KOCHI: Last week, during an online video consultation with my patient ‘S’ from the UK who has been undergoing treatment for depressive disorder with mood swings, I recognised that she was in a helpless state. “S” is in her thirties and has been doing well with a combination of medication and counselling. However, during our follow-up call, she expressed considerable distress.
She shared that she had been experiencing episodes of uncontrollable anger directed towards her husband, accompanied by feelings of fatigue, low energy, and a complete disinterest in work, social life, and even leaving the house. She reported oversleeping and struggling to engage with life, including interactions with her husband and their five-year-old daughter.
During the session, I tried to identify any new stressors or changes in her family, work, or social environment, but nothing seemed to stand out. However, one factor lingered in my mind, the shortening of daylight hours as winter set in in the UK, where my patient resides.
This shift in the seasons, particularly the reduced sunlight, stood out as a potential contributor to her current slump. This deepening depression might have been due to the co-morbid Seasonal Affective Disorder (SAD), which diagnostic classifications label now as recurrent depressive disorder with seasonal patterns.
The worldwide prevalence of SAD is 10 per cent. Regional prevalence depends on latitude. The rate is higher in regions distant from the equator. As per statistics, in the UK 20 per cent experience its milder form called ‘winter blues’ whereas 2 per cent experience SAD. In the US 5% experience SAD (1 per cent in Florida and 9 per cent in Alaska). In Canada 15 per cent experience winter blues and two to six per cent SAD. SAD is found to be more prevalent in those aged 18 to 30 and that too in women (3:1).
Though SAD is commonly observed in regions with harsh winters, such as North America and Europe, it can also affect those living in predominantly sunny climates like the Middle East. These shifts often manifest as new episodes or as relapses in individuals being treated for Bipolar Mood Disorder.
SAD has been observed in populations in the Middle East, including northern regions of Turkiye, Iraq, and parts of Iran. While latitude plays a significant role, a person’s history and family history of SAD also increases the risk of developing the disorder. SAD is often comorbid with other conditions, including major depressive disorder, generalised anxiety disorder, panic disorder, and sleep disturbances such as insomnia and hypersomnia.
Management of SAD
Once diagnosed, management of SAD involves a combination of approaches. Light therapy, using artificial light at 10.000 lux for a week (tailored to individual needs), is a cornerstone of treatment. Antidepressant medications, as well as supplements like tryptophan and melatonin, can also be beneficial. Vitamin D supplementation, particularly in cases of deficiency, is important as it plays a role in regulating mood, modulating serotonin, supporting circadian rhythms, and reducing inflammation.
In addition to these medical interventions, counselling such as Cognitive Behavioural Therapy (CBT) has been shown to be effective. Lifestyle modifications and self-care strategies, such as maintaining an active lifestyle, exercising regularly, seeking social support, ensuring good sleep, socialising, and adhering to a healthy diet, are all crucial in managing SAD and improving overall well-being.
Mind and body
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The author is a consultant in psychiatry and behavioural medicine, KIMSHEALTH Trivandrum