Weather often affects people’s mood and frame of mind. For example, while some people may revel in winter’s chills, some might notice tiredness, a bit of weight gain, difficulty getting out of bed and bouts of “the blues” as autumn turns into winter.
 
 
“While noticeable, these shifts in mood generally do not affect your ability to cope with daily life. However, some of us are vulnerable to a type of depression that follows seasonal patterns. This is known as Seasonal Affective Disorder,” explains Tamsyn Manuel, clinical psychologist at Akeso Clinic Kenilworth.
 
 
“A form of depression that occurs at the same time each year, SAD is intimately related to changes in seasons. The symptoms may start in autumn and continue into the winter months. SAD occurs less often in spring or early summer,” she points out. The condition is classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a “specifier” in a major depression. “People with SAD experience episodes of major depression that tend to recur at specific times of the year, and these episodes may take the form of major depression or bipolar disorder,” according to Manuel.
 
 
As we move into spring, it is important also to understand the impact that this new season can have on mental illness. While depression-type symptoms are more likely, and perhaps more understandable, during the winter months, it is interesting that spring also brings mental health challenges. During the spring-time months, anxiety and insomnia may be more prominent, as are symptoms of mania and hypomania in those with bipolar mood disorder. Springtime can also bring more irritability for many. These experiences are sometimes known as “reverse SAD”.
 
 
 One of the possible causes of this “spring fever” could be comparison; that is, those with depression (for example) observe others feeling more joyful, active, and embracing the sunnier and warmer change in season, but end up feeling worse as they feel unable to do so. Other contributors include allergies and inflammation. Spring can also bring an increase in suicide rates, which shows us that we cannot disregard this seasonal change and its possible impact on mental health.
 
 
Winter
Symptoms specific to the winter onset of SAD include the following:
      Irritability
      Fatigue
      Isolation
      Hypersensitivity to rejection
      Heavy , “leaden” feeling in the arms or legs
      Oversleeping
      Appetite changes (foods high in carbohydrates)
      Weight gain
 
 
Summer
Symptoms specific to summer onset SAD include the following
      Depression
      Insomnia
      Weight loss
      Poor appetite
      Agitation or anxiety
 
 
Diagnostic criteria
Manuel explains that the diagnostic criteria according to the DSM-5 for depression with a seasonal pattern include having these experiences for at least the last two years:
      Depression that begins during a specific season every year.
      Depression that begins during a specific season every year.
      No episodes of depression during the season in which you experience a normal mood.
      Many more seasons of depression than seasons without depression over the lifetime of your illness.
 
 
Prevalence
Studies suggest that between 2-3 % of the general population may have SAD, while another 15% many have a less severe experience known as “winter blues”.
 
 “Good news for South Africans is that SAD is not that common an ailment on our sunny shores. Some people do suffer from SAD in South Africa, but it really is a condition that is more common in colder and darker climates. It more commonly occurs in Nordic countries and countries like Ireland and United States. SAD in more common in women, young people and those who live far away from the equator.
 
 Some people experience symptoms severe enough to affect quality of life and 6% require hospitalisation. Interestingly, people who have SAD who travel to areas far south of the equator that have longer daylight hours during winter months, do not get their seasonal symptoms,” Manuel advises.
 
 
Cause
According to her, the exact causes of SAD are unknown. “Some researchers believe that in instances of SAD, the depression is somehow triggered by the brain’s response to decreased daylight exposure. Current theories about the cause of SAD focus on the role that sunlight might play in the brain’s production of key chemicals. Some of the factors that come into play include your circadian rhythm, serotonin levels and melatonin levels.
 
 
Treatment
Manuel stresses that a diagnosis of SAD can be made after a careful evaluation by a doctor or mental health professional. A medical check-up is also important to make sure that symptoms aren’t due to a medical condition. Once you have been diagnosed with SAD, doctors may recommend one of several treatments:
 
       Psychotherapy
The support and guidance of a psychologist can be helpful for someone experiencing SAD.
 
       Increased Light Exposure
For people with mild symptoms, it may be enough to spend more time outside during the daylight hours or adjust lighting in their environment.
 
       Phototherapy
A special light box or panel is placed on a table top or desk, and the person sits in front of the light for a short period of time every day.
 
       Medication
Sometime people with severe symptoms may benefit from medication. Your mental health practitioners might be the best person to recommend the most appropriate treatment for you. Medication should be taken in conjunction with treatment from and visits to your therapist. 
 
       Mind-body therapies like meditation, yoga, acupuncture, and guided imagery.
 “So, it is important to firstly identify the symptoms and seek medical advice to rule out any medical conditions. Thereafter, if SAD is diagnosed, one should increase your exposure to light, monitor your diet, sleep patterns and exercise levels.
 
 “If the symptoms are severe, you should seek treatment from a health care professional. Also reduce your stress levels and ask about alternative treatment methods. Remember: SAD is treatable and can be managed effectively, Manuel concludes.
 
 
BOX 1
 
Tips to counter SAD
      Following recommended treatment.
      Get plenty of exercise, especially outdoors.
      Be patient. Don’t expect your symptoms to go away immediately.
      Develop a good sleep routine.
      Eat right (increasing vegetables and healthier foods).
      Make your environment sunnier and brighter.

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