Dr. Toshi Is In! "What is SAD?"

Dear Dr. Toshi,

I get a little depressed every year around this time in the fall and winter. Is that something I should be concerned about?

Have you ever heard of a condition called seasonal affective disorder (SAD)? If you have seasonal symptoms of depression every year around the same time, and your doctor ruled out (tested and made certain) that it's not due to a specific situation or other medical condition, you may be having SAD.

Recently, the professional medical journal "American Family Physician" published by the American Academy of Family Physicians had a good article on this topic. "Seasonal affective disorder is a mood disorder with depressive symptoms that occur at a specific time of the year with full remission at other times of the year." Most of the time, it happens during the dark fall and winter seasons, but some people have it in the spring or summer. It's thought to be related to our circadian (sleeping) rhythm, so it's more common in the northern latitudes, such as North Dakota!

There are actually diagnostic criteria for SAD. First, the person must meet the criteria for major depressive disorder or bipolar disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (which is usually just called DSM-5). There is a list of the symptoms of depression and bipolar disorder (if you're interested, you can Google, or ask your provider), and the person has to have five or more of these symptoms during the same 2-week period, and they must also have a depressed mood and/or loss of interest or pleasure. Also, in order to receive a clinical diagnosis of depression, those symptoms must cause the individual significant distress or impairment in their social life, occupation, or other important areas of their life.

In addition to meeting these criteria, in order to diagnose SAD, these mood changes must always occur at the same time of the year for the individual, and they must occur for at least two consecutive years.

It's important to see your doctor or other primary care provider if you feel you're experiencing depressive symptoms because these symptoms could be due to a physical (medical) condition that should be diagnosed and treated.

There are several treatment options that are known to be effective, such as light therapy (also known as phototherapy), antidepressant medications, and mindfulness-based cognitive behavioral therapy (CBT). A special kind of light is used for light therapy at a certain time of the day (mostly first thing in the morning). Please discuss these options with your primary care provider if you're diagnosed with SAD.

Some things you can try at home include relaxation techniques such as Yoga, meditation (including guided meditation using an app, for instance), and music or art therapy. It's also helpful to make your environment sunnier and brighter, too. Also, try to go outside, even cloudy days, because that can help, and be sure to get regular exercise. Drinking alcohol or doing recreational drugs are often used by people, but studies have shown that they actually make the problem worse.

Of course, this year it's even more challenging than usual to go through the winter months due to COVID. So, hang in there! We'll get through this and see the daylight again!

Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics.