Ioana Weber

PhD Student, AG Tarabyin, Charité Medical Neurosciences

Every year, as the month of October draws near, I start feeling my thoughts getting cloudy, instead of my head being up there instead. I wake up to the gloomy Berlin mornings, and I feel as if my mind is filled with an amorphous gray fuzz that drowns away most of my usual hubbub of thoughts. This may sound like the description of peaceful meditation, but, like many other people around this time of the year, I am actually getting a bout of seasonal affective disorder.

The Cloudy Mind

The “brain fuzz” is problematic because it reminds me too much of a time when I flew into the heart of a cloud with my father and his motorized glider: it’s as if I wade around in a mass of oppressive bright light, surrounded by an eerie silence that forces me into mental passivity, with just the occasional thought fragment flying through my consciousness. The more I linger, the deeper I sink into this fog of passivity and small thought fragments. Sooner or later, the thought fragments take a turn towards hopelessness and undermining my sense of self-worth. It’s a good day if I realize that I am slipping down this downward spiral, and can still muster up energy to take logical steps for anchoring myself in objectivity, but, most often, it is already too late. Immediately upon waking up, I feel that merely existing is exhausting, and the only wish I can come up with is to sleep until I feel more like myself. Lingering in bed, which I hardly ever do in spring and summer, suddenly becomes the only notion I can conceive of. As the dark season begins, activities that usually bring my mind to effervescence, such as reading about neuroscience, creating art or meeting friends, start feeling pointless, and even my otherwise very strong sense of duty takes a dip.

Many SAD Faces

Seasonal affective disorder (SAD), also known as seasonal depression or seasonal mood disorder, affects as much as 10% of the population in territories at higher latitudes, such as Alaska or even the Netherlands  [3], and 0.5 to 3% of the general population of the US [1]. Like me, the vast majority of these people start exhibiting symptoms of depression [2] when seasons change. This happens most frequently with the waning of daylight in autumn (fall and winter SAD), but, for 10% of cases in the US and Europe, it is the coming of summer that brings the blues (spring and summer SAD)[3]. For both groups, a feeling of sadness or hopelessness, lack of drive even for activities that are normally enjoyable, and changes in sleep and eating patterns are the classical signs to look out for. However, not everyone oversleeps: some SAD patients report feeling rather agitated, particularly the group with summer SAD. In contrast to that, most people suffering from winter SAD find themselves oversleeping and overeating, craving carbohydrate-rich foods in particular [1]. I know this all too well, as no junk food is safe from me during the winter months. Eating bar after bar of chocolate is my desperate attempt to get at least that tiny hit of the endorphins that are so painfully eluding me during the dark months. Then, since we live in a society that is obsessed with looks, I start considering how this will impact my physique, which only leads to more guilty and sad thoughts. So I am one of the many cases where SAD brings on depressive symptoms. People who live with bipolar disorder are at an even higher risk of developing SAD (prevalence in this group of reaches 15-22% [6]), which causes a seasonal appearance or worsening of bipolar mood swings.

Why Do We Get SAD?

Preventing and Treating SAD

If you think I sound like a bear gobbling up food and setting up for hibernation, you are not far from the theories that attempt to explain these seasonal changes in affect. Some researchers claim that being sluggish in winter was an evolutionary advantage for our ancestors, as food was scarce in winter and going out to explore too far in the cold may have been more risky than it was worth. In current times, however, people without the energy levels to pursue their regular occupations are not at an advantage any more. The usual work hours that are expected of us or we would like to put in don’t always match up with what our bodies perceive to be the start of the day. More precisely, the phase-shift hypothesis states that, in SAD patients, the late winter dawns cause the circadian rhythm to lag behind the clock hours and the sleep/wake cycle, and that this makes us woozy and triggers low affect [7]. Such disruptions were found in many SAD patients, even though the source of the disruption is not entirely clear. What is clear, though, is that when the sleep-wake cycle can not be matched to the daylight hours, this impacts mood, in ways similar to jet lag. The consequence are thought to be changes in dopamine and melatonin production, in close interplay with serotonin [1]. In addition to this, a female gender, and some personality traits, such as neuroticism, avoidance-based coping strategies and agreeableness, have been found to increase the risk of seasonal mood dips [4].

Surprisingly, for many people with SAD, the therapy is (no pun intended) light. Daylight-imitating devices such as lightboxes are thought to normalize the production of melatonin and thereby improve the sleep-wake-cycle offset that can occur in the dark months, reducing depressive symptoms. Therefore, the recommendation for SAD patients is to spend from half an hour to an hour a day in front of these devices, but also, in general, to live and work in well-lit rooms. For many people, the combination between light therapy and physical exercise (30 minutes of aerobic exercise a day) is enough to counter the winter blues. For the patients that do not respond to this sufficiently, the therapies that ameliorate major depression also help with SAD: antidepressants, talk therapy and mind-body connection techniques, such as relaxation techniques, meditation or art therapy [5]. If one can afford to, another idea is to take an extended winter vacation to a country with plenty of sunshine. However, one shoulod also avoid overexertion when traveling, which includes too much jet lag…so save that ticket to Polynesia for another time.

You Yourself Draw the Line

When does the time come to get help? Some years ago, when I first told my former GP about my seasonal mood dips, he cheerfully told me that it is normal, and that everyone tends to feel more tired and down at the onset of fall and winter. After this, I was, for a long time, discouraged to get any other opinion on the matter, feeling as though I was just complaining too much compared to everyone else, who managed to go through their day-by-day activities without being too bothered by the winter tiredness. However, once I started lab work for my Master’s thesis and then my PhD, I could not just eschew energy-demanding activities from October to February, like I used to when I was a student. The result was that, over the past few years, my symptoms became more intense and tended to spill over further into the year. I decided for myself that this was not the life I wanted to lead, so, last year, I finally saw a psychiatrist who diagnosed me, and I started talk therapy. In addition to this, I opted for antidepressants. A life without them would surely be possible, but I decided that I want to live my life to the fullest, and, for me, that includes having enough energy from dusk to dawn to do the work I love, craft and meet the wonderful people that my life has been graced with – any time of the year.

[1] https://bit.ly/2G36r1U
[2] https://bit.ly/2dtR2WN
[3] Nolen-Hoeksema, S. Abnormal Psychology (6th ed.), 2014.
[4] Oginska, Oginska-Bruchal, Chronobiol Int, 2014
[5] https://mayocl.in/2mCi9VZ
[6] Roecklein KA et al., Curr Psychiatr. 2010 Feb; 9(2): 42–54.
[7] Lewy AJ et al., PNAS, 2006, 103(19):7414-9

Originally published in Charité Neurscience Newsletter, Spring 2019, Vol. 12, Issue 1