Dr Tina Bhat
The seasonal change brings with it shifts in temperature, sunlight, shrinking day light hours, climate effects etc. As the seasons evolve, so can our cognitive health. There are several scientific studies that confirm a significant association between weather and psychological wellbeing of the individuals. This phenomenon is often called as ‘weather reactivity’ or ‘meteosensitivity’. The transition from autumn to winter with changes in sunlight and temperature stresses the immune system disrupting sleep wakeup rhythm and can cause a general feeling of fatigue. During such seasonal transition, the body may experience a number of symptoms due to psychological adaptation to the transitory phase. Also, it has been realised that seasonal changes in human mood are probably endogenous i.e they are a part of our physiology. Although individual differences exist in sensitivity to climate changes, it is widely observed that Seasonal affective disorder affects millions of people every year especially women and children.
Diagnostic Symptoms
As discussed, seasonal affective disorder is regarded as a category of depression that is uniquely recognized by its repeating seasonal occurrences, with symptoms of sadness, anxiety, irritability, decreased activity, discomfort at work, social withdrawal, changes in appetite and sleep, lack of concentration, excessive eating especially craving for carbohydrates, lethargic attitude etc. However, this disorder tends to be ignored and casually written off as just being “sad” or “not feeling well.” It however can impact not only a patient’s mood, but his/her daily performance and function.
In light of the above discussion, the differential diagnoses for seasonal affective disorder include the following:
Major depressive disorder: Such symptoms include persistent sadness, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and suicidal ideation. However, a comprehensive assessment is necessary to differentiate between seasonal affective disorder and major depressive disorder.
Bipolar disorder: Some patients with bipolar disorder may experience seasonal mood changes, similar to seasonal affective disorder. However, bipolar disorder is characterized by distinct manic or hypomanic episodes alternating with depressive episodes, whereas SAD typically lacks manic or hypomanic features.
Adjustment disorder with depressed mood: Stressors related to seasonal changes, such as weather alteration, job loss or relationship issues can trigger depressive symptoms resembling those of SAD. However, the onset and duration of symptoms in adjustment disorder are directly related to identifiable stressors and usually resolve when the stressor is removed or the individual adapts.
Persistent depressive disorder (dysthymia): Persistent depressive disorder involves chronic depressive symptoms. It’s a continuous form of anxiety that doesn’t fully resolve. However, patients with such symptoms may not exhibit a clear seasonal pattern.
Generalized anxiety disorder: While anxiety disorders primarily manifest with symptoms of excessive worry, patients with such disorders may also experience symptoms of depression, such as sleep disturbances, fatigue, and difficulty concentrating. Differentiating among seasonal affective disorder generalised anxiety disorder requires a thorough assessment of mood and anxiety symptoms.
Substance use disorders: Substance abuse, particularly alcohol and sedative-hypnotic medications, can lead to symptoms resembling depression, including changes in mood, sleep disturbances, and decreased energy. Substance-induced depressive symptoms should be considered, especially if a history of substance use or dependence is documented.
Other medical conditions: Certain medical conditions, such as hypothyroidism, vitamin deficiencies, or chronic illnesses, can present with depressive symptoms that fluctuate seasonally. A comprehensive medical evaluation is essential to rule out underlying medical causes of mood disturbances.
Other psychiatric disorders: Various psychiatric disorders, including eating disorders, psychotic disorders, and personality disorders, may present with depressive symptoms. A comprehensive psychiatric assessment is necessary to identify and differentiate these conditions from seasonal affective disorder.
Treatment and Management
When people find difficult to cope up with the mood swings, excessive fatigue etc. due to weather changes, they often seek professional help from the physicians but the fact of the matter is that doctors often fail to diagnose the exact cause of such disorder either due to inability to gather the appropriate medical history or inappropriate knowledge about the seasonal affective disorder. Failure to understand the cause may also be due the inability to conduct the appropriate diagnostic interviews.
The effective management of SAD lies in acknowledging its unique impact on the change of weather conditions impacting the cognitive health of the individuals eduring the fall and winter months due to decreased sunlight. Early intervention is critical, which can significantly mitigate symptoms before they fully develop. Understanding the potential pitfalls and/or overlooking SAD in patients with non-seasonal mood disorders, is essential for healthcare professionals.
Clinical management for SAD encompass several key points for effective management mentioned as follows:
Light therapy: It enables to regulate circadian rhythms and improve mood. It also enhances mood, cognition, learning, memory, and numerous physiological processes.
Physical exercise which has been shown to alleviate symptoms of depression and boost serotonin levels, helping counteract the effects of SAD.
Vitamin D supplementation: Patients with seasonal affective disorder may benefit from optimizing their vitamin D levels, particularly in regions with limited sunlight exposure during colder months
Social Support and Connections: Maintaining social connections can be crucial in handling seasonal depression. Meeting with friends, family or joining support groups can help to fight feelings of isolation and loneliness. Being connected with family and friends enanle to keep a sense of normality and togetherness in life, by using video calling, messaging, and social media.
Psychoeducation: Educating patients about the importance of recognizing early symptoms of seasonal affective disorder and seeking timely treatment to prevent exacerbation of depressive episodes.
Psychotherapy: Cognitive-behavioral therapy plays a vital role in managing symptoms of such disorder by addressing maladaptive thought patterns and behaviors contributing to depression. Specifically adapted for individuals and focuses on challenging negative seasonal-related thoughts and implementing behavioral activation techniques.
Balanced Meals: Intake of nutritious diet with plenty of fresh fruits, vegetables, carbohydrates and fatty acids is important to help improve mood and overall wellbeing.
Mindfulness and stress reduction techniques: Encouraging the practice of mindfulness-based stress reduction techniques or relaxation exercises to help manage stress and improve coping skills.
Seeking Professional Advice: In case when feelings of anxiety persist resulting into more personalized and in-depth support through counselling to develop coping mechanisms, talk therapy, cognitive-behavioural therapy, mindfulness etc.
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