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Jasmine is 35 years old and recently was seen for intake at a private psychology practice. She appeared sad and sat quietly in the waiting room. When she was interviewed she reported that she had been feeling more and more down and lethargic since late August. She was tearful during the discussion and reported that she could see no reason why she was feeling so bad. She had not experienced any recent losses and was in good health. She was sleeping much more than usual which had resulted in being late to work several times too many. As she talked about her history it became clear that she had been long aware that she did not like the end of summer and the beginning of fall. She especially did not like the winter. In fact, she had been considering a transfer to California just to get away from the long, hard cold months in New England.
As she thought more about it, she realized that she had usually felt pretty depressed as the winter went on and would feel better as the spring started. Two years ago she had a bad depression in the winter and last year was even worse. She had considered seeking professional help but somehow was able to make it through the winter. When the spring bulbs came up she felt great again and forgot about getting treatment. But this year was just the worst ever. It had been cold and overcast a good deal during the fall, making it seem to Jasmine that the days were even shorter than usual for the time of year. After the clock change with the end of daylight savings time she "crashed" - fell into a "real depression" that wouldn't let up. She found the nights to be especially depressing and couldn't seem to get enough sleep to relieve her fatigue. Her appetite was up but her libido was down. She could barely get out of bed in the morning and was falling behind at work.
Jasmine was diagnosed with major depression, recurrent with seasonal pattern. This is often called Seasonal Affective Disorder (SAD). In the sleep clinic this time of year it is not uncommon to see patients who have developed a sleep problem, such as oversleeping with unrelenting fatigue, as the fall started. When questioned further they often note that they have also been experiencing symptoms of depression as well. In mental health clinics, patients often present at this time of year with depression - and also with sleeping difficulties that turn out to be seasonal in nature.
Certain sleep disorders are related to circadian rhythm problems such as the delayed sleep phase syndrome in which people can't get to sleep until hours after most other people have gone to bed for the night and then can't get themselves up until hours after most other people are out of bed and going on with their day. SAD patients are sensitive to the changes in the length of daylight as the seasons progress and experience a full blown major depression as a result. These patients often crave carbohydrates, may gain weight, are fatigued, feel anxious, have difficulty concentrating, and may sleep more than usual. Also of concern is a condition known as subsyndromal seasonal depression or the "winter doldrums". People with this condition do not meet the criteria for full major depression, a very serious psychiatric disorder, but do experience difficulty getting up in the morning, food CRAVINGS, and fatigue. It is estimated that three times as many people experience the winter doldrums as have SAD. Indeed for those of us in the northern latitudes, it is not uncommon to have a case of "cabin fever" by the time March finally rolls around.
Short of relocating to a place closer to the equator - a nice possibility if it works for you, what can be done to cope with SAD, with the winter doldrums, or with cabin fever? As it turns out, similar treatments can work for all of these and I will discuss them in the next post.
