Once the holiday season is over and we are faced with the beginning of a new year, it is common to feel down or generally unhappy. Daylight plunges, vacation days are scarce during Q1 and we are often confronted with the many demands of our New Year’s resolutions. It is no wonder we feel off and distressed. This feeling is very common and normal. Today I’d like to write about how this temporary state of general unhappiness differs from a full-fledged mood disorder also known as Seasonal affective disorder (SAD) or Seasonal Depression.
The psychopathology of seasonal depression
Seasonal affective disorder, first described in 1984 by Norman E. Rosenthal, has been considered both a unique mood disorder and a modifier -or specifier- of a recurrent depressive disorder that occurs with a seasonal pattern. In short, there are two lines of thinking about seasonal depression; those who consider it an independent disorder and those who prefer to think of it as a modifier -a special characteristic- of a major depressive disorder.
The proponents of SAD as a unique entity, support their claims with biological studies. Patients affected by a depressive disorder with seasonal pattern, have problems processing visual light, usually, develop their symptoms when adequate light is not present and respond favorably to light therapy.
Those who prefer the SAD to remain as a major depressive disorder with seasonal pattern, claim that patients diagnosed with winter depression suffer recurrent episodes of major depression. Their symptoms seem to increase during the fall and winter and decrease with the coming of spring and summer.
Diagnosis of a depressive disorder
At this point, I would like to talk about the criteria for the diagnosis of a depressive disorder. The DSM-V (The Diagnostic and Statistical Manual of Mental Disorders) indicates that 5 or more of the following symptoms need to have been present during a same 2-week period. At least one of the symptoms has to be number 1 or 2.
- Depressed mood most of the day, nearly every day (self-reported or observation made by others).
- Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
These symptoms cannot be attributed to another medical condition and cause significant stress as well as social and occupational impairment. If in the last 2-year period, two episodes of major depression have occurred and remitted in specific times of the year, we can speak about seasonal depression.
As you can see, the actual diagnosis of winter depression, it’s more complex than what many articles written these days would lead you to believe. I encourage anyone who recognizes the preceding symptoms in themselves to seek professional help. If you are just feeling down or overwhelmed these days, I will offer some tips about how to overcome the winter blues in my next post.