In the latest installment of our occasional conversations with Fort Worth leaders, Susan Franks, a clinical health psychologist and associate professor at the Texas College of Osteopathic Medicine, sheds light on the difference between depression and seasonal affective disorder, as well as how to identify and respond to the latter.
This conversation has been edited for length and clarity. For the unabridged version, please listen to the audio file attached to this article.
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Alexis Allison: Dr. Franks, as we approach the winter months, can you tell us about seasonal affective disorder?
Susan Franks: Seasonal affective disorder is basically a subtype of clinical depression. If you have major depression or major depressive episodes, and they only come on at a particular season, and then they dissipate or disappear once that season is over, that would then be diagnosed as seasonal affective disorder.
Some people might think of it as the ‘winter blues,’ where it hasn’t been light in a lot of days and you can’t get out and do things, so you feel almost under the weather. But it’s really more than the winter blues. It is that major depression — it’s just that it does only come on during a specific season, like either the fall or winter, which would be considered the winter pattern, or the spring or summer, which would be considered the summer pattern, which is much less frequent than the winter pattern.
But it’s not just due to a circumstance. For example, if you had some kind of seasonal work, and then in the winter, you don’t have that work, and so you just feel kind of down and out, it’s not related to that. It’s where your body is actually dysregulated during those seasonal months.
Allison: What’s happening to dysregulate the body?
Franks: They really don’t know exactly what the cause is — they have some speculation. We have a natural rhythm that prepares us for when the days start lengthening and when the days start shortening based on seasonal patterns that helps us adjust our sleep and wake cycle.
And they think that some system becomes dysregulated that’s related to that circadian rhythm, and that’s what causes some of the changes in mood and sleep and the symptoms that you might have that occur more during that specific season. For example, vitamin D regulation, melatonin regulation. Melatonin is a hormone that helps with the sleep-wake cycle. Serotonin is a neurotransmitter that is involved in mood and the sleep-wake cycle. So they think that, somehow, one of those particular systems becomes dysregulated for some people.
Allison: And who is likely to experience seasonal affective disorder?
Franks: There are some people that are more prone to it than others. It’s more common in younger adults, between 18 and 30 years old, but also more common for women. For women, sometimes it can start occurring in the teenage years, where your hormones are changing. Also, there is a genetic component. There were some studies of identical twins compared to fraternal twins, and they found out that identical twins were twice as likely to have seasonal affective disorder as fraternal twins.
But the most blatant risk factor is where people live. So people who live in the northern latitudes where there’s less sun are more likely to get it than people who live in the South. For example, people who live in Washington State are seven times more likely to have seasonal affective disorder than people who live in Florida.
Allison: What about people who live in Tarrant County?
Franks: Well, we get enough sun here, so it shouldn’t be as big of an issue. But people who already have been diagnosed with major depression, about 10-20% of those people may have the seasonal affective subtype. And it’s not very prevalent just as a subtype. So in the United States and the UK, about the highest prevalence rate they found is about 2.5% of the population at any one time might have seasonal affective disorder.
Allison: How would someone be diagnosed with seasonal affective disorder?
Franks: Well, you would start with your self-diagnosis. Because I think people are aware when, ‘Every winter, I go through depression, and then it goes away.’ So we probably start with your self-awareness. But you would need to go see a physician, certainly. You always want to start with a medical doctor to try to rule out whether or not there’s any other medical causes that you might have, or a mental health professional after that to come up with a more specific diagnosis. And they’re going to do a really thorough clinical interview, and then they may have you answer some questionnaires. But there’s just some specific symptoms that go along with depression, and then specifically with seasonal affective disorder that help them hone in on the fact that it’s SAD versus clinical depression.
Allison: And say, someone does receive a diagnosis of SAD, what would you recommend that they do? How can it be treated?
Franks: That’s the good news about it, because this particular subtype of depression tends to be pretty responsive to treatment. It kind of sounds hokey, but the recommended treatment is going to be light therapy. So they sell light boxes that you can get. It’s sort of like a fluorescent light that’s brighter than your typical light bulbs that you might have in the house. And then you sit in the vicinity of this light box, maybe for 30 minutes to two hours a day or something and at a certain time of day, and usually you’ll notice an improvement in several days, maybe up to two weeks. You’ll know whether or not that treatment is going to work.
Depending on the severity of your symptoms, or how you’re responding, you may also do some cognitive behavior therapy, which is the standard approach to the treatment of depression. Or, you may end up with being placed on an antidepressant — one that might target one of those regulating systems of neurotransmitters. So those would be the treatments.
There’s also some things that you can do just with lifestyle management that would be helpful with the disorder — maybe not cure it. Because it involves a sleep-wake cycle, we would always want patients to work on that behaviorally on their own as well. So having a very good, regular schedule. You want to train the body to wake up at a certain time and go to bed at a certain time. So you try to reset that circadian rhythm.
You’d want to exercise, particularly out in natural light. If you can improve the natural light sources in your home with windows or go out into the sun, or sit by a window or just get more natural light would be really helpful. Avoiding too much screen time for sure. Because that type of light source is counterproductive to the kind of light source that we need to help us regulate the circadian rhythm.
Allison: Is there anything else that you’d like us to know about seasonal affective disorder?
Franks: I want to just run through the symptoms of depression quickly so people will make sure they understand whether or not they’re feeling depressed. You feel sad and tearful most of the time. Particularly for men, sometimes they feel angry and irritable. Not having much pleasure or interest in activities, sleeping too much or not enough, a lack of energy, reduced or increased appetite. Maybe feeling agitated or restless, having difficulty concentrating or remembering things, feeling really slow — either in your thinking or your movements — and feelings of guilt or worthlessness. And then, when it becomes more severe, you may even be having thoughts of death or suicide. So those are the common symptoms that would help you know if you’re experiencing a major depression.
But then, for seasonal affective disorder, in the winter pattern in particular, it’s oversleeping. With the appetite disturbance, it’s overeating, and with particularly a craving for carbohydrate-rich foods. So then, of course, there’s weight gain associated with that. And then more of that social withdrawal where you’re kind of hibernating — you don’t feel like being around people.
That spring/summer pattern of seasonal affective disorder is kind of the opposite, where you have trouble sleeping, and you have a low appetite and weight loss and a restless or agitated feeling and anxiety. There have even been some reports of more violent behavior with a spring/summer pattern. So those are important to know in terms of the pattern of symptoms.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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