Seasonal Affective Disorder



Maggie started off her junior year of high school with great energy.
She had no trouble keeping up with her schoolwork and was involved in
several after-school activities. But after the Thanksgiving break, she
began to have difficulty getting through her assigned reading and had to
work harder to apply herself. She couldn't concentrate in class, and
after school all she wanted to do was sleep.

Maggie's grades began to drop and she rarely felt like socializing.
Even though Maggie was always punctual before, she began to have trouble
getting up on time and was absent or late from school many days during
the winter.

At first, Maggie's parents thought she was slacking off. They were
upset with her, but figured it was just a phase — especially since her
energy finally seemed to return in the spring. But when the same thing
happened the following November, they took Maggie to the doctor, who
diagnosed her with a type of depression called seasonal affective disorder.

What Is Seasonal Affective Disorder?





Seasonal affective disorder (SAD) is a form of depression
that appears at the same time each year. With SAD, a person typically
has symptoms of depression and unexplained fatigue as winter approaches
and daylight hours become shorter. When spring returns and days become
longer again, people with SAD experience relief from their symptoms,
returning to their usual mood and energy level.
What Causes SAD?

Experts believe that, with SAD, depression is somehow triggered by
the brain's response to decreased daylight exposure. No one really
understands how and why this happens. Current theories about what causes
SAD focus on the role that sunlight might play in the brain's
production of key hormones.

Experts think that two specific chemicals in the brain, melatonin and serotonin
may be involved in SAD. These two hormones help regulate a person's
sleep-wake cycles, energy, and mood. Shorter days and longer hours of
darkness in fall and winter may cause increased levels of melatonin and
decreased levels of serotonin, creating the biological conditions for
depression.

Melatonin is linked to sleep. The body produces this hormone in
greater quantities when it's dark or when days are shorter. This
increased production of melatonin can cause a person to feel sleepy and
lethargic.

With serotonin, it's the reverse — serotonin production goes up when a
person is exposed to sunlight, so it's likely that a person will have lower
levels of serotonin during the winter when the days are shorter. Low
levels of serotonin are associated with depression, whereas increasing
the availability of serotonin helps to combat depression.What Are the Symptoms of SAD?



Someone with SAD will show several particular changes from the way he
or she normally feels and acts. These changes occur in a predictable
seasonal pattern. The symptoms of SAD are the same as symptoms of
depression, and a person with SAD may notice several or all of these
symptoms:

• Changes in mood. A person may feel sad or be in an
  irritable mood most of the time for at least 2 weeks during a specific
  time of year. During that time, a guy or girl may feel a sense of
  hopelessness or worthlessness. As part of the mood change that goes with
  SAD, people can be self-critical; they may also be more sensitive than
  usual to criticism and cry or get upset more often or more easily.
  
• Lack of enjoyment. Someone with SAD may lose
  interest in things he or she normally likes to do and may seem unable to
  enjoy things as before. People with SAD can also feel like they no
  longer do certain tasks as well as they used to, and they may have
  feelings of dissatisfaction or guilt. A person with SAD may seem to lose
  interest in friends and may stop participating in social activities.
  
• Low energy. Unusual tiredness or unexplained fatigue is also part of SAD and can cause people to feel low on energy.
  
• Changes in sleep. A person may sleep much more than
  usual. Excessive sleeping can make it impossible for a student to get
  up and get ready for school in the morning.
  
• Changes in eating. Changes in eating and appetite
  related to SAD may include cravings for simple carbohydrates (think
  comfort foods and sugary foods) and the tendency to overeat. Because of
  this change in eating, SAD can result in weight gain during the winter
  months.
  
• Difficulty concentrating. SAD can affect
  concentration, too, interfering with a person's school performance and
  grades. A student may have more trouble than usual completing
  assignments on time or seem to lack his or her usual motivation. Someone
  with SAD may notice that his or her grades may drop, and teachers may
  comment that the student seems less motivated or is making less effort
  in school.
  
• Less time socializing. People with SAD may spend less time with friends, in social activities, or in extracurricular activities.
  

The problems caused by SAD, such as lower-than-usual grades or less
energy for socializing with friends, can affect self-esteem and leave a
person feeling disappointed, isolated, and lonely — especially if he or
she doesn't realize what's causing the changes in energy, mood, and
motivation.

Like other forms of depression, the symptoms of SAD can be mild,
severe, or anywhere in between. Milder symptoms interfere less with
someone's ability to participate in everyday activities, but stronger
symptoms can interfere much more. It's the seasonal pattern of SAD — the
fact that symptoms occur only for a few months each winter (for at
least 2 years in a row) but not during other seasons — that
distinguishes SAD from other forms of depression.Who Gets SAD?



SAD can affect adults, teens, and children. It's estimated that about 6 in every 100 people (6%) experience SAD.

The number of people with SAD varies from region to region. One study
of SAD in the United States found the rates of SAD were seven times
higher among people in New Hampshire than in Florida, suggesting that
the farther people live from the equator, the more likely they are to
develop SAD.

Interestingly, when people who get SAD travel to areas far south of
the equator that have longer daylight hours during winter months, they
do not get their seasonal symptoms. This supports the theory that SAD is
related to light exposure.

Most people don't get seasonal depression, even if they live in areas
where days are shorter during winter months. Experts don't fully
understand why certain people are more likely to experience SAD than
others. It may be that they're more sensitive than others to variations
in light, and therefore may experience more dramatic shifts in hormone
production according to their exposure to light.

Like other forms of depression, females are about four times more
likely than males to develop SAD. People with relatives who have
experienced depression are also more likely to develop it. Individual
biology, brain chemistry, family history, environment, and life
experiences may also make certain individuals more prone to SAD and
other forms of depression.

Researchers are continuing to investigate what leads to SAD, as well
as why some people are more likely than others to experience it.How Is SAD Diagnosed and Treated?



Doctors and mental health professionals make a diagnosis of SAD after
a careful evaluation. A medical checkup is also important to make sure
that symptoms aren't due to a medical condition that needs treatment.
Tiredness, fatigue, and low energy could be a sign of another medical
condition such as hypothyroidism, hypoglycemia, or mononucleosis. Other medical conditions can cause appetite changes, sleep changes, or extreme fatigue.

Once a person's been diagnosed with SAD, doctors may recommend one of several treatments:

Increased Light Exposure. Because the symptoms of
SAD are triggered by lack of exposure to light, and they tend to go away
on their own when available light increases, treatment for SAD often
involves increased exposure to light during winter months. For someone
with mild symptoms, it may be enough to spend more time outside during
the daylight hours, perhaps by exercising outdoors or taking a daily
walk. Full spectrum (daylight) lightbulbs that fit in regular lamps can
help bring a bit more daylight into your home in winter months and might
help with mild symptoms.

Light Therapy. Stronger symptoms of SAD may be treated with light therapy (also called phototherapy).
Light therapy involves the use of a special light that simulates
daylight. A special light box or panel is placed on a tabletop or desk,
and the person sits in front of the light for a short period of time
every day (45 minutes a day or so, usually in the morning). The person
should occasionally glance at the light (the light has to be absorbed
through the retinas in order to work), but not stare into it for long
periods. Symptoms tend to improve within a few days in some cases or
within a few weeks in others. Generally, doctors recommend the use of
light therapy until enough sunlight is available outdoors.

Like any medical treatment, light treatment should only be used under
the supervision of a doctor. People who have another type of depressive
disorder, skin that's sensitive to light, or medical conditions that
may make the eyes vulnerable to light damage should use light therapy
with caution. The lights that are used for SAD phototherapy must filter
out harmful UV rays. Tanning beds or booths should not be used to
alleviate symptoms of SAD. Some mild side effects of phototherapy might
include headache or eyestrain.

Talk Therapy. Talk therapy (psychotherapy) is also
used to treat people with SAD. Talk therapy focuses on revising the
negative thoughts and feelings associated with depression and helps ease
the sense of isolation or loneliness that people with depression often
feel. The support and guidance of a professional therapist can be
helpful for someone experiencing SAD. Talk therapy can also help someone
to learn about and understand their condition as well as learn what to
do to prevent or minimize future bouts of seasonal depression.

Medication. Doctors may also prescribe medications
for teens with SAD. Antidepressant medications help to regulate the
balance of serotonin and other neurotransmitters in the brain that
affect mood and energy. Medications need to be prescribed and monitored
by a doctor. If your doctor prescribes medication for SAD or another
form of depression, be sure to let him or her know about any other
medications or remedies you may be taking, including over-the-counter or
herbal medicines. These can interfere with prescription medications.Dealing With SAD



When symptoms of SAD first develop, it can be confusing, both for the
person with SAD and family and friends. Some parents or teachers may
mistakenly think that teens with SAD are slacking off or not trying
their best. If you think you're experiencing some of the symptoms of
SAD, talk to a parent, guidance counselor, or other trusted adult about
what you're feeling.

If you've been diagnosed with SAD, there are a few things you can do to help:

• Follow your doctor's recommendations for treatment.
  
• Learn all you can about SAD and explain the condition to others so they can work with you.
  
• Get plenty of exercise, especially outdoors. Exercise can be a mood lifter.
  
• Spend time with friends and loved ones who understand what you're
  going through — they can help provide you with personal contact and a
  sense of connection.
  
• Be patient. Don't expect your symptoms to go away immediately.
  
• Ask for help with homework and other assignments if you need it. If
  you feel you can't concentrate on things, remember that it's part of the
  disorder and that things will get better again. Talk to your teachers
  and work out a plan to get your assignments done.
  
• Eat right.
  It may be hard, but avoiding simple carbohydrates and sugary snacks and
  concentrating on plenty of whole grains, vegetables, and fruits can
  help you feel better in the long term.
  
• Develop a sleep routine. Regular bedtimes can help you reap the mental health benefits of daytime light.
  

Depression in any form can be serious. If you think you have symptoms
of any type of depression, talk to someone who can help you get
treatment.