Estimated reading time: 4 minutes
Revati’s Story
Revati* is a 59-year-old mother of a first-generation Indian immigrant, Raghav, who lives in the Twin Cities (Minneapolis-St. Paul), Minnesota. She is a widow and a retired teacher from India who has been living with her son and his family in the US for the past three years.
Every year, from about November until April or May, Revati feels rather sad, does not want to meet anyone, becomes lethargic and prone to oversleeping, overeats, and gains weight. Worried about this pattern of behavior, she approached us for advice.
Q: Why do I feel like this?
Dr. S: Revati, from what you are describing, the symptoms appear to be those of Seasonal Affective Disorder (SAD). SAD is a well-recognized condition that adversely affects the mental health and well-being of many people. It is characterized by mood variation with a change in season, especially during the winter months with reduced daylight.
SAD was first described in 1984 and is now classified as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders. People suffering from this disorder often show depressive episodes in the fall or winter months and usually feel better by spring or summer. Like what you are describing, SAD may be the cause of excessive sleeping, overeating, a craving for carbohydrates and sugars, and significant tiredness.
Q: What could have caused this condition?
Dr. S: The exact understanding of the cause of SAD is not known, but it has been attributed to variations in the circadian rhythm (the human biological clock) that result in the upsetting of brain neurotransmitters like dopamine, norepinephrine, melatonin, and glutamate. A research study has attributed the ZBTB20 gene as a potential risk factor for susceptibility to SAD. There is also evidence that more women than men are prone to this condition. It typically starts in young adulthood (18-30-year-olds).
Q: What should I do to feel better?
Dr. Sharma: Revati, you should begin by discussing this with your primary healthcare provider. There are several screening tests available for this condition. Two of these are the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Seasonal Health Questionnaire (SHQ), which the healthcare provider will administer, and based on your history, physical examination, and other tests, will be able to confirm your diagnosis, ruling out other causes, and suggest therapy.
Q: How can I prevent this condition?
Dr. S: Revati, there are several ways you can prevent and reduce the adverse effects of SAD. Light is the main tool for regulating the biological clock of sleep and wakefulness, which is very important. So, maximizing exposure to natural sunlight during the day is an effective tool.
While in the Minnesota winters, sunlight may be restricted, in the mornings right after waking, you can try phototherapy. This is bright light therapy using 10,000 lux through a commercially available lamp for 20-30 minutes before starting the day. The optimal distance between the recipient and the light source is recommended to be 60 to 80 cm. In addition, you must set up a consistent sleep schedule by going to bed and waking up at set times.
Regular physical activity, particularly walking or another form of aerobic activity during the day, maintaining social connections, and healthy eating are also good strategies to prevent SAD. Remember to also avoid alcohol consumption, as that also plays an important role.
Q: What if the depression persists?
Dr. S: In cases where SAD persists, psychotherapy, especially cognitive behavioral therapy (CBT), antidepressant medication, and Vitamin D supplements may be recommended by the healthcare provider.
Q: Can yoga and meditation help with SAD?
Dr. S: Yes, yoga and meditation are useful in enhancing coping with seasonal affective disorder. Surya namaskar or sun salutation, which is a complete yogic asana with its 12 steps, is very helpful in this condition. There are other yogic asanas also that can be practiced along with dhyana (meditation).
Question: Can you share some additional resources?
Dr. S: Here are some additional resources from which you can find more information:
- 5 Yoga poses for combating seasonal affective disorder
- Cleveland Clinic’s website on seasonal affective disorder
- Mayo Clinic’s website on seasonal affective disorder
- YouTube: Yoga for seasonal affective disorder – Yoga with Adriene
- WebMD’s website on seasonal affective disorder
If you have questions, reach out to Dr. Manoj Sharma at editor@indiacurrents.com
*Names changed upon request.