Is Depression Seasonal?

It’s monsoon, the thunders, and Mumbai rains wake you up, the cold breeze leaves you no choice but to make your self a cup of hot Masala Chai! You curl up in the warm blankets and not do anything at all. Maybe just lay inert in your bed! You move around in your pajamas the whole day and bathing seems like a task. Doesn’t it? It’s the season of hot chocolate drinks, strong coffees, and yes let’s not forget the delicious onions bhajis!

Personally, summers are most irritating especially traveling on the local train in a dripping sweat. Monsoons are just what I need and love, winters sure bring the jingles of Christmas to the ears but sometimes it gets to my “low” moods. These low moods may include loss of appetite or increased appetite, if I reflect I tend to eat a lot more in winters, lose interest in activities, and overall just feel sluggish.

Why does our mood shifts so drastically just because something as natural as the “season” changes? What makes “seasons” play such a significant role in our mood, sleep, appetite, activity patterns? What is that one thing that keeps some people “going ” regardless of the change in season, whereas others grapple with the whole seasonal change? More importantly, what exactly separates causal “lethargy” in winters from a diagnosable “seasonal affective disorder (SAD)?”

Here is one of the most heartbreaking poems that scribe Seasonal Affective Disorder precisely to a certain extend, ” it’s getting colder and so is my heart. It’s getting darker and so are my thoughts. The leaves are falling and so am I, falling…….apart (1).” The heaviness in the words and the fear of losing oneself in the dark is more than enough to convey how strongly a person battling Seasonal Affective Disorder feels.

Scientifically, seasonal changes have a direct effect on the levels of the metabolism and hormones of an individual. The basic law of nature “change” is very prominent in our emotional well-being in accordance with the seasons too. Hence, the changes in levels of metabolism and hormones affect the moods and behaviors of the person. Some tend to become agitated and short-tempered while others become more lethargic and inactive.

Nonetheless, the way my body reacts to a certain season will be different from the way your body reacts to the same season. For some people, seasonal changes have a relatively deeper and stronger impact on their bodies than others. For the people who are already battling mental health adversities and challenges, seasonal changes can worsen the symptoms. Seasonal Affective Disorder throws light on how seasons contribute to depressive symptoms in an individual.

On one hand, people experience depressive symptoms only for specific seasonal periods such as winters. So the changes in mood, appetite, sleep patterns, interest levels, and activities begin and end with a certain season. Also known as “winter blues”, where people tend to feel low as the days get shorter and nights get longer. One of the major reasons being the lack of sunlight exposure in the winters. However, with the onset of spring or summer, the individuals can heal themselves on their own, with the major source of the remedy remains increased exposure to daylight.

On the other hand, these seasonal changes cause a detrimental effect on some individuals. Seasonal changes can cause grave long-lasting effects. As a result, the depressive symptoms continue for the whole year followed by another year beyond a specific seasonal period.

Therefore, if an individual observes a significant change in their mood and behavior constantly throughout the year whenever seasons change, there are chances of the individual battling Seasonal Affective Disorder (SAD). Said that consulting a professional mental health practitioner, therapist or clinical psychologist would be the best option before concluding on your own. Moving on, There can be two main types of SAD:

1. Winter depression – when the symptoms start in the latter period of fall or early winter and go away during the spring and summer.
2. Summer depression– when depressive episodes are experienced during the spring and summer months. This is less common.

Dr. Samir Parikh, the Director of The Department of Mental Health and Behavioural Sciences, Fortis Healthcare, suggests,” SAD is not a separate entity of depression but should be seen as a sub-type. This is prevalent in people who are already under the spectrum of depression. Though more prevalent in countries where there are larger spans of winter, we are coming across several cases in North India too.”

Furthermore, SAD is more recurrent in temperate climates such as The United States due to lack of sunlight in the winters. On contrary, the reverse of this is experienced in the warmer parts of India, that is, the seasonal affective disorder is more likely to be experienced during summer months because of excessive heat and dehydration.

According to Varsha Makhija, a clinical psychologist with immense experience in the field of summer SAD in India highlights that the major factor that affects SAD is either the sudden increase in appetite and carbohydrates or a sudden loss of appetite where Indians eat as little as possible to avoid the nauseous feeling.

Additionally, certain claims have been made that India’s humid climate has cultivated a habit in most of us to avoid the sun. This could merely be an instinct to avoid sunstroke, fainting, dehydration, sunburn, and to dodge other cultural issues such as a change in skin tones.

Another perspective sheds light on the possibility that changes in levels of estrogen due to the heat cause mood changes. The gender difference is evident in both types of SAD. Women are more likely to be affected by seasonal depressive symptoms than men. One of the common reasons being hormonal fluctuations, another factor being societal pressure of maintaining a certain socially desirable skin tone and external aspects (2).

More importantly, an intriguing and novel viewpoint proposed that the prominent symptoms, of winter blues or SAD, tend to be longer sleeping hours, increased inactivity, and increased appetite especially fattening foods. This points towards a vestigial hibernation instinct. However, it was disregarded by many psychologists it persists to make a reasonable point.

Similarly, some studies claim that SAD is nothing but a tendency to benefit mankind’s reproduction patterns. Baffled by the remarks, I tried my best to justify this claim. Here it is- Let’s consider the prehistoric ages, if an infant is conceived between May and September, that leads to a higher probability of being born between February and June, according to few researchers this increases the likelihood of the infant’s survival before the onset of winters.

Now coming back to SAD, people with winter SAD are lethargic in winters but generally active in spring and summer, therefore increasing the likelihood of procreation in those seasons. I know this is a far-fetched explanation to SAD but what if it is the underlying truth?

Hence, Robert Levitan at the University of Toronto considers SAD to be an evolutionary disorder. Our lifestyle and ways of copping up with seasonal changes have dramatically transformed over the decades however our body functioning still follows the age-old instinctual patterns of saving oneself and our offsprings from rash winters. Thus, It could be considered as an energy-conserving process that is no longer helpful in modern society.

SYMPTOMS

SAD Symptoms can be distinguished into two categories:

1. Winter depression include

• Oversleeping (hypersomnia)
• Overeating, particularly with a craving for carbohydrates
• Weight gain
• Social withdrawal (feeling like “hibernating”)

1. Summer-pattern SAD include:

• Trouble sleeping (insomnia)
• Poor appetite, leading to weight loss
• Restlessness and agitation
• Anxiety
• Episodes of violent or aggressive behavior

To add on, Symptoms of major depression include:

• Depressed mood most of the day, nearly every day. An example could be feeling sad, empty, hopeless, in children and adolescents, it could be an irritable mood.
• Significant decrease in interest of pleasure in all activities most of the day, nearly every day on a subjective account.
• increase or decrease in appetite compared to before.
• Significant increase or decrease in weight without dieting.
• insomnia- lack of sleep or hypersomnia- oversleeping, nearly every day.
• Psychomotor agitation or retardation nearly every day.
• Loss of energy and fatigue nearly every day.
• a strong feeling of helplessness.
• A strong feeling of worthlessness and excessive inappropriate guilt; which may be delusional.
• difficulty in concentration, indecisiveness nearly every day.
• suicidal ideations, thoughts or tendencies, recurrent thoughts of deaths.

To be diagnosed with SAD, a person must meet the following criteria:

1. Patients must have symptoms of major depression or the more specific symptoms listed above.
2. The depressive episodes must occur during specific seasons (i.e., only during the winter months or the summer months) for at least 2 consecutive years. However, not all people with SAD do experience symptoms every year.
3. The episodes must be much more frequently than other depressive episodes that the person may have had at other times of the year during their lifetime (3).

CAUSES OF SEASONAL AFFECTIVE DISORDER

1. Changes in the exposure of light or sunlight
2. Low levels of serotonin
3. Higher levels of the hormone melatonin
4. Disruption in body clock
5. Traumatic life events
6. Physical illness
7. Changes in medication or diet
8. Use or withdrawal from drugs alcohol (4).

TREATMENTS FOR SEASONAL AFFECTIVE DISORDER

1. Light Therapy: It’s Lit!

As the name suggests this therapy involves exposing a diagnosed person with SAD to rays of bright light every day for a certain amount of time. In this way, the person is given artificial light to compensate for the lack of natural sunlight in the winters.

For this treatment, the client is expected to sit in front of a very bright lightbox (10,000 lux) every day for about 30 to 45 minutes. Usually in the morning, from fall to spring. The lightboxes, which are about 20 times brighter than ordinary indoor light, filter out the potentially damaging UV light, making this a relatively safe treatment. However, people with certain eye diseases or people taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision (5).

2. Antidepressant Medications: One Of The Solutions.

Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD’s symptoms. These antidepressants are useful to maintain the levels of serotonin and enhance the client’s moods significantly. The commonly used SSRIs are fluoxetine, citalopram, sertraline, paroxetine, and escitalopram.

All medications tend to have side effects hence consulting a doctor is a must.

3. Psychotherapy: Let’s Talk!

Psychotherapy, Cognitive Behavioural Therapy, and other talk therapies tend to focus on the negative thoughts of the client related to the winter season (e.g., about the darkness of winter) and then replace these negative thoughts with more positive thoughts. Also, CBT- SAD uses a process called behavioral activation, which helps individuals identify and schedule pleasant, engaging indoor or outdoor activities to combat the loss of interest they typically experience in the winter.

4. Go Get Your Vitamins!

Supplements are the most important of all. Vitamin B12 helps to maintain healthy blood cells and prevents anemia (anemia leads to weakness, lethargy, and tiredness). Hence vitamin B12 is a necessity at this age. Further, Vitamin D is equally important. People diagnosed with SAD tend to show low levels of vitamin D resulting in a deficiency. Thus, Vitamin D supplements are likely to treat symptoms of SAD to some extent.

In the end, all that matters is the 20 Minutes workout we tend to skip, the 30 minutes walk in nature we tend to procrastinate and the unconditional love we deprive ourselves of. To lead a healthy and satisfying life- firstly, you need to start making a list of things you like to do like dancing, art, clay, running, cooking (for yourself), reading, anything that gives you a feeling of “happiness” or “bliss”.

Secondly, you need to stretch! In-between work hours, do some stretches to wake up from the body. Stretching and deep breathing will not necessarily recover your losses but surely save you some unforeseen expenses.

Thirdly, don’t lose your charm. Don’t let others define you and your potential. We are capable of a lot more than what we think we are.

Lastly, I request all the readers NOT to self diagnose themselves after reading this article. We are all human beings, a part of nature, and a major part of constant change. If you strongly feel that you are going through similar patterns mentioned in the article please consult a professional. Self-diagnosing is not the answer!

Your body needs you more than ever, especially amidst this pandemic where you and your body is going through so much uncertainty, stressors, and altogether a new pattern of living. Don’t forget to love your body the way it is, don’t forget to take a break for yourself, and don’t forget to savor every sip of that tea (or coffee, whatever you like) during these winters.

References

1. Ofinkandpapers. (2014, June 25). Ofinkandpapers. Retrieved November 08, 2020, from http://ofinkandpapers.tumblr.com/post/89828815780
2. The Swaddle. (2018, April 08). How Seasonal Affective Disorder Affects Indian Women. Retrieved November 08, 2020, from https://theswaddle.com/seasonal-affective-disorder-works-in-reverse-in-warmer-climates/
3. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, DC: American Psychiatric Publishing.
4. Seasonal affective disorder (SAD). (2017, October 25). Retrieved from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
5. Seasonal Affective Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/index.shtml