Seasonal Affective Disorder is a form of depression prompted by the time of year and relative to the amount of light present due to the change in seasons. Many of us may have heard of SAD, but may not fully understand its condition, or its counterpart, Reverse SAD.
ALE discusses both kinds of SAD and also how to help our elderly residents diagnosed with this condition.
What Does SAD Look Like?
Seasonal Affective Disorder type of depression whose onset is triggered by changes in seasons. The most common form of SAD occurs in fall through winter, but there are some cases in which the condition affects an individual in the spring/summer months. This is sometimes referred to as Reverse SAD.
In either form, there are marked changes in mood and disposition, starting out mildly with the initial stages when the season starts, and becomes more severe as the season progresses. The fall/winter manifestation resembles the more classic symptoms of depression, but the spring/summer expression presents more like a manic depressive episode.
- Irritability, trouble getting along with others
- Fatigue, lethargy, low energy
- Emotionally hypersensitive
- Change in appetite, especially craving for high carbohydrate foods
People living in regions with distinct weather changes or with limited sunlight (e.g., further up in latitude) are more likely to develop symptoms SAD. However, even in places such as California where the weather may not change as dramatically, cooler temperatures can reduce frequent visits outside, especially for elderly residents, and therefore less exposure to sunlight.
Does the Amount of Sunlight Really Make a Difference?
The reduced sun exposure can lead result in deficiencies or imbalances in the body. For example, serotonin production drops with a lack of sunlight, and this chemical imbalance causes an individual to feel depressed. The cravings for high carbohydrate foods are the body’s way of attempting to increase serotonin levels. Vitamin D also plays an important role in our health, including supporting bone health, preventatives with certain cancers & conditions, as well as help with incontinence. However, Vitamin D is also found naturally in certain foods and also via dietary supplements. Sleep patterns can also be thrown off as well, since the body’s circadian rhythms depend on regular sun exposure. The disrupted sleep prevents the resident from getting quality rest, which can result in depressive symptoms.
For individuals with Fall/Winter SAD, symptoms persist for more than two weeks.
Spring/Summer SAD (also referred to as ‘Reverse SAD’)
Out of the entire U.S. population, 4%-6% of people are affected by SAD and of that population, about 10% experience a reverse of the winter symptoms.
- Problems staying asleep, insomnia
- Poor appetite
The cause of Reverse SAD is unknown but thought to possibly result from the excessive heat, or even too much light. Whereas fall/winter SAD sufferers are more lethargic and depressed, those with spring/summer SAD tend to be more agitated and angry. The manic type of behavior presents as irritability, agitation, and restlessness. Adults with Reverse SAD are more inclined to feel suicidal as a result of the agitated mood.
What Can You do for SAD / Reverse SAD?
During the ‘active period’ when the resident is suffering from SAD symptoms, antidepressants can be helpful, especially if the condition’s pattern is known. The antidepressant regimen can begin prior to the expected onset of either winter or summer SAD to be most effective.
Light therapy is another proven effective and useful strategy for fall/winter SAD, especially for those who dislike taking medications or do not want to add to their medications list. Light therapy is also helpful for elderly or those with limited mobility who are not as able to access the outside or natural light.
For residents with executive cognitive functioning within normal range, Cognitive Behavioral Therapy (CBT) is another possible treatment as well.
Residents suffering from Reverse SAD may also benefit from staying in cooler or air-conditioned environments during the warmer months, as well as avoiding rooms or areas that are too brightly lit. If residents are outside or are in areas that may be too bright, dark sunglasses can help, especially the wrap-around type that can block out light from all angles.
Let the Team Make the Decisions
Don’t forget, any change in a resident’s individual health care plan must be approved by the team or the attending psychiatrist and/or physician before they are put in place. They or the team together will be able to determine the best course of action or treatment with the patient’s medical needs, cognitive capabilities, and other symptoms in mind.
Any care prescribed by one of the resident’s team must be communicated to the rest of the team to maintain consistency and treatment efficacy.
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