Maggie, a single thirty-six year old teacher, began each school year feeling energized and optimistic. Once daylight savings time arrived, her mood spiraled downward. Invariably in the weeks following the winter break Maggie’s energy dragged. It became harder for her to get out of bed in the morning and her enthusiasm for work subsided.
Maggie told me she hibernated in the winter. By each February her level of fatigue felt deep and relentless. Her social life suffered to the point that she did not attend social activities because getting together with friends required too much effort. She essentially isolated herself during the darkest months yet felt deep pangs of loneliness.
After work, Maggie routinely flopped on the couch, turned on the tube, ate crackers or another starchy food, and then usually ended up sleeping for several hours. Most days she managed to get herself off the couch and into bed, sleeping until the next morning, when the cycle repeated.
Seasonal Affective Disorder
All the signs pointed to Maggie suffering from seasonal affective disorder (SAD), which is a form of depression that occurs and reoccurs along with shorter periods of daylight during the fall and winter. SAD is a biochemical imbalance triggered by the brain’s response to diminished exposure to natural daylight.
It is believed sunlight might play an important role in the brain’s production of melatonin and serotonin, which help regulate sleep, mood and energy levels. Most SAD sufferers are women and the age of onset is usually between 18-30. The severity of SAD depends on a person’s particular sensitivities combined with their geographical location.
Symptoms include feelings of hopelessness, fatigue, anxiety, social isolation, irritability, oversleep, loss of interest in activities usually found to be pleasurable, weight fluctuations, carbohydrate cravings and difficulty concentrating and processing information. These symptoms can be mild or can run serious interference in one’s sense of well-being. In the most extreme cases SAD can be associated with suicidal ideation.
Treatment for SAD
Regular exposure to natural light is one of the best ways to treat SAD. I suggested to Maggie that whenever the sun is shining to make a point of getting outside and walking. When driving in the car crank up the heat if necessary and open the sunroof. Whatever natural sunlight can be had on any particular day will help.
There are also ‘light boxes’ that provide phototherapy or light therapy. These light boxes can be bought on-line and are about 25 times stronger than the typical light found at home. The problem for most people is that they need to sit under these light boxes for about 30-90 minutes daily and compliance to follow through with this regimen is often a challenge.
Of course relocating to a part of the country that is sunnier could also help considerably, but this is not always a viable option. Vacationing someplace sunny helps, but once returning home the symptoms quickly return and sometimes with a vengeance.
Anti-depression medication is also used to help alleviate this debilitating form of depression. However, it is important to keep in mind that medication alone is not considered to be a complete treatment modality for SAD. When one is taking anti-depression medication it is always best to combine this treatment with a ‘talking therapy.’
Maggie Manages Her SAD
Maggie came to therapy to talk about her feelings and managing her stress level more productively. She also took a low dosage of medication. Motivating herself to come to therapy once a week was helpful in a number of ways – connecting instead of isolating herself and not succumbing to her couch habit at least one day a week.
After a few weeks of working together Maggie also agreed to institute a walking program on the sunnier days. Taking her outdoor activity to another level, I instructed her on mindful walking. She also kept a gym bag packed in her car so she had the option of exercising after work. Maggie immediately felt that short walks in the sun positively affected her mood and energy level, as did her workouts.
Maggie is now armed with some strategies for managing this disorder. She understands the cyclical nature of SAD and can prepare for the next round well in advance. Maggie also makes sure to connect with others now whether she is in the mood or not, for invariably her friendships buoy her sense of control, balance and happiness.
Have you noticed your moods changing with the seasons and what have done to help yourself feel better?