Winter Blues: Seasonal Affective Disorder and Addiction.
By Elizabeth Ossip, LCSW, CAP, ICADC
Seasonal Affective Disorder, or SAD, is a form of depression that occurs seasonally, most often during the winter months, and is linked to shortened exposure to daylight, maladaptive circadian rhythms, etc., production of serotonin in the brain. People with Winter Pattern SAD become depressed with the changing seasons in the fall or winter and experience depression and low energy, hypersomnia, overeating, weight gain, craving for carbohydrates, and social withdrawal. Much fewer people experience Summer SAD, including poor appetite with associated weight loss, insomnia, agitation, restlessness, anxiety, and episodes of violent behavior. Women are four times more likely to suffer from SAD than men (citation). Other risk factors include living in areas far from the equator, having a history of depression or bipolar disorder, having a family member with depression, and being a young adult, teen or child. There also seems to be a possible link to the overproduction of melatonin and a deficiency of vitamin D.
To have a diagnosis of SAD, you must have a seasonally cyclical depression for at least two years that is more frequent than non-seasonal depression and also meets the criteria for Major Depressive Disorder, which includes at least five of these symptoms: feeling depressed most of the day, nearly every day, feeling hopeless or worthless, having low energy, losing interest in activities you once enjoyed, having problems with sleep, experiencing changes in your appetite or weight, feeling sluggish or agitated, having difficulty concentrating and having frequent thoughts of death or suicide.
The connection between depression and addiction has been long known and well documented. People with depression will often turn to alcohol or drugs to relieve their depression or as an escape. Alcohol and other drugs can act as a depressant and cause or increase depressive symptoms to become a vicious cycle. According to the National Institute on Drug Abuse (NIDA), people with a mood or anxiety disorder are almost twice as likely to suffer from a substance use disorder. If you experience SAD, it is important to get treatment and avoid drugs and alcohol as a means of self-medicating. If you use substances and develop SAD or another form of depression, treatment becomes even more imperative.
Because of its cyclical nature, SAD may be more difficult to diagnose and detect. If there is a co-occurring substance use disorder, this may appear to cycle as well, giving the person and their loved ones the impression that the condition is getting better, only to have it return with the change of seasons. Keeping a mood diary or journal may be a helpful tool in recognizing SAD, recording the ups and downs of the seasons, and reporting this to your therapist and psychiatrist.
There are effective treatments for SAD. Anti-depressant medications are one course of treatment. Light therapy is equally effective as an anti-depressant. (Am J Psychiatry 163:5, May 2006.) In light therapy, the person is exposed to a full spectrum bright artificial light to replace the lessening natural light during the fall and winter months. SSRIs and other types of antidepressants are also first-line therapy with positive results, though these pose more risk than light therapy due to side effects. Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is also advantageous, and a modified form of CBT has been developed specifically to address the nuances of SAD. Some studies indicate that vitamin D supplementation may have some benefits, though this is not conclusive. When combined with substance abuse treatment concurrently, these treatments can help overcome SAD, and the substance use disorder can be more successfully addressed. However, if one is ignored and left untreated, there will likely be minimal progress for both disorders, and relapse often will occur.
As stated before, proper diagnosis and early treatment are crucial to recovery. Many times people get treatment for a substance use disorder. Still, the underlying SAD or other depression is overlooked or misdiagnosed, and with a recurrence of the depression comes a relapse of the substance use disorder. Working with a team of knowledgeable professionals and being open and frank, as well as observant about your symptoms, can help pinpoint an exact diagnosis and help you on the road to recovery.