Why do we sadly flow back into the river in winter?

seasonal affective disorder

Lead: When winter comes, many people will become drowsy and appetite increase, but they are listless and depressed; near the end of the year, it should be a joyous time to celebrate the New Year and Spring Festival and reunite with relatives and friends, but there will be pessimistic thoughts from time to time. . If the above symptoms are bothering you, if you have this feeling every winter, then you may be experiencing "winter depression".


"Winter depression" is a manifestation of seasonal emotional disorders (SAD). Although the 'sadness' brought about by people's gloomy and cold and gloomy winters has long been part of our lives since ancient times, 'Winter depression' was first proposed as a treatable clinical disease late In 1984. When Norman Rosenthal moved from sunny South Africa to the United States, the cold + blizzard winter made him depressed and his work efficiency decreased. He believes that this phenomenon occurs because of the decrease of natural light in winter, so he invented light therapy and wrote a popular Winter Blue ("Winter Melancholy"). Despite Rosenthal's ideas being questioned, the term seasonal emotional disorder (SAD) is generally recognized.


Are seasonal emotional disturbances real? Does it only appear in winter? What are its manifestations and how to treat it? In this issue of "Sister School Is Here", we invited Ma Hong, a doctor of psychology from Zhejiang University and a national second-level psychological counselor, to talk about this "source of grief" that may be around us.


seasonal affective disorder

What is a seasonal emotional disorder? Does it only appear in winter?

Seasonal emotional disorders are a kind of mood disorder (Mood Disorder). People who suffer from it usually have depression symptoms at a certain time of the year and good mental health at other times. A common type of SAD is winter depression, which begins in late autumn and early winter, and there is also a relatively rare summer depression, usually starting in late spring or early summer.


The symptoms of seasonal emotional disturbances are of different importance. Mild emotional disturbance (S-SAD for short), which is often referred to as "little sadness in winter", has the widest impact. Patients with severe disorders are so severe that they cannot live normally and need to be hospitalized. When professionals interview patients with suspected SAD, they will pay special attention to whether they have suicidal thoughts and conduct suicide assessments.


Feeling depressed in winter # winter SAD

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published in the United States, SAD is classified as a depression, and it is a type of depression that repeats as the seasons change. To be diagnosed with SAD, patients must first meet the diagnostic criteria for depression, accompanied by at least two years of experience of depression episodes in the same season. In his medical history, the number of patients with seasonal depression episodes is much greater than the number of episodes in other time periods.


seasonal affective disorder

What are the manifestations of seasonal emotional disorders?

Whether it is winter depression or summer depression, the symptoms appear mild at the beginning of the onset, but the symptoms will become more serious as the season progresses.


symptoms of SAD in winter are:

Sleepiness or tendency to oversleep

Appetite changes, craving sweets or starchy high-calorie foods

Weight gain

Feeling heavy limbs, decreased physical fitness, reduced physical activity, and easy to feel tired

Difficult to focus

Irritability, more sensitive to rejection by others, avoid social activities

Cry easily, feel sad, hopeless and even have suicidal thoughts

The symptoms of SAD in summer are:

Appetite decline

Weight loss

Insomnia

Anxiety

Do I have seasonal emotional disturbances?

The SPAQ (Seasonal Pattern Assessment Questionnaire) questionnaire compiled by Rosenthal and his colleagues in 1984 is widely used in the diagnosis of SAD. This questionnaire contains 6 questions, which can be downloaded for free and tested independently. By answering questions 2 and 3, you can quickly determine whether you belong to SAD or Winter Blue.


After evaluating yourself, take a look at the corresponding evaluation results:

What are the causes of seasonal emotional disorders?

The specific mechanism of SAD is still unknown. Known demographic sociological factors include: (1) gender, the probability of women suffering from SAD is 4 times that of men; (2) age, the initial age of onset is around 18-30 years old; (3) personality traits, in the fifth year Individuals with high neuroticism, pleasantness, and openness in the Personality Quality Scale have a higher prevalence rate; (4) The distance from the equator, the higher the probability of morbidity, the greater the distance from the equator; (5) Family History of depression.


Biological factors that have been confirmed by research include:

1. Serotonin (also known as serotonin). Serotonin is considered to be a neurotransmitter responsible for regulating mood. The level of SERT (a protein responsible for the delivery and transport of serotonin) in SAD patients in winter is higher than 5% in summer. Higher SERT levels lead to lower serotonin activity, which leads to depression. In the summer, adequate sunshine will keep the SERT in the body at a normal low level, but as the sunshine time decreases in autumn, the serotonin level in the body will also decrease accordingly.


2. Melatonin. Melatonin is a hormone secreted by the pineal gland of the brain and participates in synchronizing the circadian rhythm. When mammals are in a dim environment, melatonin secretion increases, causing drowsiness. In autumn and winter, the night becomes longer, and the body secretes more melatonin, which makes people sleepy. It should be noted that melatonin only has a side effect on the production of SAD, and it will not cause SAD alone.


3. The body's biological clock. The above-mentioned changes in serotonin and melatonin work together on the circadian body clock. Studies have shown that the circadian clocks of SAD patients are abnormally marked for the length of day and night, that is to say, there is a "time difference" between their body clock and the actual clock. For example, when it is time to rest quietly at 10 pm, the clock in the body stays at the excitement of watching the series at 8 pm. The abnormality of the circadian clock prevents the patient from making correct adjustments to the circadian changes, thus causing depression.


4. Vitamin D. Due to the short sunshine time and reduced outdoor activities in winter, the human body's skin is less likely to be exposed to sunlight, and the body's vitamin D synthesis is reduced. Studies have shown that lack of vitamin D can cause depression.

How to treat seasonal emotional disorders?

1. Light therapy. This method has been proven to effectively alleviate SAD and S-SAD. Starting in early autumn, the patient sits near a special white fluorescent tube (usually 10,000 lux) for about half an hour every morning. The tube is covered with a plastic cover to block ultraviolet light. Intense artificial light can cause a chemical transformation in the brain, which improves mood and alleviates SAD disorders. In the Nordic countries, there are also special Light Rooms, where people can receive more natural scattered light. Common side effects of light therapy include eye fatigue, headache, irritability, fatigue, and insomnia, and their side effects are less than drug treatment.


2. Antidepressant drugs. The second-generation antidepressant drugs, such as bupropion (Wellbutrin) and Prozac (Prozac) treatment effect is significant. Research shows that Prozac is comparable to traditional light therapy treatments, and its cost is lower. Taking 150–300 mg of bupropion daily before the onset of SAD can effectively prevent depression attacks. It should be noted that some patients react strongly to the side effects of drugs.


3. Psychological consultation. Cognitive behavioral therapy (CBT for short) is commonly used to treat depression. The main goal of CBT is to break the patient's original negative thinking pattern, understand symptoms such as pessimistic mood and low mood from a positive perspective, and encourage patients to take practical actions to reasonably eat, increase outdoor activities, and participate in social activities. Studies have shown that six consecutive weeks of 90-minute group therapy twice a week has the same effect as receiving 30-minute light therapy daily. SAD proposer and founder of light therapy, Norman Rosenthal has also been committed to exploring ways to help people help themselves in recent years. He believes that beyond meditation, yoga, walking, and other forms of mindfulness training (Mindfulness) are beneficial to SAD patients.


seasonal affective disorder

How to prevent seasonal mood disorders?

Regular work and rest. Following the natural law of sunrise and sunset, excessive deviation from this biological model will destroy the delicate hormone cycle in the body, which will have an impact on mood and health.


Diet conditioning. Supplement vitamin D3, eat more fresh vegetables and fruits, stay away from processed foods, and reduce sugar intake.

Sports health care. Regular exercise is one of the most effective ways to prevent depression and improve mood.

Expose the sun more. On sunny days, as much as possible outdoors, develop the habit of walking at noon.

Try to keep the home and office sunny and bright. Move the position of the furniture so that you can sit close to the window and open the curtains during the day.


What other seasonal mental illnesses are there?

Mental illness is more common in winter, but it has declined in summer. The researchers analyzed Google search records and found that in the United States and Australia, the search rates for anxiety, obsessive-compulsive disorder, bipolar disorder, eating disorders, depression, suicide, attention deficit hyperactivity disorder, and schizophrenia have obvious search rates Seasonal characteristics-high in winter and low in summer. The difference in search volume for eating disorders is most significant: in the United States, winter is 37% higher than summer; in Australia, winter is 42% higher than summer. The smallest difference is the anxiety entry: in the United States and Australia, winter is 7% and 15% higher than summer, respectively. The reason behind this phenomenon is currently unknown, but it reminds us that we must pay special attention to mental health in autumn and winter.