When the winter period arrives, for many it is a wonderful time filled with holidays, presents and hours spent with loved ones—well, when we haven’t been in a global pandemic that is. For others however, the winter months can be an extremely hard period. One such factor that contributes to this feeling is commonly referred to as ‘seasonal depression’, also known by its official medical name, Seasonal Affective Disorder (SAD). So, what is it and how can you help someone who’s suffering from it?
The UK-based mental health charity Mind defines SAD as a “type of depression that you experience during particular seasons or times of year. Depression is a low mood that lasts for a long time, and affects your everyday life.” Such episodes most typically manifest during the months of the year where days become noticeably shorter and weather used to get colder (thank you, climate change). While some may experience it as a temporary event, studies have shown that as much as one in three people frequently battle this depression throughout autumn and winter.
The NHS made note of the symptoms that commonly occur due to such a condition, some signs include: feeling generally irritable, a low self-esteem, stress and anxiety, an incessant low mood, tearfulness, a reduced sex drive, feelings of despair and worthlessness, a tendency to become less social and difficulty in finding interest in everyday activities like hygiene. Of course, depression is not limited to the above symptoms and varies in intensity from person-to-person—with some developing thoughts of suicide.
For seasonal depression in particular, for example, other more specific symptoms can arise. These can be: changes in appetite, weight gain, intense fatigue or low energy and trouble concentrating to name a few. It can really affect your day-to-day living and is more serious than just ‘winter blues’. So, now we are a bit more clued on how to spot it, let’s take a look at the underlying causes of why it happens in the winter.
While the exact cause of SAD has yet to be verified and backed by scientific study—likely due to its complex and multifaceted nature—there are some suspected theories that are thought to contribute to the disorder. Since it occurs most often during the months of winter, light, or lack thereof, is thought to be a major player.
Healthline stated, “One theory is that decreased sunlight exposure affects the natural biological clock that regulates hormones, sleep and moods. Another theory is that light-dependent brain chemicals are more greatly affected in those with SAD.” It must be noted that these are just some of the ideas behind why light alone could be a large contributing factor—the theories are endless.
The American Psychiatric Association, for example, has suggested that those living furthest from the equator are at a higher risk of developing the disorder and have linked SAD to a biochemical imbalance brought about by a shift in a person’s biological clock—causing a misalignment with their typical schedule. If you find yourself relating to the content, fear not, there are some steps you can take to help manage SAD.
It goes without saying that the symptoms you may be experiencing should be relayed to a medical professional. As SAD is part of the spectrum that is depression, it is vital to have it examined and correctly diagnosed by the relevant mental health expert. Doctor Deborah Pierce, MD, from the University of Rochester School of Medicine and Dentistry in Rochester, New York told Everyday Health, “There are a number of screening questions that can help determine if someone is depressed… Your doctor will be able to sort out whether you have SAD as opposed to some other form of depression.”
Following diagnosis, there may be opportunities to pursue treatments via your health professional. The National Institute for Health and Care Excellence (NICE) suggested that the condition is adequately treated by the same methods used for alternative forms of depression. This includes, but is not limited to, medicines like antidepressants, forms of traditional therapies as well as CBT, counselling and even light therapy.
Light therapy is an emerging method being investigated into its effectiveness of treating SAD—as of now, its capability as a standalone treatment is incredibly inconsistent. Overall, the NHS pointed out that although there is mixed evidence, some studies have shown it can be useful—especially when used in the morning. Light therapy usually involves a lamp or light box that a patient would sit with from 30 minutes to an hour every morning.
Though varying in design, such light therapy tools typically produce a very bright light that is supposed to simulate sunlight that is limited for many during the winter. “It’s thought the light may improve SAD by encouraging your brain to reduce the production of melatonin (a hormone that makes you sleepy) and increase the production of serotonin (a hormone that affects your mood),” the NHS wrote. The treatment is however not usually available via the NHS, it’s best to speak to your doctor if you wish to try it.
If you find that there is a lack of accessibility to therapies or that you’re struggling to get a diagnosis, there are some things you can do yourself to assist in the alleviation of your symptoms. While having a light box or a dawn simulator—an alarm clock that wakes you up with ‘sunlight’—sounds convenient, there’s another really easy way to get light. Go outside.
According to one study cited by The Conversation, going for a daily one-hour walk outside showed a substantial improvement in all symptoms as opposed to those in the study who just had artificial light. The advice across the web is to get outside as much as you possibly can—especially the times of day when the sun is at its brightest. This usually falls around noon. If you are unable to get outside or work remotely, keep your curtains open and choose a working station closest to the natural light if possible. Try to exercise or do some kind of movement activity regularly.
Trying to do the above with others could be a two-birds-one stone solution. Try to find ways to stay connected with the people around you and refrain from excessive social isolation—hard to do in a pandemic, I know. Despite the need to stay indoors because of COVID-19, it is important to find alternative ways to socialise. “When the winter weather makes it super cold to be outside or unsafe to drive, we can FaceTime with friends and extended family members or set up Zoom calls with them,” said psychologist Kim Burgess, PhD.
These are just a few simple ways to manage the symptoms, but the list is endless. Other things to watch out for or implement are: healing nutritional deficiencies like Vitamin D, journaling, taking a trip and creating a simple schedule or routine. And remember, your mental and emotional health are just as important as your physical health. So take care of those too.
Last month, The Lancet Regional Health – Americas published a study examining the effects of the COVID-19 pandemic on our mental health. Polling participants both at the very beginning of the pandemic and a year later, the researchers concluded that depression rates have more than tripled in the US. Not only has the pandemic aided a spike in mental health concerns, but the findings proved that the increase is actually worse than other large-scale traumatic events like catastrophic weather or terror attacks.
At a time when mental health conditions like depression remain stigmatised across cultures—with people often spending years just to land crucial appointments for diagnosis and treatments—scientists at the Indiana University School of Medicine have developed a coveted tool, claimed to be psychiatry’s “first-ever biological answer to diagnosing a mood disorder.”
The study, as noted by Al Jazeera, delves into the biological basis of mental health concerns by developing a blood test using ribonucleic acid (RNA) markers that help distinguish the type of condition a person has. Drawing on 15 years of previous research into how psychiatry relates to blood gene expression biomarkers, the team—led by Doctor Alexander Niculescu—has proved that it’s possible to diagnose depression and bipolar disorder with a blood test. The blood test has clinical utility, is able to distinguish between the two conditions and can eventually match people to the right medications.
“This avoids years of trial and error, hospitalisations, and side-effects,” Doctor Niculescu told Al Jazeera. “As these are very common disorders, we think we can do a lot of good with this and other tests and apps we have developed.”
So how exactly can a blood test diagnose a mental health concern? This essentially loops back to the systems in our body—including the brain, the nervous system and the immune system—which have a common developmental route. “For example, when you’re stressed or depressed, there are psycho-neurological mechanisms, hormones and other things that are released that affect your blood and your immune system,” Doctor Niculescu explained, adding how an immune activation or inflammation would therefore affect the brain.
In the first stage of the study, the group of scientists identified a list of RNA biomarkers that could track one’s mood over a period of time. After validating the list among subjects with clinically severe depression and mania, they finalised 26 biomarkers—which they narrowed down to 12 with further testing. “With these findings, doctors would be able to send patients to a lab for bloodwork to indicate the causes of their symptoms, just as they would for a physical illness,” Doctor Niculescu said.
The biomarkers could additionally help with treatment, given how some of them were found to be affected by Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants. Three other biomarkers were identified in previous work to be affected by lithium carbonate—a mood stabiliser used in the treatment of bipolar disorder. “Depending on which of those biomarkers are changed in [a patient], we have a list of medications… ranked by how tightly they match [the patient’s] biological profile,” the expert continued.
The blood tests developed by Doctor Niculescu and his team are currently available as Clinical Laboratory Improvement Amendments (CLIA)—a set of US government standards for laboratories that test human specimens for health assessment or to diagnose, prevent, or treat disease—for physicians to order.
However, according to Professor Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, finding one single algorithm that applies to all people with mood disorders is unlikely—because the conditions are unique and based on clinical presentation at different stages of life. His teammates are instead in the pursuit of connecting physiology and biology to the personalised symptoms of individuals and not their broad categories of illness.
“What systems are actually perturbed? How are they represented? What are the markers of that that you can detect?” he explained. “And [then] what is the combination of biological, behavioural and other treatments that corrects the situation… and then keeps you well?” According to the professor, all of these findings can be coupled with clinical assessment for a more accurate and conclusive diagnosis and treatment.
Nevertheless, innovations like Doctor Niculescu’s blood test can undoubtedly transform early diagnosis of mental health concerns altogether. According to Doctor Sonia Kumar, a Sydney-based psychiatrist, such objective tests are a game changer especially for conditions like bipolar disorder which first manifests itself as depression with the full array of manic symptoms taking years to appear and evolve over the years. In other cases, these symptoms may exist but on a lower spectrum capable of bypassing existing diagnosis. “If there were a biological test that could clarify these variables along with clinical assessment, clinicians could start accurate treatment earlier—which could mitigate a lot of suffering before it even happens,” Doctor Kumar told Al Jazeera.
With the ‘you’re just sad, sleep it off’ stigma still attached to mental health conditions like depression, the study led by Doctor Niculescu harbours the potential of playing a significant part in the psychiatric toolkit for diagnostics. And as Kathmandu-based psychiatrist, Doctor Pawan Sharma, explained, such tests could break down barriers—particularly among those from more rural and isolated communities where there is lower cultural awareness about mood disorders.
“They come [to physicians] with physical symptoms—like headaches, insomnia, loss of energy, heart palpitations—and they [are then referred] to psychiatrists,” Doctor Sharma noted, adding that an objective test would give patients something tangible to help explain how they are feeling. This, in turn, makes such innovations a necessary step to reach a horizon where we don’t have to bank on scientific test results to ‘validate’ our mental health concerns.