (MayoClinic 2017).

Preventing Seasonal Affective Disorder

Unfortunately, there is currently insufficient evidence to conclude whether psychological therapy is effective in preventing SAD (Forneris et al. 2015).

Similarly, there is not enough high-quality research (e.g. RCTs) to compare the effectiveness of psychological interventions (e.g. CBT, behaviour therapy) to other treatments such as light therapy, melatonin treatment, agomelatine, lifestyle modifications, placebos and second-generation antidepressants (SGAs) (Fornasier et al. 2015).

What is ‘Light Therapy’?

Light therapy is the act of exposing a person to light to simulate different times of day in the hope to manipulate the body clock and, in turn other body functions (Cunnington 2015).

Examples of light therapy can include bright white light and dawn simulation (Terman, 2005 cited in Nussbaumer et al. 2015).

As there is evidence to suggest disruptions to sleep and circadian rhythms can contribute to mood disorders (Srinivasan et al. 2015), the idea behind using light therapy to treat seasonal affective disorder is that it might manipulate brain chemicals to improve mood (MayoClinic 2016).

According to a systematic review by Nussbaumer et al. (2015), only limited evidence was found in support of light therapy as an effective tool in preventing SAD.

Can Pharmacological Supplements Prevent or Treat SAD?

According to Srinivasan et al. (2012), disruptions to sleep and circadian rhythms, such as ‘Malfunctioning of the SCN–pineal–melatonin link’, can contribute to mood disorders (e.g. SAD).

‘Melatonin is essential for the control of mood and behaviour’, and it is involved in rhythm-regulation and sleep regulation (Srinivasan et al. 2012).

Agomelatine is a ‘melatonergic antidepressant’ that Srinivasan et al. state is also effective for treating mood disorders (e.g. SAD).

However, Kaminski-Hartenthaler et al. (2015) found in their systematic review that there is not enough evidence to determine whether or not melatonin or agomelatine are able to prevent SAD or improve outcomes for clients. Thereby, more high quality RCTs are necessary to investigate their effects, particularly in comparison to other SAD therapies (e.g. light therapy, psychological therapy) (Kaminski-Hartenthaler et al. 2015).

It is proposed that other second-generation antidepressants can be used in the treatment of Autumn/Winter SAD and may help to prevent depression (Gartlehner et al. 2015). However, research by Gartlehner et al. (2015) and Morgan et al. (2015) state that to confidently conclude SGAs should be used in preventing SAD, more high-quality research on this topic would be needed.

Seeking Help

Better Health Channel (n.d.) reinforces that seasonal affective disorder is uncommon in Australia, and mostly suffered in colder-climate-areas of the Northern Hemisphere who experience shorter days with longer durations of darkness, however, if you are experiencing any extended feelings of sadness, Better Health Channel recommends the following resources to reach out to:

• Call 000
• See your GP
• Access a mental health team and/or psychologist (e.g. at a community health centre)
• beyondblue Support Service Tel. 1300 22 4636
• Lifeline Tel. 13 11 14
• Kids Helpline Tel. 1800 55 1800
• SuicideLine Tel. 1300 651 251
• SANE Australia Helpline Tel. 1800 187 263
• Australian Psychological Society – Find a psychologist service Tel. 1800 333 497 (outside Melbourne) or (03) 8662 3300 (in Melbourne)
• Mind Australia Tel. 1300 AT MIND

References

• Better Health Channel n.d., Depression, Victorian State Government, viewed 19 June 2018, https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/depression
• Cunnington, D 2015, ‘What is Light Therapy?’, SleepHub, 21 May, viewed 20 June 2018, http://sleephub.com.au/light-therapy/
• Forneris, CA, Nussbaumer, B, Kaminski-Hartenthaler, A, Morgan, LC, Gaynes, BN, Sonis, JH, Greenblatt, A, Wipplinger, J, Lux, LJ, Winkler, D, Van Noord, MG, Hofmann, J & Gartlehner, G 2015, ‘Psychological therapies for preventing seasonal affective disorder’, Cochrane Database of Systematic Reviews, no. 11.
• Gartlehner, G, Nussbaumer, B, Gaynes, BN, Forneris, CA, Morgan, LC, Kaminski-Hartenthaler, A, Greenblatt, A, Wipplinger, J, Lux, LJ, Sonis, JH, Hofmann, J, Van Noord, MG & Winkler, D 2015, ‘Second-generation antidepressants for preventing seasonal affective disorder in adults’, Cochrane Database of Systematic Reviews, no. 11.
• Healthdirect 2016, Seasonal affective disorder, Department of Health, viewed 19 June 2018, https://www.healthdirect.gov.au/seasonal-affective-disorder
• Kaminski-Hartenthaler, A, Nussbaumer, B, Forneris, CA, Morgan, LC, Gaynes, BN, Sonis, JH, Greenblatt, A, Wipplinger, J, Lux, LJ, Winkler, D, Van Noord, MG, Hofmann, J & Gartlehner, G 2015, ‘Melatonin and agomelatine for preventing seasonal affective disorder’, Cochrane Database of Systematic Reviews, no. 11.
• MayoClinic 2017, Seasonal affective disorder (SAD), viewed 19 June 2018, https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
• MayoClinic 2016, Season affective disorder treatment: choosing a light therapy box, viewed 19 June 2018, https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298
• Morgan, LC, Gartlehner, G, Nussbaumer, B, Gaynes, BN, Forneris, CA, Kaminski-Hartenthaler, A & Wipplinger, J 2015, ‘Efficacy and Harms of Second-generation Antidepressants for the Prevention of Seasonal Affective Disorder: a Systematic Review’, European Psychiatry, vol. 30 no. 1, p. 808.
• Nussbaumer, B, Kaminski-Hartenthaler, A, Forneris, CA, Morgan, LC, Sonis, JH, Gaynes, BN, Greenblatt, A, Wipplinger, J, Lux, LJ, Winkler, D, Van Noord, MG, Hofmann, J & Gartlehner, G 2015, ‘Light therapy for preventing seasonal affective disorder’, Cochrane Database of Systematic Reviews, no. 11.
• Srinivasan, V, De Berardis, D, Shillcutt, SD & Brzezinski, A 2012, ‘Role of melatonin in mood disorders and the antidepressant effects of agomelatine’, Expert Opinion on Investigational Drugs, vol. 21, no.10, pp. 1503-22.