If you experience the same symptoms every year with the change of season, this could point to Seasonal Affective Disorder (SAD). Sandy enlightens that it is now known as Major Depressive Disorder with Seasonal Patterns according to the DSM 5 - The Diagnostic Manual of Mental Disorders as published by the American Psychiatric Association. “In addition, according to the DSM 5, it is considered to be a subtype of Bipolar Mood Disorder, known as Bipolar Mood Disorder with Seasonal Pattern.
Essentially, these refer to the change in seasons that creates environmental triggers for mood switches in the brain and can result in the onset of a major depressive episode, a bipolar episode (either depression or mania) or the recurrence of such episodes, according to the National Institute of Health in the USA.” And she explains that in order to be diagnosed with a disorder with seasonal patterns, the episode of illness should recur at exactly the same time, coinciding with the change in seasons, for at least two years.
Glamour: What are the symptoms?
Sandy Lewis: At the onset of autumn moving into winter, one could expect symptoms of depression to emerge. To be classified as depression, the symptoms need to continue unabated for a period of two weeks consecutively.
Symptoms may include:
● depressed mood - feelings of sadness, emptiness and hopelessness
● loss of interest and pleasure in usual activities
● being overly and inappropriately sensitive to rejection
● weight gain, in many cases
● appetite changes with a craving for carbohydrates, mostly
● changes in sleeping patterns, mostly excessive sleeping
● loss of libido
● agitated, jerky movements or very slow and heavy movements
● feeling as though your body, especially your arms and legs, are weighed down and leaden
● brain fog with difficulty concentrating
● constant fatigue
● feeling worthless, like a burden with excessive and inappropriate guilt
● being preoccupied with thoughts of death and suicide
During spring and summer, one can expect symptoms of mania to emerge in the case of bipolar mood disorder in which there are BOTH extreme mood swings from the darkness of depression to the elevated, expansive and irritable feelings and behaviours that are indicative of mania.
These symptoms, if they persist unbroken for a week, constitute a manic episode:
● feeling very happy, elated or overjoyed
● talking very quickly
● feeling full of energy
● excessive libido with sexual acting out/increased, often risky, sexual behaviour
● feeling self-important
● feeling full of great new ideas and having important plans
● taking unusual risks without thought of the consequences
● acting more impulsively than usual
● being easily distracted
● being delusional, having hallucinations and disturbed or illogical thinking
Glamour: What are some of the risk factors?
SL: People who already have been known to be vulnerable to mood disorders are particularly at risk. This is because seasonal changes alter brain chemistry. In winter, it is the lack of light that causes the problem, the brain produces more melatonin and less serotonin, which can result in the symptoms of depression emerging. In spring and summer, it is the opposite - the increased light reduces melatonin and increases serotonin to the point of inducing mania in some people. So, anyone with known delicate brain chemistry and a history of mood disorder is at risk. In winter, people very far from the equator are most at risk, and in summer those very close to the equator are. It is important to remember that it is the change in the number of hours of light per day that is the crucial factor here, not the temperature outside. In fact, cooler weather is better for mental health than very hot weather (according to the National Institute for Mental Health, USA).
Glamour: How can one manage it?
SL: There are five ways to manage these disorders with seasonal patterns:
● With psychotherapy, to address lifestyle and relationship issues and to build up a support network. Very importantly, to reinforce constructive coping skills in the whole system and encourage self-care and self-compassion as priorities. Education is part of this, since more knowledge allows for greater empowerment in understanding and coping with the areas of challenge and struggle. Knowledge also builds empathy and compassion for those who are suffering in these times of transition. When we know the person is ill, this decreases the tendency to minimise, judge and stigmatise.
● With light therapy, also known as phototherapy, to recreate a more even exposure to light on a daily basis, on the referral of a mental health professional. Phototherapy involves sitting in front of a specially created light box for a period of time each day.
● With increased exposure to light, which means being outdoors as much as possible when there is natural light (sunlight), although indoor lighting can also work.
● With medication, to balance the brain chemistry that goes off kilter with the environmental changes.
● Mind-body therapies like massage, yoga, meditation, and guided visualisation can be powerful interventions as well, encouraging healing at the nexus of mind and body (for example, visualising light can have an effect in the brain).
All of these should be administered by, or at least be on referral by, a qualified mental health professional who understands the shifting patterns of neurotransmission in the brain - we cannot afford a trial-and-error approach from a non-qualified person, as suicide can and does result from these disorders. It has been shown through research that suicidal behaviour increases during seasonal changes, significantly so for those with bipolar disorder. (Olin Centre for Neuropsychiatry, Hartford, CT).
Glamour: Are there ways to prevent it especially if you experience it at the same time every year?
SL: Complete prevention may not be possible since we know that this disorder emanates from changes in the brain that we cannot control. The deeper areas of the brain like the hypothalamus and the cerebellum may react to seasonal change even before we are fully aware and conscious of this happening. However, it is most helpful to anticipate that you may experience an episode of depression or mania and prepare yourself and the people around you for it. Then, if or when it happens, you are not in a space of shock or denial, but prepared to go immediately into compassionate action mode to address the symptoms that emerge in a constructive way, to seek immediate help, get treatment and make the necessary lifestyle changes required to ride out the episode.
It is so important to accept and work with a change in your health status, rather than resist it. In fact, the calmer you are and the more equanimity you can bring to the situation, the milder your symptoms are likely to be. If you are very sensitive to seasonal change and you know you are likely to struggle, then the moment you can feel the symptoms creeping up on you, the quicker you can put action plans in place to mitigate them. Having a plan in place before the episode hits is very empowering for everyone involved. Again, acceptance is key. Work with the changes, not against them, even if you don't like or want them. We can't change reality, our best course is to flow with, lean into, and work with, not against, the experiences we are having.
Glamour: When should one be concerned?
SL: Any episode of mental illness is very serious and should create concern. Mood disorders bring great suffering, they impact functioning in a very significant way, and they are potentially fatal. Bipolar disorder and suicide are strongly linked, particularly in the depressive phase. As soon as symptoms look like they are overwhelming the capacity of the person and their support system to cope, emergency medical treatment must be sought. In some instances, hospitalisation may be required. What we are talking about here is not just "winter blues" or "spring fever". We are talking about very serious medical conditions, and once the two weeks for diagnosing a depression episode or the one week for diagnosing a mania have passed, then medical treatment must be sought urgently. There is very definitely cause for concern once a disorder of the mind has been diagnosed clinically.
Glamour: What type of help or support is available?
SL: It would be my suggestion that any individual who suffers from a mental disorder with seasonal patterns should have a treating doctor (a psychiatrist), a psychotherapist or counsellor, and a professional person who is able to offer light therapy if the doctor deems it necessary. If you don't have any of these available to you, please contact the Netcare Akeso helpline on 086 143 5787 or [email protected] and they will refer you. The South African Depression and Anxiety Group (SADAG) are also available to assist on 0800 205 026 or 011 234 4837 or visit www.sadag.org for further contact information.
Glamour: Can it worsen if not attended to?
SL: Yes, it can as this is usually part of a larger disorder and it is important to know that mood disorders, like all disorders of the brain and nervous system, are serious, chronic, and potentially fatal.
Glamour: Please add any information you may deem necessary?
SL: An interesting point to make might be to share that researchers can show how our brains would have developed this sensitivity to seasonal change as a survival mechanism during our evolution. So, what started out as adaptation to ensure the human species could cope with and live through extreme changes in weather and light, later became disorders in certain vulnerable individuals. The causation is definitely in the brain, and it is not a matter of ‘seeking attention’, ‘copping out’, ‘acting out’ or ‘making it up’. People who fail to realise how serious these mental health difficulties are, sometimes say misguided things like ‘pull yourself together, other people are coping with this’, however that is a very dangerous message to someone with a mental disorder.
Sandy’s Top 5 tips for managing seasonal depression or mania
● Don't minimise the seriousness of these illnesses
● Have a mental health treatment team in place, and if you don't have one, ensure you know how to find one quickly
● Read and learn as much as you can on this subject and share it with all the important people in your life (including your workplace)
● Have your own action plan in place for if you should become ill and especially remember the five-point management plan described above
● Don't panic, be extremely self-compassionate for the duration of the episode and know that it will pass if you take excellent care of yourself through the steps suggested, and ask for help (with no shame) from people trained to assist you if you are not coping.
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