Winter is quickly approaching. Days will soon become shorter. Skies will turn bleak. And the brisk fall air will bluster into icy winds.
As the season shifts so can our mood. We spoke to an expert about seasonal affective disorder, most commonly referred to as seasonal depression, and how to combat it.
Shedrick Martin, Pharm.D, BCPP, is a clinical pharmacist specialist in psychiatry and a board certified psychiatric pharmacist who treats patients with psychiatric and neuropsychiatric disorders.
“Generally, people look at seasonal affective disorder as what we call ‘winter blues’,” Martin says. “During the winter time when there’s less light available, people tend to have a lower mood, lower energy and a worse diet. Most people look at this as being down in the dumps, but it’s an actual mood disorder similar to depression.”
When diagnosing depression, healthcare professionals use the mnemonic, SIGECAPS:
S: Sleep. (Having insomnia)
I: Interest. (Losing interest in normal routine activities)
G: Guilt. (Feeling guilty or a sense of worthlessness)
E: Energy (A decrease in energy)
C: Concentration or Cognition. (Having trouble completing mentally strenuous tasks)
A: Appetite. (Having a decrease in appetite)
P: Psychomotor Agitation (Having slow, purposeless movements)
S: Suicidality (Having suicidal thoughts)
While depression and seasonal affective disorder both share parallel symptoms, according to Martin, signs of SAD are usually out of the norm for an individual and harder to recognize since it’s often attributed to being tired and sleepy during winter months. Instead of insomnia, people with SAD generally exhibit hypersomnia – the tendency to sleep more. Instead of the loss of appetite, people tend to load up on carbs. Losing energy and interest in society is common as well, which leads to people isolating themselves at home.
— Marco Malavasi @ ? he/him/his (@Marco_Malavasi) October 29, 2020
But why do depression and seasonal affective disorder even occur? Because of the decrease of serotonin – a neurotransmitter that regulates mood.
“Studies in the United States show that in the winter months or darker months, people produce less serotonin,” Martin says. “The other thing that’s common in SAD that’s not as common in regular major depressive disorder is an increase in what we call melatonin.”
To non-medical professionals, melatonin is known as a drug used to promote sleep. Martin says the body naturally makes more of this based on the decrease of light during winter. Even more, data shows that people who live closer to the equator generally have lower rates of SAD. States like Florida and Georgia, for example, have around a 1-2 percentage level of SAD, compared to Alaska, which is closer to 7-9 percent, Martin says.
“There’s more melatonin present in the darker months because the use of light cues our brains to either make more melatonin or stop making it all together. In the darker months, especially in the northern states, melatonin obviously increases, causing people to sleep more, which contributes even more to SAD.”
Martin also says SAD doesn’t have to coincide with winter, but can occur around dates that trigger trauma, like the death of a loved one, for example.
Is there a connection between vitamin D and depression?
Winter is also the time when people are most at risk for vitamin D deficiency, a vitamin critical for physical health that the body makes following sun exposure.
Years ago, the National Institute of Health recognized that patients with mental health disorders such as depression, anxiety and schizophrenia generally have lower levels of vitamin D compared to populations who didn’t have any mental health disorders. Martin says this observation prompted studies to see if the increase of vitamin D would help depression. Interestingly enough, it didn’t.
According to research, people with mental health disorders, especially depression, are more likely to be socially isolated, resulting in less sun. They typically have poor diets and more medical conditions such as obesity, diabetes, cardiovascular diseases and immune-related disorders. These populations also have lower levels of vitamin D, and while Martin says he doesn’t think there’s a specific connection to low vitamin D and depression, the lifestyle of people with depression worsens their health overall and can lead to vitamin D deficiency.
Martin also notes that people in Black and minority communities often have low vitamin D, which he attributes to the lack of health education, exercise and concern for medical issues. People with darker skin are also at risk for vitamin D deficiency because darker skin blocks more of the sun’s rays needed for producing the vitamin. Just because people with depression have low Vitamin D, that doesn’t mean it causes depression or SAD,” Martin says “But it is insight on health status.”
SAD, depression or Other?
Data shows mental health has plummeted during the pandemic, including SAD. While lots of people have suffered loss in some form or the other, other determinants have been attributed to people having more sedentary lifestyles, yo-yo sleep schedules, followed by the lack of fresh air and sunlight.
Considering the nuances of depression and SAD, however, how do you go about determining the difference? Martin’s first recommendation is to seek a professional to make sure you’re “getting it right.” Too often, SAD is confused with other undetected issues, and determining the root of any health issue leads to better care and understanding.
The best way to improve SAD naturally is with sunlight, which Martin suggests getting as much of as possible. “When you wake up in the morning, open your blinds, maybe go for a short walk, anything you can do to soak up some sun.” For grayer locations such as Detroit and the rest of the Midwest and northern states, Martin proposes light therapy. Using light boxes as a source of artificial sunlight for a brief period daily can improve the symptoms of SAD.
Let’s talk Light Therapy. Living in NE, fall/winter can be pretty dreary/cold/dark. I quickly realized my mood was impacted by shorter days & cold weather. I’ve been using a Light Box daily during fall/winter for yrs. If you’re considering adding Light therapy to your routine 1/
— Dr Nicole Christian Brathwaite, MD (@Drnicolecb) October 28, 2021
Another natural way to minimize SAD is with good sleep hygiene, which Martin considers the “cornerstone of health.” According to him, when your circadian rhythm is off, outcomes for mental and physical health are worsened. The last way is a good diet.
So often, we look for ways to medically combat disorders and diagnoses. And while medicine is recommended, I believe we can tag team certain occurrences through health education and proactive measures. Seasonal affective disorder is real, but we have to do our part to combat it. Martin agrees.
“Overall health is significant in preventing deficiencies and reducing mental health and other physical conditions,” Martin says. “That’s always important to remember.”