Depression is a very serious mental illness. It can occur in any given person at any age. The affected suffer from a very depressed mood, lose interest in things they usually enjoy, and are exhausted, sometimes even apathetic. This disease persists for a long time and usually does not get better on its own without treatment.
Some people talk about getting into the same state of mood during the colder months and automatically assume it’s a seasonal depression. But what exactly is ‘seasonal depression’? Is there a way to prevent it? Are there effective treatments? Why do seasonal changes affect our mood? And why do we use the term ‘seasonal depression’ so carelessly?
What is depression?
First of all, we’re going to clear up our knowledge of depression in general, since it will be necessary to understand what seasonal depression is.
Depression is different from “regular” sadness and listlessness. Grief, sadness, lack of motivation, are an inevitable part of life. Depression, however, does not usually go away on its own. There’s no ‘time will heal all wounds’, no easy words of encouragement, and distraction. To find (and fight) your way out of depression is a hard fight, and sadly, not everybody makes it out to the other side.
Symptoms of depression
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), at least five of the following symptoms have to be present over a time period of the same two weeks. Depressed mood, and/or loss of interest must be a part of the five or more.
- Depressed mood
- Loss of interest
- Weight loss or gain (or decrease/increase in appetite)
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Feeling worthless or excessive guilt
- Decreased concentration
- Thoughts of death
Furthermore, there are four more required criteria. The affected person needs to show all of them plus five or more of the above.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The symptoms are not caused by physiological effects of any substance or another medical condition.
- The feelings cannot be better explained with another mental illness like schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other (un-)specified schizophrenia spectrum and other psychotic disorders.
- The person has no history of manic or hypomanic episodes.
Differences in symptoms
Most studies report gender differences in symptoms of depression. Those who are affected and are male mostly show more signs of aggression and severe irritability. They have poor impulse control and low stress tolerance. Moreover, most have a higher tendency for risky behaviors (e.g., fast driving), a relatively higher consumption of alcohol and cigarettes, and sometimes other drugs. Their dissatisfaction with themselves and the world around them makes them reproach the people around them.
It is possible that a reason for this behavior lies in them feeling more ashamed of being weak, since they might feel like it makes them less manly. As a result of that, they live out their feelings in a different way from most women.
How common is depression?
Depression is way more common than you might think. If you take a look at the statistics worldwide, up to 4% of men and 8% of women suffer from clinically significant depressive disorders. Obviously, women get twice as many diagnoses. This does not necessarily mean that women are prone to develop a depressive disorder twice as much. Maybe men just don’t seek help as often as women do. The most common age of onset begins in young adulthood at an average age of 18 to 25 years.
According to WHO, 5% of all adults globally suffer from depressive disorder, which equals around 280 million people.
Single or combined depressive symptoms are way more common than full depression, which, however, does not make them any less severe.
It is the leading cause of disability worldwide and, as mentioned above, suicidal ideation is a common symptom. To be exact, over 700.000 people die due to suicide every single year, according to WHO.
Treatment for depression
There is a light at the end of the tunnel. Effective treatments for mild, moderate, and severe depression are available. However, more than 75% of people in low- and middle-income countries receive no treatment. They either don’t have access to the system or there simply aren’t enough professionals.
The best-case scenario is that the patient will receive an early diagnosis and treatment will begin immediately. The longer the patient has to deal with their mental illness, the harder the treatment becomes and the chances of the depression turning into a chronic depression rises.
Depending on the severity, there are three possibilities: psychotherapy, antidepressant medication, or a combination of the two. The combination is particularly used for patients with chronic and recurring depression and for those who suffer from a very severe depressive disorder. Medication usually consists of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).
Psychopharmaceutical medication influences the metabolism of neurotransmitters in our brains. Most of the time, they affect the number of neurotransmitters in the synaptic gap by prolonging or shortening their time span in this gap.
What is seasonal depression?
Seasonal depression (seasonal affective disorder, SAD) is a mood disorder. The affected have a normal mental health state throughout most of the year but show depressive symptoms (mostly) during the winter months.
Some of the most common symptoms are the same as the ones of major depressive disorder. Those include feelings of hopelessness and worthlessness, thoughts of suicide, loss of interest, withdrawal from social interaction, sleep and appetite problems, and difficulty concentrating.
However, the symptoms do differ. People suffering from SAD usually fall asleep earlier and have difficulty waking up in the morning, which is why they often oversleep. And although they sleep a lot of hours, they suffer from little to no energy. Furthermore, they often complain about nausea and a tendency to overeat, which can then lead to weight gain.
Experts were skeptical about acknowledging SAD as a common disorder, but it is as of today. However, the validity of this mental illness is still in question, and an analysis by the Center for Disease Control found no links between depression and seasonality.
“With a seasonal pattern”
The addition ‘with seasonal pattern’ is a specifier for bipolar and related disorders. The greater number of people experience major depressive disorder, but around 20% of people suffer from bipolar disorder. It is important to specifically find out whether it is depression or bipolar, since there are important treatment differences.
People with the ‘with seasonal pattern’ specifier may experience depressive episodes due to major depressive disorder. However, they might also experience them as part of bipolar disorder during the darker and/or colder months and remit in the lighter and/or warmer months.
How common is seasonal depression?
Seasonal depression occurs in around 0.5 to 3 percent of the general population. 10 to 20 percent of people with a major depression diagnosis and around 25% of those with bipolar disorder show SAD.
Seasonal affective disorder usually lasts for around 40% of the year. Only around 10% of the affected peopleshow the opposite seasonal pattern. The SAD symptoms occur during spring and summer and stop during fall and winter. Those people also show the opposite of the symptoms: they lose their appetite and sleep less than usual.
For around 40% of the people, the depressive episodes continue into the summer months and change their diagnosis to either major depression or bipolar disorder.
Why do people develop seasonal depression?
There is no one cause of seasonal depressive disorder. Additionally, experts are not quite sure which of the following is the biggest contributor, and which is the most effective.
On one hand, seasonal affective disorder seems to stem from biochemical imbalances due to shorter daylight hours and overall, less sunlight. Let’s take the USA as an example. The percentage of people suffering from SAD ranges from 1.4% in Florida to 9.9% in Alaska. Try to keep that in mind, since I will get back to this example in the next paragraphs. These stats, and the fact that it is more common for people living far from the equator, can be evidential for this theory.
Serotonin and melatonin
Findings indicate that imbalances are to be found in serotonin and melatonin. Both help the body maintain a daily rhythm which is tied to the seasonal night-day cycle. Changes in these two hormones then change one’s rhythm and cause seasonal affective disorder. They can no longer adjust to seasonal changes in day length, which lastly leads to sleep, mood, and behavioral changes. It is possible that genetics can also predispose this condition.
Deficits in vitamin D can increase problems because vitamin D is believed to promote serotonin activity. Vitamin D can be consumed through our diet, but the body also produces vitamin D when our skin is exposed to sunlight. Fewer amounts of daylight in the winter can then lead to people with SAD having lower vitamin D levels. Furthermore, serotonin activity will be slowed and decreased.
However, too much sunlight can also cause these imbalances, which would also explain why some people show SAD during spring and summer. But little is known about how and why they influence certain individuals.
Treatment for SAD
There are three main ways to treat seasonal affective disorder, and they are all linked to a significant improvement in seasonal depression.
- Light therapy: You will sit in front of a light therapy box which emits very bright light for 20 or more minutes per day. You do it the first thing in the morning and will feel improvement within one to two weeks. Light therapy is usually continued throughout winter and begins in fall as a preventative method.
- Antidepressant medication: Selective serotonin reuptake inhibitors (SSRIs) prolong time and increase the amount of serotonin in the synaptic gap. Therefore, more serotonin will be transmitted. Serotonin is linked to a better mood and overall well-being.
- Talk therapy: The method of choice is cognitive behavior therapy. This type of therapy helps the patient identify and change their thinking and behavioral patterns. They practice new skills and become more empowered to face daily life.
It is also possible to do a combination of all. And in general, it is helpful to also try and do the best you can for your overall well-being. Approaches include regular exercise, healthy and balanced eating, creating a well-rounded sleeping pattern, and staying socially active.
Ways to help yourself
Talk to your doctor: As you know now, seasonal affective disorder is a form of depression. Seasonal depression needs a professional diagnosis. You need to see a doctor who can help you screen your symptoms.
Ready your mind: Make time for things and activities that lighten up your mood. It doesn’t matter what it is to you, reading a book, taking a walk, or simply listening to a good podcast.
Dawn simulators: Dawn simulators are alarm clocks which gradually increase their light intensity and wake you up just like the sun usually would.
Prioritize social activities: Long periods of isolation can have a long-term psychological effect on people and can increase symptoms of depression and PTSD, which is why you should always try and keep your social butterfly active.
Stick to a schedule: Going to sleep and waking up at regular times will expose you to light at predictable times and help maintain a normal circadian rhythm. Also, try and stick to your regular mealtime intervals.
Get active: Outdoor exercise is most helpful to alleviate SAD. However, if the weather conditions don’t allow any outdoor activity, try to break a sweat at home or, if possible, at a gym nearby. Remember: something is better than nothing.
Let light in: Keep your blinds open as long as possible and try to let your home be as naturally light as possible.
Try to avoid alcohol: Drinking can cause further depression and put you in a downward spiral. As soon as you start noticing a change in your drinking pattern, ask yourself “Why do I think I’m drinking more?”
Keep a journal: A journal can help you identify specific triggers. You can get negative feelings out of your system and look at them from a different perspective.
Seasonal affective disorder
Whether you are of the opinion that seasonal depression is a real disease or not, any condition which makes someone feel bad and depressed is worth treating. There are effective ways to help reduce symptoms and help you regain your usual mood. It is important to always listen to what your body is telling you, and whenever you feel the need, don’t ever be ashamed to consult a professional. Your mental health matters.
Feature image credit: Max Böhme / Unsplash