Every morning I wake up in darkness and come home in darkness, day after day. Just being present is difficult. People ask me to get together, but it’s too cold and I really dislike going out of my house. I go home every day after work and go to bed, I eat in bed and spend time with my children from my bed; then I feel guilty because I didn’t spend “quality” time with my kids. Facebook is my best friend. 8 pm is my bedtime. Eating makes me happy, but I feel remorseful and “fat” for eating junk. I would love to drink or take something to escape and make me numb, but then I will feel the shame, guilt and anxiety from the relapse. I detest the holidays, and pumpkin spice makes me want to throw up. Weekends are a time to isolate and binge watch dumb shows. Family get-togethers make me so anxious I have a hard time going, and if I do I want to drink, I am mentally absent. Most of my relapses back into alcoholic drinking and drug use occurred between the months of September to December. Why do I feel this way every fall???
My doctor and therapist call it Seasonal Affective Disorder or SAD. What is this???
Its cause is unknown. But there are some things that are thought to cause it. Here are the items that my doctor and therapist suggest may cause SAD:
- Circadian rhythm: a decrease in sunlight in fall and winter may cause winter-onset SAD. The reduction in sunlight may disturb your body’s internal clock which may trigger depression.
- Serotonin levels: A decrease in serotonin (the brain neurotransmitter that affects mood) might influence SAD. Reduced sunlight can cause a drop in serotonin that may lead to feelings of depression.
- Melatonin levels: Change in seasons can also disrupt the balance of the body’s level of melatonin, which can influence sleep patterns and mood.
I also asked my doctor why I have it, after all, I am strong in my recovery for 15 years and work in the behavioral health field. I thought I would be “immune” to things like this by now. She said that there are some risk factors that may be at play. Here are the risk factors she proposed:
- Family history: many of my close relatives have depression and SAD, they said that individuals with SAD may be more likely to have relatives with SAD or another form of depression.
- Having major depression or bipolar disorder: I have never been diagnosed with bipolar disorder, but I definitely have major depression, these symptoms are thought to worsen seasonally if you have these.
- Living far from the equator: I live in at longitudinal coordinates of 44.99° N, 93.27° W, otherwise known as Minneapolis Minnesota, which feels like the North Pole this time of year! In October we get 11 hours and 40 minutes of sunlight, which quickly drops to 8 hours and 45 min by Christmastime when the sun rises at 7:50 and sets at 4:30 pm. She said that SAD appears be more common in individuals who live far north or south of the equator, which may be due to reduced sunlight during the winter and longer days during the summer months.
Although I have never had plans for suicide, it definitely has crossed my mind during these months! She said it can also cause other problems like relationship problems, school and work difficulties, relapse into substance abuse and other mental health problems like increasing anxiety and can even trigger eating disorders.
So, once I recognized the cycle, which is the first step in figuring out what to do, I went to my doctor and my therapist for a couple of thorough evaluation. I went to my doctor who did a physical exam, she found no major underlying medical concerns. After that she checked my thyroid and vitamin D3 levels. My thyroid was fine, but my vitamin D3 was very, very low. She also checked other hormones, which at 42 years old were a little off.
I then went to my therapist did a diagnostic assessment. This is an assessment that therapist does to figure out what, if any mental health diagnosis I am suffering from. She checked for signs and symptoms, asked me about my thoughts, feelings and behavior patterns. I filled out a couple of forms to check for depression, anxiety and PTSD (we already knew I had all of these diagnoses underlying). She checked her diagnostic manual, and diagnosed me with Seasonal Affective Disorder.
I then sought treatment. The treatments for this seemed to be easy and accessible. First, she suggested I do “light therapy” or “phototherapy”. This is where I sit a few feet away from a special light, which is very bright. It mimics sunlight. My therapist suggested to do it in the morning and can cause brain neurotransmitters to help lift my mood. She made a few suggestions for boxes, I purchased one on Amazon for about $20. My doctor changed my mental health medications to ones that are thought to prevent SAD symptoms. She suggested I take a Vitamin D supplement and she increased one of my medications, which she does every year from August to March to combat it. I, of course, had to see my therapist regularly. In our sessions we talked about identifying and changing negative thoughts and behaviors. We looked at healthy coping skills, like avoiding behaviors and managing stress. She also suggested I start a Meditation or Guided Imagery. She said if I found it difficult, to try a Yoga or Tai Chi class. She also thought I could try some music or art therapy or take a class of some sort. She also suggested I leave my curtains open in my home and office during the day to make it brighter and sunnier. I also picked up some outside activities to do in winter, I downhill ski and take walks outside. My doctor told me to exercise regularly to reduce stress and anxiety. When it is financially feasible, I take a trip to a sunnier place! My treatment plan isn’t so bad!
I still can have symptoms of SAD, but the biggest key in my treatment is to plan and prepare for it! I tell my coworkers that my office is going to mimic Florida! It’s warm and sunny. I make my bed every day, I find it harder to go there too early if it’s made. I make plans with friends to get out and socialize. I plan lots of weekend activities, which include at least one outside activity. I stick to my hygiene, diet and exercise routines. My husband and kids know I have this and I have garnered their support in my treatment. I avoid chaos and stressful activities by establishing safe boundaries. I make plans for social gatherings, my husband and I have a “key word”, such as “sweetie, we should check on the kids”, which really means “I am uncomfortable here, let’s go now.” When at parties or family events, I try to cook or help set up and clean up , join the kids, or engage only with safe people. Sometimes I don’t go to family gatherings, or I stay for a sort time and leave early. I realized it’s okay to detest “pumpkin spice” and egg nog. I have a “pill box” for my medications and vitamins, which I take daily. I cook at home and eat as a family as much as possible. I also see my therapist routinely. And finally, I plan at least one trip to somewhere sunny each winter during this time.
I still really dislike this time of the year, but when I am armed with a treatment and preparation plan, it makes it tolerable! I have maintained my recovery and have managed to remain active and managed my symptoms for the past few years. I suggest seeing your doctor or therapist if you think you have SAD.