What’s New in Psychology?
Tis the Season for Feeling Sad?
Jim Windell
While it might be picturesque to sit in a cozy chair in a warm house and watch the snow gently cover your lawn, there’s also something depressing about that. As my wife Jane put it recently as we stood by the door wall plate glass taking in the first snowfall of the year, “In four months we can go back outside.”
That’s what some people do when the snow comes. Hibernate. Stay inside where it’s toasty and comfortable, snack on comfort foods and wait for spring to return.
There’s no doubt about it for me. I feel less energetic in the winter months, but when it is sunny and warm, my mood changes and I have almost boundless energy. I want to go out and do things. I don’t care what it is, just let me out. I might even do yard work – anything as long as I’m outdoors.
Does this mean I have Seasonal Affective Disorder (SAD)? Is that even a thing?
Well, of course, it is a thing. After all, it is considered a subtype of major depression in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). But does it have specific symptoms leading to a diagnosis?
According to Scott Patten, M.D., Ph.D., professor of psychiatry and epidemiology at the University of Calgary, Calgary, Alberta, Canada, “…it’s important to emphasize that that’s not an officially recognized diagnosis by the major classifications.”
Nonetheless, researchers coined the term SAD 40 years ago to describe a pattern of depression that sets in during the fall or winter and remits in the spring or summer. And clinicians do often diagnose the disorder even if it is not recognized in all the major classifications of psychiatric disorders.
Recently, Jake Remaly wrote about SAD in Medscape Medical News. He pointed out that for patients who meet the criteria for recurrent major depressive disorder, the specifier “with seasonal pattern” might be given. The DSM-5 states that the subtype covers cases where depressive episodes have followed a seasonal pattern for at least two years. Typically, onset occurs in the fall or winter followed by remission in the spring or summer. When stressors such as seasonal unemployment better explain the pattern, the seasonal specifier should not be used, according to the manual. Bipolar disorder can follow a seasonal pattern as well.
Researchers estimate that SAD affects about 5% of adults in the U.S. The diagnosis is more common in women than in men, and more prevalent farther from the equator.
And what are the symptoms?
The DSM-5 lists five characteristics of winter depression: Loss of energy; hypersomnia; craving carbohydrates; overeating; and weight gain. Kelly Rohan, Ph.D., a researcher at the University of Vermont, who has studied SAD since the 1990s, sees one symptom as a possible hallmark for the disorder: Fatigue.
“I’ve personally never met someone who met the full diagnostic criteria for the seasonal pattern that did not have fatigue as one of their symptoms,” Rohan says. “In theory, they could exist, but I have spoken to hundreds of people with seasonal depression, and I have never met them if, in fact, they do exist.”
Patten says that differs from nonseasonal depression, for which insomnia is a more common problem with sleep. In general, clinicians look for at least five symptoms of depression that cause substantial impairment and distress for at least two weeks, such as pervasive sadness, difficulty concentrating, low self-esteem, or loss of interest in hobbies.
An average episode of winter depression can last five months, however, Rohan says. “That’s a long time to be in a major depressive episode.”
For people who do not meet the criteria for major depression with a seasonal pattern, the change of seasons still can affect energy levels and mood. Some have “subsyndromal SAD” and may benefit from treatments that have been developed for SAD such as bright light therapy, says Paul Desan, M.D., Ph.D., director of the Winter Depression Research Clinic at Yale School of Medicine in New Haven, Connecticut.
“Many people come to our clinic because they have seasonal changes that don’t meet the full criteria for depression, but nevertheless, they want help,” Desan says.
As far back as the 1980s, artificial bright light has been seen as a promising treatment for the condition. Subsequent studies have found the approach effective. A recent meta-analysis found that even in nonseasonal depression bright light therapy may increase the likelihood of remission. Light therapy also may bolster the effectiveness of antidepressant medication in nonseasonal major depressive disorder.
Other treatments for SAD include cognitive behavioral therapy (CBT) and bupropion XL, which is approved as a preventive medication.
To read the original article on which this blog is based, find it with this reference:
Remaly, J. (2024).Winter Depression: How to Make the ‘SAD’ Diagnosis. Medscape Medical News.