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Seasonal Affective Disorder: Myth or Not?

Editor’s Note: When people are affected by the winter blues, some shake it off with the support of self-help techniques and a sunny day. For others, it can progress into chronic depression and become life-threatening. When that happens, it’s important to get help, quickly. Fortunately, help is available. Here are some tips from Angela Beckerman, a licensed counselor based in Guilford on how to tell the difference between the winter blues and depression, and how to get help. Beckerman also is offering a series of free meditation sessions in early February to those who would like to learn more about the role of meditation when it comes to mental wellness. If you, or if someone you know is considering suicide or other forms of self-harm, you can always call The National Suicide Prevention Lifeline is 1-800-273-8255.

—Pem McNerney

Do you wonder why there are people who only feel down, are fatigued, only in the winter, and don’t feel any better, even when they oversleep?

Most people have heard of the winter blues, but they may have felt that it was a myth. Lack of energy and tiredness can be confused with laziness or lack of will power.

Just as it may be difficult to believe there are more hospital admissions for mental health disorders during a full moon, it may be hard to believe in the existence of winter blues.

In actuality, there is a mental health condition called winter depression or seasonal affective disorder (SAD).

A major concern presents when the winter blues progresses into chronic depression and becomes life threatening. Many times, we may not know when friends and neighbors in our community are suffering from this.

As a Branford resident and shoreline psychotherapist based in Guilford, it concerns me to know that suicide rates in New Haven county have increased over the last five years, according to recent press reports and the Connecticut Office of the Chief Examiner.

I wrote this article to help people know more about how to recognize SAD, how it can be treated by medical and psychological interventions, and how available community resources can reduce its prevalence.

Recognition of SAD or early stages of other depression and treatment for depression can prevent later suicidal symptoms of chronic depression.

Prevalence, stats and trends

SAD is more common in women than men and more common with younger adults than older ones. But both genders and people of all ages can be affected. People who have a history of psychosocial conditions, particularly other depression or anxiety disorders, are at greater risk of developing SAD.

The symptoms can become chronic and can interfere with daily functioning.

The symptoms usually occur during the fall and winter months when there is less sunlight and may improve once spring approaches.

The most common months and highest prevalence for SAD in the U.S. tends to be January and February.

Symptoms of Seasonal Affective Disorder

Common symptoms of SAD include sadness, fatigue (even with too much sleep), and weight gain associated with overeating and carbohydrate cravings. If SAD occurred other times of the year, it may be defined as major depression. These symptoms of SAD can include other symptoms of major depression such as loss of interest or pleasure in activities once enjoyed, isolation, change in weight (loss or gain), difficulty sleeping or oversleeping, low energy, trouble concentration or making decisions, restlessness, feelings of worthlessness or guilt, and thoughts of death or suicide. In the DSM5, the diagnostic manual published by the American Psychiatric Association, SAD is diagnosed as major depression with seasonal patterns.

Causes and Contributing Factors of SAD

• Environment/brain chemistry: It is unclear why decreased exposure to sunlight affects the natural biological clock that regulates sleep, hormones, and moods. However, there are natural chemicals or neurotransmitters that are related to positive moods and happiness. These brain chemicals are reduced due to lack of sun and/or exercise and symptoms of depression may result. In the winter, shorter days with less sunlight result in less serotonin, dopamine, and endorphins. Loss of outdoor summer leisure/ social activities are associated with less dopamine and less endorphins.

• Less Social Interaction: Generally, people socialize less in the winter because they do not have the opportunity to participate in those outside activities like sports and exercise such as biking, running, hiking, and boating which shoreline residents enjoy over summer months. Thus, they do not have the same opportunities for support of friends when work, financial, or family problems arise. Isolation is a symptom of depression.

• Economic difficulties: Some occupations are less productive during the holiday season and winter, and thus people might be more apt to live paycheck to paycheck. During these difficult economic times, loved ones might struggle financially, and then feel guilty for not haven given expensive holiday gifts. Crowded stores remind them of this. Thus, many depressed people stay reclusive at home.

• Family conflicts and childhood memories: Seasonal depression is accentuated when people are unable to see famly members who live far away. They may have spent holidays alone. The elderly are very vulnerable to seasonal depression as they are reminded of their losses when remembering past winter holidays with their deceased spouses, extended family members, and/or friends. Anxiety and anger about past family conflict and unhappy childhood memories exacerbates seasonal depression.

Remedies, Help Available

• Medical Intervention: Sometimes winter depression can be helped by eating a balanced diet, exercise at the gym, good nights sleep, and maintaining leisure activities with family, friends, and co workers.

While symptoms might improve on their own with that kind of help and the change of season, symptoms can improve even faster with medical treatment and counseling. Just as with other forms of depression, it is important to make sure there is no other medical condition causing symptoms.

SAD can be diagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections because these conditions are associated with fatigue as well as changes in eating and sleep.

SAD occurs the same winter months of the flu season. A psychiatric assessment for accurate diagnosing is appropriate before considering treatment. Other mental health conditions and other depressive disorders that may be causing symptoms need to be ruled out before counseling approaches can be recommended.

If diagnosed with SAD, light therapy may be recommended in which a specialized light box or visor is used for at least 30 minutes daily to replace natural light. If sadness and fatigue do not improve, medications such as antidepressants with counseling may be appropriate, depending on the patient. Selective serotonin reuptake inhibitors (SSRIs) are the type of antidepressant most commonly prescribed, but there are other options as well.

• Counseling Methods: Whether depression symptoms are related to the season or are another form of depression, counseling is appropriate if symptoms continue or worsen in frequency, duration, or if they become chronic. Talk therapy, particularly cognitive behavior therapy, can effectively treat SAD to address and help resolve these socioeconomic issues. While other forms of therapy are available, cognitive behavioral therapy (CBT) has proven to be extremely effective.

Along with challenging negative thoughts and promoting behavioral change, other effective treatments can include meditation, methods of breathing, relaxation, sensory mindfulness, and imagery to address the actual physical symptoms of depression and anxiety. Behavioral therapy includes devising and implementing goals, developing effective coping mechanisms, assertiveness training, conflict resolution skills, and relaxation exercises.

• Community Resources: There are resources and activities along the shoreline and in the Connecticut River valley that can help to reduce SAD. Support groups in the community such as church and 12-step programs can help reduce isolation and loneliness, and provide suggestions from others for resolving problems and family issues. Exercise and sports programs at community centers and YMCA increase brain neurotransmitters of endorphins and dopamine and, thus, decrease depression. There are private counselors and practitioners that offer meditation and yoga. Research studies have shown that meditation and yoga increase serotonin, dopamine, and endorphins, even more so than exercise.

Other ways of connecting to the community can include these resources:

• Most towns have a parks and recreation department that offer a wide range of activities to help keep people connected with others in the winter months.

• Local yoga studios can offer a range of classes, including many for beginners.

• Meditation classes can be useful as well. I am providing two more free meditation/relaxation classes on consecutive Saturdays, Feb. 8 and 25 to introduce methods to reduce seasonal depression. Contact me to sign up at angela.beckerman@gmail.com.

Suicide Prevention

Family members, co-workers, and neighbors are often the best people to pick up on signs of suicide risk, if they know what to look for.

The most common signs of suicidal risk are moodiness, significant changes in personality, behaviors, or activities. This may include talking about death or suicide, withdrawing from others, and self-harm behaviors such as driving recklessly or using drugs. Also, there can be loss of weight and changes in sleep.

More serious symptoms might include giving away of prized possessions, a sudden disinterest or interest in religion, and statements of feeling trapped or hopelessness.

Becoming calm suddenly after a depressive episode can be a sign that the person has decided to end his/her life.

Characteristics of later stages are starting to plan a suicide (time, place, and means) or writing a will or goodbye note.

Individuals with SAD are more likely to commit suicide if they have another depressive disorder such as bipolar disorder or have previously attempted suicide.

If someone says he or she is thinking of suicide or acts in a way that makes you think the person may be suicidal, do not ignore it. Take all signs of suicide behavior seriously. He or she needs professional help, even if suicide isn’t an imminent. The person may need to be hospitalized until the suicide potential is alleviated. Encourage the person to communicate with you. Ask them if they are thinking of suicide. Asking them is the right thing to do. Scientific evidence has shown this direct inquiry can be helpful when it comes to finding out if someone needs help.

Someone who is suicidal may be too embarrassed or ashamed to talk about their feelings and need someone to listen attentively and not judge them. Acknowledge their feelings, be supportive, and understanding. Reassure the person that things will be better after they follow through with treatment. Do not leave them alone. Tell a family member or another friend about the situation. Make sure the person doesn’t have possible means to be used for suicide such as drugs, guns, knives, razors.

Then, help them connect with help from a trained professional as quickly as possible by calling 911 or call the local suicide hotline number, which is the Shoreline Psychiatric Mobile Crisis line 203-800-7177 at BHcare in Branford, or 203-483-2630. The mobile crisis will arrive and implement a wellness check which includes a suicidal assessment. The National Suicide Prevention Lifeline is 1-800-273-8255.

By being aware of our community resources on the shoreline and communicating with our neighbors, we can help each other through when they are suffering emotionally this time of year, and all year round.

Angela Beckerman has been a practicing professional Masters level counselor and Addiction Specialist over the last 35 years. She now counsels as a private psychotherapist at the at Shoreline Center for Wholistic Health in Guilford. More information about her is available at angelabeckermantherapy.com, or by emailing angela.beckerman@gmail.com.