December is SAD awareness month, drawing attention to a condition with growing notoriety that, often compared to the winter blues, can be debilitating in its true nature and severity. SAD, or seasonal affective disorder, is a mood disorder related to other forms of depression, such as major depressive disorder (MDD), dysthymia, and bipolar disorder.
However, while seasonal affective disorder affects roughly 10 million people in the United States alone, it is a poorly understood condition with various potential causes and triggers. Let’s take a moment to dive further into how seasonal affective disorder works and why it can exacerbate and amplify existing pain conditions and bring new pain symptoms to light.
What Is Seasonal Affective Disorder?
Seasonal affective disorder (SAD) is characterized by increased depressive symptoms with seasonal changes. Most people who develop seasonal affective disorder are most strongly affected by the shift toward the winter or the summer. A variety of reasons are thought to contribute to the development of seasonal affective disorder, and every case is a little different:
- For one, there is a genetic component. Some people are inherently predisposed towards feeling more down as seasons change. This can contribute to their risk of developing mood disorder symptoms in winter or summer.
- While our bodies have internal biological clocks, they still rely on certain environmental factors to regulate physical and psychological function. Spending too much time away from daylight or struggling to get rest as the days grow longer can affect a person biologically and mentally. Some people are more susceptible to these changes.
- Seasonal stressors can affect the development of a seasonal affective disorder. For example, feeling lonely around the holidays, struggling financially due to increased heating bills, or assorted winter costs. Alternatively, those who find seasonal work might find themselves stressed and overworked in the summer months and are more likely to dread the next work season.
- Chronic health issues, particularly chronic pain conditions, can increase the risk of seasonal affective disorder. Some conditions generally worsen with the shift in seasons as it gets progressively colder or hotter. In addition to physical symptoms, a change in seasons for patients with chronic pain can bring mental health symptoms such as depressive thoughts and irritability, and in some cases, lead to a seasonal affective disorder.
- Some neurological processes can be affected by seasonal changes, whether due to an increase in stress hormones or a change in environmental factors. Something as minute as a shift toward vitamin D deficiency might significantly contribute to mood stability and emotional regulation.
What Are the Symptoms of Seasonal Affective Disorder?
Identifying seasonal affective disorder takes work. Most people experience some form of winter blues as the days get shorter, the nights get colder, and prices go up. Some people thrive in the winter and rainy months, preferring it to the oppressive heat and generally getting more out of their day.
But these individual preferences are wholly different from the pathology of a seasonal affective disorder, which can be debilitating. Up to 6 percent of people affected by SAD are hospitalized at some point, and over a third have an increased risk of substance use disorder due to their condition. Depressive symptoms for a seasonal affective disorder can differ from case to case but usually involve:
- Feelings of hopelessness.
- Feeling lonely and isolated, even in a crowd or during festivities.
- Increased feelings of anhedonia or an inability to feel joy.
- Feeling total dread for the future or feeling like you aren’t long for this world.
- Heavy limbs, physical fatigue, and being tired despite oversleeping.
- Trouble concentrating or focusing on tasks at hand.
- Drastic changes in appetite, ranging from sudden weight gain to extreme weight loss.
- Intentionally becoming socially isolated, pushing away friends and family.
- Irritability and anxiety, shorter temper, heightened stress.
- Symptoms are debilitating enough to affect work, school, and real-life relationships.
- Other conditions, physical conditions, medication use, or substance use cannot explain symptoms.
- Symptoms last a few weeks or more than a month and are consistent with seasonal shifts.
As a mood disorder, seasonal affective disorder also has a complicated relationship with pain. As a risk factor and potential trigger, ongoing pain – such as chronic pain – can contribute to the development of mental health issues like anxiety, medical trauma, and depression. The stress of being in pain makes a person more vulnerable to other compounding stressors and makes it harder to manage mental health symptoms successfully.
But chronic pain and depression share an unfortunate two-way relationship. Studies have shown that depressive symptoms and a low mood actively reduce pain thresholds and increase pain sensitivity, causing you to feel aches you might not have even noticed in a healthier, more positive mindset. How you think and feel can actively make conditions like rheumatoid arthritis and chronic fatigue syndrome a lot worse.
How Does Depression and Mood Affect Pain?
There is a link in the brain between how you process pain signals and manage your mood. While your brain utilizes various brain chemicals to communicate important information and enable conscious and unconscious change, some overlap exists in the brain’s pathways to transmit pain signals and mood changes.
This means that a lot of the medication used in the treatment of depression can also reduce pain, and certain conditions that promote depressive thoughts and low mood worsen the pain. A person’s risk for seasonal affective disorder is increased by pain conditions, while depressive thoughts worsen the pain. This dangerous cycle requires a treatment plan.
Incorporating Mental Health Treatment in Pain Management
When pain specialists and clinics discuss holistic treatment approaches and comprehensive pain management, they discuss treatment plans that consider a person’s biological, psychological, and social health profile. It isn’t enough to look at a person’s symptoms and prescribe them the matching painkillers.
Lifestyle factors, mental health symptoms, and social context – especially when a person’s symptoms seem to spike around certain times of the year – all matter when formulating a treatment plan. To that end, an experienced pain specialist will incorporate traditional pain management tools in addition to one-on-one therapy, counseling, group therapy, or unique mental health treatments for treatment-resistant symptoms.