Winter has rolled in again. The days are shorter and much more pleasant weather-wise than the excruciating summer months. But temperatures dip and as the daylight vanes, many of us begin to feel somewhat sluggish, withdrawn or depressed for inexplicable reasons. As a result, we tend to sleep more and even eat more than we normally would. If this sounds familiar to you, chances are that you are at a risk of Seasonal Affective Disorder (SAD), a negative change in mood perpetuated by changes in the weather outside. In scientific terms, SAD is a less popular but prevalent and mild form of depression most commonly felt during winter.
Why so SAD?
Nearly 10% of the world’s population suffer from SAD, also referred to as the winter blues, without any knowledge of its existence. Medically speaking, it can best be described as a mood disorder associated with depression that follows the vagaries of the seasons. The most common occurrence within the disorder is winter depression.
Nargis Asad, a consultant psychologist at Aga Khan University Hospital in Karachi, sheds some light on the phenomenon, saying SAD was an old classification initially used for depression. It is now referred to as a depressive disorder with a seasonal pattern. “This is a sub-disorder under depressive disorders and applies to a pattern of major depressive episodes that occur in line with seasonal changes,” explains Nargis. The onset begins during fall and soars to its peak during winter with spring sparking the remission period.
Here in Pakistan, the lack of awareness regarding the disorder and depression in general means patients often overlook any symptoms they might be manifesting. For instance, 35-year-old homemaker Sara Khan initially blamed her children for making her dislike the cold weather she had adored ever since childhood. “I would feel depressed, lazy and extremely sad,” she recalls. “I thought it was because I was not working and missing the life I had before the children.” But as the symptoms persisted throughout the winter and faded the rest of the year, Sara sought professional help. She was diagnosed with SAD and given prompt treatment for her winter blues. Interestingly though, the condition rarely affects people above the age of 30. Its main age of onset is between 18 to 30 years.
Rooting out the cause
Despite its prevalence, the precise cause of winter blues still remains unknown. Psychiatrists speculate that it is often instigated by the changes in the abundance of sunlight, which would explain why the blues are particularly common in areas that receive lesser sunlight during winter. The severity, however, depends not only on the patient’s geographical location but also on the extent of their vulnerability.
Decreased exposure to sunlight causes one’s biological clock — responsible for regulating their mood, sleep and hormones — to slow down during winters. “For the first two years, I did not realise it could be anything that I should get help for,” says 25-year-old Ammara Khan*. “My mother would get really annoyed at how much time I spent in bed and my desire to just sleep the season away,” she adds. It was the third winter of extreme winter blues when Ammara finally looked up her symptoms online and spoke to a psychiatrist.
Another theory suggests that the brain releases chemicals that diffuse information amid nerves. One of the major biological implications is on the production of melatonin — a chemical turned on by darkness and off by light. Lack of sunlight reduces the production of melatonin. SAD tampers with one’s biological clock and when the day suggests it’s time to get up, the patient’s internal clock asks for more rest. In either case, it is believed that these imbalances can be sorted by appropriate exposure to natural light. Most patients have one thing in common: they are sensitive to light or the lack thereof.
Treating the SAD-ness
While most people take winter blues very lightly and expect them to be normal, depression can be draining and restrictive for the patient. Their social and professional lives are affected severely as they lose the desire to socialise, work and function in general. It also impacts patients’ relations with others and their productivity through the season.
Even though the disorder is less common in Pakistan — found mostly in the higher altitude regions — Nargis has had a few patients who have come in for SAD. “These patients are recommended various kinds of treatments, including light therapy and counselling, depending on their situation,” she says. Some sufferers experience immense anxiety and mood changes while others lose the will to get out of bed in the mornings. “A formal diagnosis can only be made once the patient experiences three consecutive winters of the symptoms, followed by complete remission during the rest of the year,” she adds.
One of the most recommended therapies for patients suffering from serious winter blues is light therapy, also often called photo therapy. It is administered by a device that contains white fluorescent light tubes covered with a plastic screen to block ultraviolet rays. The patient may not necessarily need to look directly into the light, but doing their daily tasks around it can help immensely. Light therapy is known to be safe and generally well-tolerated by most patients as its basic aim is to give adequate light to the patient’s body. The patients can also spend time outdoors during the day to maximize the amount of sunlight absorbed during the day.
Uncharacteristically intense cravings for starchy and sweet foods and overeating are also common indications of the disorder, which ultimately lead to weight gain or perhaps, the infamous ‘holiday weight’. As a result, it is best to get a diagnosis and begin the appropriate treatment in time. The treatment may vary from patient to patient as for some therapy alone may be ideal but others might require medicinal assistance as well.
PHOTO CREDIT: ACCESSHEALTHCARESERVICES.COM
Did You Know?
Almost 60% to 90% of people suffering from SAD are women. If you are a female between the age of 15 and 55, you are most likely to develop the disorder. Factors such as PMS, menopause, pregnancy and child birth could also contribute to depression in women.
*Names have been changed to protect privacy.
Hafsah Sarfraz is an Islamabad-based reporter for The Express Tribune.
Published in The Express Tribune, Ms T, January 10th, 2016.
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