Feeling SAD?

December 2, 2024
• December is Seasonal Affective Disorder Awareness Month, and a local expert spoke with Needham Local about the onset of the disorder, its symptoms, affected demographics and prevention.

As the weather cools and the amount of daylight decreases, some people may experience negative mood shifts. The changing of the seasons could result in just semi-annual sadness or lead to a diagnosable condition.

Those who experience symptoms of Major Depressive Disorder with a distinct seasonal pattern may have Seasonal Affective Disorder, or SAD. SAD can be caused by changes in the environment, which trigger changes in the body, licensed mental health counselor Jen Pinto said. Pinto serves as the Trotman Director of Behavioral Health at Beth Israel Deaconess Hospital – Needham.

What causes SAD?

Reduced sunlight exposure during the winter months disrupts our internal clocks, which experts theorize causes a dysregulation of serotonin — a chemical responsible for feelings of happiness, Pinto said. That, in turn, affects mood and sleeping patterns, she said.

But both biological and psychological components play a role, she added.

“Usually in the winter months, when it gets darker, people don’t necessarily want to go out as often. There’s decreased socialization,” Pinto said. “Maybe people are changing their eating habits, their sleeping patterns change, and I think the socialization is a huge piece which is definitely largely connected to potential vulnerability for depressive symptoms.”

Daylight saving time disrupts current habits, leading some to take a longer time adjusting, Pinto said.

“To try to shift to new hours and a new schedule, I think, is a lot harder on people than we would anticipate,” she said.

What are the symptoms of SAD?

SAD is a subtype of Major Depressive Disorder, meaning both are associated with the same symptoms: persistent feelings of sadness or low mood, social withdrawal, loss of interest, fatigue, and difficulty sleeping and concentrating. Pinto said depression can often present as irritability, which may be misidentified.

“With the onset of the symptoms in the winter months, you’d be less interested in doing social activities, choosing to stay home versus go out and meet up with friends or go to gatherings or things with that,” Pinto said.

Pinto said SAD is likely underdiagnosed, as people show symptoms but aren’t being assessed.

SAD disproportionately affects women and younger adults, Pinto said, with the latter group typically staying more active in the summer and falling into isolation in the fall and winter. The disorder is also more prevalent for people with a history of depression or bipolar disorder, Pinto said.

What prompts an SAD diagnosis?

While patients may report symptoms connected with SAD, Pinto said a clinical diagnosis requires five or more different symptoms of depression, a distinct recurrence during the fall and winter and remittance in the spring and summer. The disorder will often showcase if it’s impacting someone’s daily functioning.

Before a diagnosis, Pinto and other behavioral health experts look at patients’ history. At least two major depressive episodes in the past two years, with each occurring at the same time of year, could lead to a formal evaluation, Pinto said. They also ensure there are no underlying physical or psychiatric symptoms that could explain the pattern, she added.

Pinto said the condition is “more common than we think.”

“We don’t necessarily see people in the emergency room with major depression with seasonal recurrence, but we see a lot of people with major depression,” Pinto said. “So that’s why I think it’s so important that people are recognizing the symptoms sooner if they can to be preventative and proactive.”

How is SAD treated?

For those who are diagnosed with SAD, several treatment recommendations follow: psychotherapy, cognitive behavioral therapy and psychotropic drugs — such as SSRI medication, which increases serotonin.

SAD can also be treated with light therapy, Pinto said. Patients are exposed to artificial light that helps regulate their internal clocks and boost their levels of serotonin.

How do you prevent SAD?

Before SAD-related symptoms worsen and reach the level of clinical criteria, Pinto offered several suggestions to prevent that from happening.

Keeping up socialization habits through the winter is critical, Pinto said, and people should avoid withdrawing. When working in an office, Pinto suggested increasing access to sunlight by sitting near a window or taking walks during the day — anyway to ensure “you’re taking advantage of the sunlight when it’s there,” she said.

“If people have low vitamin D or vitamin D deficiency, there’s always the option of talking to your health care provider about assessing your levels and getting vitamin D supplements, managing stress and sticking to a consistent sleep schedule,” she said. “The more you can open your windows and just get access to that sunlight when it’s there throughout the day, I think that’s a pretty important aspect as well.”