Summertime Sadness
Everyone may experience the blues at some point. It’s normal to feel sad, gloomy, or exhausted at times. However, depression is not the same as a normal emotional phase. Depression symptoms include lack of interest in previously enjoyed activities, fatigue, detachment from loved ones, and prolonged hopelessness. These shifts in mood may begin and end with the changing of the seasons.
What is Seasonal Affective Disorder (SAD)?
Seasonal affective disorder (SAD) is a form of depression characterized by symptoms that appear at the same time each year. Many individuals feel “down” or experience the “winter blues” as the days shorten in the fall and winter but feel better in the spring when longer daylight hours return.
However, in the UAE and other Middle Eastern countries, the situation may be reversed, according to a study team from Zayed University in Dubai and King Saud University in Riyadh. According to their observations, summer SAD is more prevalent than winter SAD in equatorial nations.
What Causes Seasonal Affective Disorder (SAD)?
Studies suggest that both forms of SAD relate to altered levels of melatonin—a hormone important for maintaining the normal sleep−wake cycle. People with winter-pattern SAD produce too much melatonin, which can increase sleepiness and lead to tiredness and low energy. In contrast, people with summer-pattern SAD may have reduced melatonin levels which worsen sleep quality.
People with SAD also have reduced levels of the brain chemical serotonin, which helps regulate mood. Research suggests that sunlight affects the levels of molecules that help maintain normal serotonin levels. Shorter daylight hours – or staying inside climatized or darkened rooms during hot months – may prevent these molecules from functioning properly, contributing to decreased serotonin levels in the winter or during long indoor periods.
In summary, both serotonin and melatonin help maintain the body’s daily rhythm tied to the seasonal night-day cycle. In people with SAD, changes in serotonin and melatonin disrupt normal daily rhythms. As a result, they can no longer adjust to seasonal changes in day length, leading to sleep, mood, and behavior changes.
Vitamin D deficiency may exacerbate these problems because vitamin D is believed to promote serotonin activity. In addition to vitamin D consumed in food, the body produces vitamin D when exposed to sunlight on the skin. With less daylight in the winter or less outdoor activities during the hot summer period, people with SAD may have lower vitamin D levels, further reducing serotonin activity.
Furthermore, rising temperatures, humidity, and longer days cause changes in daily routines. Staying indoors all day, not connecting with friends at school or university, limiting outside activities like sports, and shifting bedtime, sleep, or mealtime, may all trigger depressive symptoms.
What are Symptoms of Seasonal Affective Disorder (SAD)?
SAD is a condition with symptoms lasting approximately 4-5 months of the year, if not treated. Not all people with SAD experience all of the symptoms described below.
This list is not intended to be used for self-diagnosis. If any of the symptoms listed below apply to you, consult your doctor.
Symptoms of depression can include:
- Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
- Feelings of hopelessness or pessimism
- Feelings of irritability, frustration, or restlessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, or feeling slowed down
- Difficulty concentrating, remembering, or making decisions
- Changes in sleep or appetite or unplanned weight changes
- Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
- Thoughts about death or suicide or suicide attempts
For summer-pattern SAD, additional symptoms can include:
- Trouble sleeping
- Poor appetite, leading to weight loss
- Restlessness and agitation
- Anxiety
- Aggressive behavior
Be aware:
The depression associated with SAD is not related to the calendar.
Holiday stress, as well as predictable seasonal changes in work or school schedules, family visits, and other factors, is not the same as seasonal affective disorder.
How is Seasonal Affective Disorder (SAD) Treated?
Treatments are available to support people with SAD. They fall into four main categories that can be used alone or in combination:
- Light therapy
- Vitamin D
- Psychotherapy
- Antidepressant medication
Light therapy and vitamin D are treatments for winter-pattern SAD, whereas psychotherapy and antidepressants are used to treat depression in general, including winter- and summer-pattern SAD.
However, vitamin D deficiency is a growing issue around the globe and is highest in the Middle East North Africa region. Whereas, the sun is the primary source of vitamin D, people in the Middle East, including the UAE, typically avoid sun exposure due to the high temperatures especially in the summer period. Therefore. around 90% of people in the UAE experience vitamin D deficiency, and this prevalence is continuously increasing. This, checking the vitamin D level may be reasonable also for summer depression on hot countries.
In case you or a loved one are affected by SAD, talk to a health care provider about the potential benefits and risks of different treatment options and which treatment is best for you.
