'Tis the Season to Be... Melancholy?

It is certainly one of the cruelest of ironies: At a time when everyone is supposedly full of laughter and good cheer, some of us instead experience a depression that comes as regularly and predictably as Black Friday, but lasts much longer. Sadness eventually departs, but often not until spring. Some call it the holiday blues. In medicine, it’s referred to as Seasonal Affective Disorder (SAD). But whatever you call it, it’s an unwelcome holiday visitor.

Bah, humbug!

Precisely speaking, SAD is defined as major episodes of depression that occur regularly at particular times of the year. They may have begun as early as adolescence. Everyone has mood swings, but in SAD it is true depression and it happens far more often in the fall and winter. It is like the usual form of depression in some ways, but people with SAD also experience irritability, significant fatigue, an increased appetite (particularly for sweets) and weight gain. In contrast, people with the usual form of depression lose the ability to feel pleasure, have decreased appetite and weight loss and suffer from insomnia and feelings of guilt. They feel slowed down rather than irritable.

Even if you are sad, you probably don’t have SAD. Around one to five people out of 100 suffer from SAD. It usually starts in one’s 20s, although it can occur in children, and it is almost three times more common in women than in men. Other medical conditions like hypothyroidism can mimic SAD.

One of the most difficult things for people to handle when it comes to mental disturbances is that it’s hard to see how anything physical could be involved. By extension, it’s hard to see how a doctor could treat it, other than just giving drugs that paralyze the mind. This kind of thinking is probably left over from the time when mental illnesses were shameful. Families kept them hidden. People with severe mental illnesses were sent off to insane asylums.

Orchestrating Good Cheer

In fact, the origins and rhythms of mood are quite physical. All neurons in the brain are organized into specific groups with specialized functions. Some of these neurons control our moods: they wake us up in the morning, get us energized to start the day, allow us to feel pleasure, slow us down at night and put us to sleep. These daily rhythms are called circadian rhythms and one group of neurons sets this rhythm for the body. These neurons are like the conductor of an orchestra. Other groups of neurons change our moods by secreting chemicals called neurotransmitters that activate waking, breathing, heart rate, pleasure, etc. These neurons are the members of the orchestra, taking their cues from the conductor so that they play in synchrony. To make sure one wakes at dawn, the conductor neurons are connected to the eyes so that they can sense light.

In SAD, it seems there is a malfunction in the conductor, so the connection between light and mood becomes out of synch. It’s worst in the winter because people see less daylight; days are shorter and people are mostly indoors. When things are out of synch, the orchestra doesn’t secrete its neurotransmitters properly, leading to depression.

Having some idea about how this system operates has allowed us to develop treatments for SAD. In addition to the antidepressants used to get neurotransmitters back in balance, we can also try to get the conductor back in the groove. This can be done with bright light therapy, applied early in the morning. Although these two are the mainstays of therapy, exercise and (in some cases) psychotherapy may also be used. It is important to monitor nutrition. Vitamin D supplementation has also shown benefit.

So, if you think you may be SAD, you should know that this is a real disorder; it’s not just all in your head. However, there are other things that could be going on. Your doctor will be the best person to make the diagnosis and begin the appropriate treatment to get you back on the road to being glad.

May your holiday season be filled with laughter and good cheer.