With changes in the seasons, less sunlight, and more time spent indoors, some people experience the winter blues. If you or your patient experiences decreased interest in once enjoyable activities or persistent feelings of hopelessness that interfere with daily life, it may be more than the winter blues.
What is Seasonal Affective Disorder?
Seasonal Affective Disorder (SAD), often referred to as seasonal depression or seasonal mood disorder, is when an individual experiences depression associated with seasonal changes and the decreased sunlight associated with those times of the year, which has a chemical effect on the brain. This seasonal mood disorder typically begins in adulthood and is more common in women than men. Approximately 5% of adults in the United States experience some form of SAD. It is difficult to pinpoint the official cause, but many factors contribute to its occurrence.
Decreased sunlight during the winter months can disrupt the bodys internal clock, cause a drop in serotonin levels (a neurotransmitter that affects mood), and decrease melatonin levels (which affect sleep). Because decreased sunlight plays a vital role in SAD, people living farther from the equator, such as in the Northern and Southern Hemispheres, may be more likely to experience this disorder.
Vitamin D is an important vitamin that can impact mental health and is produced by certain foods and sunlight. One of the benefits of Vitamin D is that it helps increase serotonin levels. With less sunlight exposure during the winter months, vitamin D levels can be lower, leading to decreased serotonin levels that can lead to depression.
Medical history and family history have been linked to seasonal depression. Those with bipolar disorder or major depression may experience more intense SAD symptoms. Those with a family history of the disorder may be at higher risk of having SAD themselves.
Signs, Symptoms, and What to Watch For
The seasonal mood disorder involves a recurring seasonal pattern of depression symptoms that typically last 4-5 months. Many symptoms resemble those of clinical depression but occur during specific seasons. Symptoms that last longer than two weeks may indicate the disorder.
General symptoms of SAD can include:
- Feelings of sadness most of the day, and almost every day
- Low energy or fatigue
- Feelings of hopelessness, worthlessness, or feeling empty
- Loss of interest in activities that were once enjoyable
- Sleeping difficulties
- Difficulty concentrating
- Feelings of guilt
- Suicidal thoughts or ideations
- Appetite changes
- Weight gain
- Feelings of frustration, pessimism, or restlessness
- Anxiety
- Physical pains, aches, cramps, or digestive issues (these physical indicators typically do not appear to have an explainable cause)
Is this disorder always prevalent in the fall and winter? Most individuals with SAD experience depression during the fall and winter months. Less commonly, some experience the disorder during the spring and summer months, with symptoms resolving in the fall and winter. Research has shown specific symptoms are more likely to be seen with spring and summer depression, such as poor appetite, weight loss, anxiety or agitation, insomnia, or aggressive behavior. At the same time, specific symptoms of fall and winter depression include low energy, weight gain associated with food cravings and appetite changes, oversleeping, and social withdrawal.
Diagnosing Seasonal Affective Disorder
Diagnosing this specific disorder involves evaluating the patient's symptoms and experiences to determine if it contributes to the depressive episodes. SAD can be diagnosed using the Seasonal Pattern Assessment Questionnaire or the Seasonal Health Questionnaire.
Diagnostic criteria include:
- Depressive episodes occur specifically during either the winter or summer (seasonally) for at least two consecutive years (some may not experience symptoms every year)
- Episodes of depression are more frequent during the specific season compared to episodes at other times of the year
- Exhibiting symptoms of depression or the specific winter or summer SAD symptoms
Seasonal Affective Disorder Treatment
Treatment can vary from lifestyle interventions to phototherapy and antidepressant medications. It is always best to consult with a health provider, psychiatrist, or mental health professional to ensure that treatment is tailored to the needs of the individual and the severity of the depression.
Lifestyle Interventions: Steps to combat symptoms can include lifestyle modifications or interventions such as getting regular exercise, spending time outside, eating well-balanced meals, avoiding alcohol and illegal drugs that worsen depression, focusing on the positive aspects of daily life, engaging in activities to improve mood, spending time with family and friends or in social settings, and if needed, additional treatment may be necessary. If you are experiencing symptoms, be sure to find a trusted friend or family member to confide in. Seek assistance from a mental health provider if concerns or inclinations are pointing towards the seasonal mood disorder.
Light Therapy: This unique form of treatment helps those with SAD. During light therapy, also known as phototherapy, patients are exposed to a bright light of 10,000 lux (dangerous UV light is filtered out), which is 20 times brighter than typical indoor light, for 30-45 minutes every morning in the fall and winter. How does light impact the brain? Bright lights can affect brain chemistry and alter the circadian rhythm, thereby improving symptoms. When using light therapy, take precautions for those with skin sensitivities or those taking medications that increase sun sensitivity, such as retinoids or some antibiotics.
Vitamin D: Vitamin D supplementation may be used for patients with SAD. As mentioned previously, Vitamin D increases serotonin. Vitamin D supplements can be used to improve mood and combat the disorder. Consult a healthcare specialist before consuming any supplements or medications. A trained professional can help determine the best type of treatment for you or your patient.
Psychotherapy: Therapy and counseling, including cognitive behavioral therapy (CBT), can be beneficial for those dealing with this disorder. It can help individuals discover new ways of thinking, learn to adjust habits to reduce the effects of the disorder, and find positive activities to cope with decreased interest in hobbies. CBT-SAD is cognitive behavioral therapy that is specific to the seasonal disorder and is often done in a group setting.
Medications: Selective serotonin reuptake inhibitors (SSRIs) are a common class of antidepressants used in the treatment of SAD. Bupropion is another medication prescribed for this diagnosis. Always consult a healthcare professional for appropriate treatment, including prescription medications.
When to Seek Help
If depression is impacting your daily life or has impacted normal daily functioning, seek help from a mental health professional. If you experience any thoughts of not wanting to live or of harming oneself, seek emergency assistance and call 911 or go to your nearest emergency department immediately.
Offering Patient Support
Nurses must be aware of patients' symptoms, even subtle ones. Nurses can interact with patients with the disorder in any setting, including the emergency department, outpatient clinics, community health centers, school campuses, and skilled nursing facilities. They play a vital role in administering depression and suicide screenings in hopes of identifying the disorder prior to severe depression and encouraging early interventions. They also educate patients in healthcare settings to recognize signs in themselves or those in their social circle, and encourage them to seek help as needed.
For nurses caring for patients in an inpatient hospital setting or a skilled nursing facility, it is important to encourage activities to reduce the effects and to monitor patients or residents for any signs of SAD.
Nurses can assist those with the disorder in healthcare settings by:
- Promoting light exposure through opening blinds and allowing for natural sunlight.
- Encourage time outside when possible.
- Be aware of the signs and carefully monitor patients for symptoms.
- Encourage attending social gatherings, activities, and promote family visits.
- Show empathy when communicating with patients, build rapport, and foster a safe environment for patient conversations and assessments.
- Actively screen for SAD.
Conclusion
There is still much to be understood about SAD, and especially spring and summer seasonal depression. It is important to recognize the factors that contribute to SAD, signs and symptoms, and treatment options. Nurses play a vital role in advocating for mental health and awareness by educating patients and families about the disorder, helping patients reduce the effects of SAD, and noticing symptoms in patients. With the darker and colder months around the corner, depressive episodes caused by the disorder will become more prevalent. Being aware of signs of depression in family members, friends, and patients can help individuals receive help and improve their quality of life.
About Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfast's Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
