Seasonal Affective Disorder

Winter Depression – Description

Winter depression is one of the seasonal disturbances of emotional life (SAD = seasonal affective disorder). It occurs every year in the dark season: winter depressions begin in the autumn months and usually end in spring. During this time, sufferers complain of lack of energy and excessive sadness. They have a pronounced need for sleep and usually more appetite than usual, especially on sweets.

SAD occur much less often at other seasons – even in the summer. Some patients with SAD are not depressed but manic, meaning they are inappropriately euphoric, prone to lack of distance and overconfidence.

Not every depression in winter is a winter depression

Of course, even in winter people get sick of classic depression. Only about one in ten depression that occurs in winter is actually a true winter depression.

Winter depression is less common than other types of depression. Estimates suggest that around one to three percent of adults in Europe suffer from SAD.

As the depressive symptoms regularly appear during the winter season, winter depression is reported in the group of recurrent depressive disorders.

Women are more affected by winter depression than men. Even children and adolescents can get sick. In more southern countries, winter depression is less common. In the northern latitudes it is more common.

winter Blues

A harmless – because much weaker – form is the winter blues. Unresponsive and moody, the blues sufferers drag themselves through the dark days, but they are not really depressed. Among professionals, this milder-going form is also called subsyndromal SAD (s-SAD).

Winter depression: symptoms

The symptoms of winter depression are in some ways different from those of classic depression. Thus, people with winter depression are extremely tired to the point of drowsiness (hypersomnia). Especially in the morning, they find it difficult to get out of bed.

Another typical symptom of winter depression is an increased appetite and cravings for carbohydrates, especially sweets. Therefore, sufferers in the winter regularly gain weight. Stronger need for sleep and desire for sweets are nothing unusual in winter. Only when these needs degenerate and become a burden, a treatment is necessary.

Other symptoms of winter depression are

• shiftlessness
• General listlessness
• imbalance
• Gloomy mood
• irritability
• listlessness
• Neglecting social contacts and one’s own person

Winter depression: causes and risk factors

In the onset of depression genes, hormones but also the stress and stress processing play a role. Experts suspect the cause of the SAD, especially in the changed light conditions in winter. Depression can be the result of altered hormone production in the dark season.

Little light, a lot of melatonin

If it gets dark in the evening and less light falls in the eye, this is a signal for the pineal gland. She releases the hormone melatonin – man gets tired. In winter, the light intensity is lower overall. Therefore, more melatonin is released during the day.

In patients with winter depression, the flow of information from the visual cells in the eye to the brain is disturbed. Their visual cells are less sensitive to light than other people. If light is in short supply in winter, its brain is stimulated more strongly to production of the sleep hormone than usual in winter anyway. This could be an explanation for their severe fatigue and depressive symptoms. Because melatonin also dampens drive the mood.

Lots of melatonin, little serotonin

The neurotransmitter serotonin is most likely involved in the onset of winter depression. For the production of melatonin, the body converts serotonin – the serotonin level drops. This has an effect on the mind: Serotonin is considered a happiness hormone – it raises, among other things, the mood. Antidepressant drugs that increase the level of serotonin in the brain (SSRI = serotonin reuptake inhibitor) can improve winter depression.

If the brain is lacking serotonin, it tries to compensate for the deficiency: An overwhelming desire for sweetness comes over many people with a winter depression. Sugar and some of the ingredients in chocolate help rebuild brain cells with more serotonin.

Altered bio clock

The human body follows a biological rhythm. Above all, the sleep-wake rhythm is regulated by the light in the eye. In people with winter depression, the bio-clock is apparently obstructed: they release late melatonin, and production continues in the morning on a higher level.

Winter depression: diagnosis

For the diagnosis of winter depression, the characteristic, recurrent complaints in the dark season are crucial. The depressive symptoms occur within several winter seasons and resolve completely within 90 days.

Stronger need for sleep and sweet tooth are not uncommon in winter. Only when these needs degenerate, a treatment is necessary. Only a psychiatric specialist is able to distinguish a mild winter blues from a true depression. Therefore, you should not hesitate to visit the doctor in dull mood in the cold season. He will first of all talk to you in detail in order to be able to estimate the severity and side effects of the low mood.

With this knowledge in mind, the doctor examines you physically, under internal and neurological aspects. Blood tests, ultrasound (ultrasonography) and in rare cases magnetic resonance imaging of the head help to rule out other causes. These may be, for example, a lack of vitamin B12, dementia or hyperthyroidism (hypothyroidism). Various medications can trigger or increase depression.

An aid to the classification of the depressive complaints offer questionnaires, which are used in the outpatient clinics of psychiatric hospitals, by psychiatrists and neurologists.

Winter depression: treatment

light therapy

The main therapy option for patients with winter depression (SAD) is light therapy. The patient sits for two weeks daily before sunrise and after sunset for a maximum of one hour before a light device with about 2,500 lux. This extends the day artificially.

With a stronger light source of 10,000 lux, 30 minutes of light therapy are sufficient during the day. With their help, the mood can already lighten after a few days. By comparison, a bright sunny day can radiate up to 100,000 lux.

Medication

In particular, in severe winter depression in addition to a drug treatment is necessary. It uses drugs that are also used in other forms of depression, especially Selective Serotonin Reuptake Inhibitors (SSRIs).

Psychotherapeutic support

In addition to light and tablets, psychotherapy also helps. For example, cognitive behavioral therapy has proven itself for the treatment of winter depression.

What you can do yourself

In the dull months, the body needs as much natural daylight as it can get. This does not only apply to people with winter depression. Move a lot outdoors, such as:

• To go biking
• to jog
• Cross-country skiing or skiing
• Nordic Walking
• Long walks, especially in the morning

All lazybones should remember that even a cloudy sky is much brighter than any ordinary artificial light source. The movement in the fresh air should activate the cycle as early as possible in the first morning. Even a well-structured daily program can have a positive effect on a winter depression.

Winter depression: disease course and prognosis

Most patients with winter depression have a good prognosis, because usually a consistent treatment helps. In the spring, the improvement announces an increase in performance and an increase in activity; in the summer, those affected are symptom-free.

After the winter depression has subsided, it can seldom come to a post-fluctuation in March to May with a very upbeat mood. The transitions to manic-depressive illness are fluent here. A specialist in psychiatry can distinguish the different forms of depression.

If several seasonal depressive episodes (SADs) have already occurred, the risk of breaking down again next fall is relatively high. The return of winter depression can be effectively counteracted with antidepressive long-term therapy (prophylaxis).

Winter Depression: Prevention

One can prevent a winter depression: Experts recommend starting with a light therapy at the first depressive signs in the autumn. As with other depressions, depending on the severity of winter depression, preventative antidepressant therapy is possible. These are taken in small doses throughout the year.

Anyone who does not take a long-term preparation should try to timely notice the onset of a further decline in sentiment. If psychotherapy is started on time, it is often possible to alleviate the symptoms of winter depression in advance. For the treatment of winter depression, especially a light therapy is used. Strong exposure to light can compensate for the lack of light intensity in the dark season and inhibit melatonin secretion. In fact, light therapy is very effective in treating winter depression. It can already be started for prevention in autumn. If you are under one Seasonal Affective Disorder you should also spend as much time outdoors as possible.