Ask Dr. Bob: A discussion on Seasonal Affective Disorder

A discussion of SAD, otherwise known as Seasonal Affective Disorder.  Many people have this syndrome, and it was recently featured in the January Bergen Record in an article by science writer Gene Myers where I had the opportunity to comment on the large numbers of patients who suffer from this condition.

What is SAD?

This is a type of depression that is related to the changes of seasons.  It begins and ends about the same time each year. The symptoms begin in the fall and resolve in the spring and summer months. There is a variant that begins in the summer and spring and resolves in the winter months.  I am not sure that the elimination of daylight savings time would have a positive effect on SAD, but I think we all look forward to the long days and shorter nights.

How do you treat SAD?

Treatment for SAD is light therapy, psychotherapy, and medications. The “winter blues” should not be shrugged off as “nothing of concern”.  This condition can cause major depression and with the emotional pressure of the winter holidays, can result in many more suicides than usual.

How are the symptoms related to regular depression? (Mayo Clinic.org 2024)

They are not very different in SAD versus clinical depression.  Some people suffer more than others. Some of the symptoms include feeling listless and sad most of the day, losing interest in activities that you once enjoyed, having low energy and feeling sluggish, sleeping too much, overeating, and finally thoughts of not wanting to live.

Are there any people who hurt more than others?

Yes. People with bipolar disorder are at increased risk of SAD.  In patients with bipolar disorder, episodes of mania can be linked to a specific season.  If you are bipolar, you should be aware of this exaggeration of symptoms.

What about the countries in the north or the south where light and dark are exaggerated?
Unless you have been to the arctic circle or antarctica, you will have problems understanding this question.

Let me give you an example.  Several years ago, I had to lecture in Tromso, Norway in the middle of July. When I got to my hotel I noticed that there were thick black shades on the hotel windows.  These were to keep the light out of the room in the middle of the night. You see, in northern Norway in the middle of summer there is only one hour of darkness in the middle of the night (usually between 3-4 AM) and even then, it was like a cloudy day.  The rest of the night, the sun shone brightly. Without the shades one’s light-dark cycle was disturbed, and it wreaked havoc on sleeping.

The same thing happens in the winter months.  There are only one to two hours of light during the day and the rest is pitch black as if it were night all the time.

Despite these findings, the rate of suicides is slightly elevated in the Scandinavian countries, but not to the degree that one would expect in contrast to those in the temperate zones.

What causes SAD?

The main cause of SAD is not known.  There are several theories, however. First is your body’s internal clock when disrupted, results in feelings of depression. 
This is common among pilots and flight attendants who have disrupted day and night cycles when flying around the world. Another idea is the level of serotonin which is a chemical in the brain that affects mood.  Third are the melatonin levels which can be altered by too much light and too much darkness.

Is SAD genetic?

It does tend to occur in families.  It is also more common to women than in men. It also is more frequent in young people rather than older individuals. If there is a family history of depression, bipolar disorder, or if the person lives far north or south of the equator, SAD is more common.

Surprisingly, a low level of vitamin D is associated with SAD.  Vitamin D is produced in the skin when one is exposed to sunlight, and vitamin D boosts serotonin activity. In the winter months where there are shortened days, the levels of vitamin D go down because of lack of sunlight and serotonin metabolism is affected. The result is SAD.

What are some of the complications of SAD?

Some complications of this condition can be quite serious.  Leaving it alone without professional help might result in social withdrawal, school or work problems, drug abuse, anxiety or eating disorders and most importantly suicidal thoughts.

What is the latest on the infection front?

On another note, there is a current wave of winter respiratory viruses that will hopefully abate by the time you read this column.  If not, we are back to masking again.  Influenza types A and B lead the way with the most emergency room visits, followed by Covid19 (thanks to the JN.1 variant, a further descendant of Omicron), and of course respiratory syncytial virus (RSV).

It is really a challenge for doctors to be able to distinguish between the three respiratory conditions. They do have similar presentations. Generally, Covid patients have more fever, dry cough, and labored breathing.  The little sacs in the lungs called alveoli get inflamed and accumulate fluid locally.  No oxygen can pass through these inflamed alveoli.  In my office and in each emergency room a pulse oxygenation is obtained which should show oxygen saturation over 90%.  If it does not, you will be admitted to the hospital (not necessarily the ICU) for treatment and observation.  It is this lack of oxygen that is very concerning in the immunosuppressed, very elderly, and those with pre-exiting problems who are at greatest risk.

People with RSV and influenza have more upper respiratory symptoms, a runny nose, slight cough, and continuous sneezing.  These patients do not usually experience hypoxemia or low blood oxygen.

What is the average person to do?

If there are any questions, get tested in the hospital ER.  Home tests are good but  not  terribly accurate if you are really sick.  Don’t wait. Only call the ambulance if you are unable to walk and sit upright in an automobile.  EMS is replete with calls because patients feel that it is easier to be seen if you are delivered to the hospital by ambulance. That is not fair to the critically ill patients who must be examined at once.

Don’t forget to send your questions to me at my website www.doctorboblahita.com.  Better yet, go to Substack and find me there and see some other writings.   Go to my link: tinyurl.com/subscribetoAskDrBob.