Identifying Season Affective Disorder in Older Adults and Treatment
This article was reviewed by Mighty Health physician, Eric Tam, MD. Dr. Eric Tam is a board certified family physician. Having received his training at UCSF’s Family and Community medicine program, he recognizes the importance of understanding the world his patients come from. As a result, he approaches every patient with humility and deep empathy.
Approximately 1 to 5% of older adults are clinically depressed, according to the Centers for Disease Control and Prevention, though that number is higher among people who need home health care or are hospitalized. Seasonal affective disorder (SAD) is a specific type of depression. Unlike Major Depressive Disorder, which can strike at any time of year, seasonal affective disorder happens at the same time each year. In the northern hemisphere, seasonal depressive disorder typically happens during the fall and winter months. If you find yourself slipping into depression as the days become shorter, it’s worth talking to your doctor to determine if SAD may be the cause.
What Is Seasonal Affective Disorder?
Seasonal affective disorder is sometimes called “winter depression” because it tends to happen at the same time each year, usually in the winter. This corresponds with the time of year when the days become shorter and there is less daylight.
Scientists do not understand the exact causes of seasonal affective disorder. Most research suggests that it is related to changes in circadian rhythms in response to lower levels of sunlight. Getting less sunlight can affect your internal clock. This changes levels of hormones as well as brain neurotransmitters such as melatonin and serotonin. These changes lead to difficulty regulating sleep and mood symptoms.
What Are the Symptoms of Seasonal Affective Disorder?
The symptoms of seasonal affective disorder often overlap with the symptoms of Major Depressive Disorder. Some of the typical symptoms include:
Depressed mood. People with seasonal affective disorder often describe feeling sad, hopeless, or even despair. You may also notice that you have less interest in everyday activities or feel less pleasure from the activities you typically enjoy.
Fatigue. Chronic fatigue is a hallmark symptom of seasonal affective disorder. People with SAD often describe themselves as feeling drained of energy. This can mean both physical energy and mental energy. Even routine daily tasks like getting out of bed or preparing meals for yourself can feel like a burden.
Sleep disruption. Disregulated sleep is very common in seasonal affective disorder. You may notice yourself sleeping more than usual, including difficulty getting out of bed in the morning. You may also feel groggy or sleepy throughout the day.
Appetite changes. Typically, people with SAD report an increase in appetite. You may feel particular cravings for carbohydrates and comfort foods. These cravings may be linked to altered levels of brain neurotransmitters. Indulging in these comfort foods may lead to weight gain during the winter months.
Social withdrawal. Seasonal affective disorder may cause you to withdraw from your social relationships, partly because interacting with other people may feel exhausting or not pleasurable. This can worsen feelings of loneliness and social isolation.
Difficulty concentrating. Difficulty focusing is a common symptom of seasonal affective disorder. You may notice that you feel distracted, cannot solve problems as effectively, or feel mentally foggy. This can affect performance at work or in your home life.
Irritability. People with SAD often notice that they become more irritable or on edge. SAD can also make you more sensitive to everyday stressors, which puts strain on your personal relationships.
Physical symptoms. In some cases, people with seasonal affective disorder report an increase in headaches, muscle aches, stomach pain, or other aches and pains. It is unclear what causes these physical symptoms, but they are related to the mood changes you experience.
While the majority of people with seasonal affective disorder develop symptoms in the fall and winter, some people may actually get a milder form of SAD in the spring and summer. Sometimes called “summer-onset SAD,” this form of seasonal affective disorder often presents as insomnia, decreased appetite, and weight loss.
How Seasonal Affective Disorder Affects Older Adults
It’s especially important for seniors to stay aware of symptoms of seasonal affective disorder. Older adults may be at higher risk for seasonal affective disorder, possibly due to age-related changes in hormone levels or circadian rhythms. Additionally, SAD symptoms can be worse for older adults. This may be due to many older people having pre-existing chronic health problems or cognitive changes that worsen with seasonal affective disorder.
There are other factors to be aware of when considering how seasonal affective disorder affects older adults, including:
Medication interactions. Many older people take multiple prescription medications to manage various medical conditions. Treatments for seasonal affective disorder can interact with certain medications. This is true even of light therapy, which can interact with medications like lithium, antipsychotics, and certain antibiotics.
Worse sleep symptoms. Older adults naturally undergo changes in circadian rhythms and sleep patterns. SAD can make this worse, leading to chronically poor sleep.
Sensory changes. Age-related changes in vision or hearing can affect seasonal affective disorder symptoms. This is primarily due to making it more difficult to engage in activities that can improve SAD, such as reading, listening to music, or socializing.
What Is the Treatment for Seasonal Affective Disorder?
The good news is that there are several effective treatment options for seasonal affective disorder. The first step is to talk to your doctor about your symptoms to rule out another medical condition.
Light Therapy
Light therapy, or phototherapy, replaces the light that is missing from your natural environment due to shorter daylight. Typically, this involves purchasing a specialized lightbox that produces light at a specific intensity and light spectrum. This closely mimics natural sunlight. Exposure to a lightbox for 20-60 minutes in the morning can help to regulate your circadian rhythms.
Psychotherapy
Cognitive behavioral therapy, or CBT, can be particularly helpful for people dealing with symptoms of seasonal affective disorder. The goal of CBT is to help you identify thought patterns and behaviors that are keeping you stuck and may be making depressive symptoms worse. A psychotherapist with expertise in SAD can help you develop healthier coping strategies to deal with your symptoms.
Medication
For some people, an antidepressant medication may be prescribed to manage seasonal affective disorder symptoms. Most often, these medications are selective serotonin reuptake inhibitors, or SSRIs, which increase the availability of serotonin in the brain.
Dawn Simulators
While not exactly like light therapy, a dawn simulator gradually increases light levels in your bedroom over the course of the morning. The goal is to mimic a natural sunrise, which can help you feel more alert and get out of bed on time.
Vitamin D
Vitamin D is sometimes called the “sunshine vitamin,” because our bodies produce it in response to sunlight. Particularly for people in more northerly latitudes, vitamin D deficiency is common. Ask your doctor to check your vitamin D levels. Taking a vitamin D supplement can help you make sure you get enough.
Proactive Self Care Strategies for Seasonal Affective Disorder
In addition to light therapy, medications, or psychotherapy for seasonal affective disorder, there are a variety of self care strategies that can help. Consider some of the following approaches for coping with SAD symptoms:
Regular physical activity. Moving your body every day can help to regulate your mood and promote better sleep patterns.
Outdoor activities. Getting outside each day during the daylight hours can help to combat symptoms of SAD. Even if it is cloudy or overcast, exposure to natural light will help.
Consistent sleep schedule. As hard as it can be, maintaining a regular sleep schedule is important for managing SAD symptoms. Set a standard bedtime and wake-up time each morning – including weekends – to keep your circadian rhythms on track.
Social support. Engaging in social activities can help to combat feelings of isolation that often occur in people with SAD. Even if you don’t feel like going to an event or talking to a friend, reminding yourself that it will make you feel better can be helpful.
Mind-body techniques. Practicing meditation, yoga, tai chi, or relaxation exercises are a great way to combat stress and boost your mood.
More Health Guidance for Those Over 50
No matter the time of year, Mighty Health is here to join you on your personal journey to better health and aging. We encourage all of our Mighty Health family members to stay vigilant about the signs and symptoms of seasonal affective disorder. Regular exercise, a healthful diet, and social interaction with your in-person or online community can help to combat symptoms of seasonal affective disorder. Your personal health coach can give you specific recommendations to keep you on a path of balanced physical and mental health.