8 Facts About Seasonal Affective Disorder

iStock/Martin Dimitrov
iStock/Martin Dimitrov

As the winter days get colder, some look forward to making snow angels and curling up with a mug of hot chocolate. But for millions of people, winter brings debilitating depression and lethargy. Seasonal Affective Disorder (SAD) is thought to affect 6 percent of the U.S. population, with millions more having milder forms of seasonal malaise. Here’s what you need to know about this condition.

1. Seasonal affective disorder is a relatively recent diagnosis.

Doctors have commented on the seasonality of depression in their patients for hundreds of years. The 19th-century psychiatrist Jean-Étienne Esquirol described a Belgian man whose life was generally good, but “at the beginning of autumn [he] became sad, gloomy, and susceptible,” and this pattern had continued for years. Esquirol prescribed a trip to the south of France and then into Italy as winter progressed. In May, the patient returned to Paris “in the enjoyment of excellent health.”

The modern understanding of SAD, however, didn’t emerge until the 1980s. A 1981 article in the Washington Post described a patient who was “almost dysfunctional in the winter, with both her mood and her energy levels at low levels.” It added that Norman Rosenthal, a researcher at the National Institute of Mental Health, “would like to hear from anyone with distinctly seasonal mood disorders. Applicants will be sent questionnaires, from which participants will be selected” for an experimental treatment program.

Decades later, Rosenthal told the Washington Post, “I thought I was dealing with a very rare syndrome. […] We got 3000 responses from all over the country.” In 1984 Rosenthal and colleagues identified SAD in the journal Archives of General Psychiatry, and in 1987 it was added to the American Psychiatric Association’s manual DSM-III-R.

2. Seasonal affective disorder doesn’t just happen in winter.

In the APA's current DSM (DSM-5), one benchmark for diagnosing depressive disorders “with seasonal pattern” is “a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year (e.g., in the fall or winter).” It also indicates that there must be no seasonally related stressors (such as consistent unemployment in winter), that full remission occurs at “a characteristic time of the year,” and that the pattern has repeated for two years without non-seasonal episodes.

Nothing in that definition requires winter, however. An estimated 10 percent of people with SAD experience the opposite of the conventional diagnosis—their depression appears in spring and summer. And in places like the Philippines, studies have found more people feel their worst in summer rather than in winter [PDF].

According to the National Institute of Mental Health, summer-onset and winter-onset SAD can even have different symptoms. Winter symptoms can include oversleeping, weight gain, carbohydrate cravings, and low energy, while summer symptoms might be poor appetite, insomnia, agitation, anxiety, and even violent behavior.

3. It’s also not the ‘winter blues.’

SAD is not the same as feeling a little down as it gets gloomy outside. A SAD diagnosis meets all the criteria for major depression and should be treated as seriously—the only difference is that SAD has a seasonal pattern. Psychiatrists do recognize ‘winter blues,’ or sub-syndromal SAD (S-SAD), for “individuals who do not meet diagnostic criteria for depression during the fall/winter months, but who experience mild to moderate symptoms during fall or winter,” SAD expert Kelly Rohan told the APA. This form may affect an additional 15 percent of the US population. (This number is highly dependent on where the S-SAD patients live, however.)

4. Your chance of experiencing SAD depends on your latitude (to a point).

It might seem obvious that as you get further north—to regions with colder, darker, and longer winters—SAD would be more prevalent. There is some evidence for this: An estimated 1 percent of Floridians experience SAD compared to 9 percent of Alaskans. But one study in Tromsø, in northern Norway, found “no significant differences in the reporting of current mental distress depending on season” (although they did find people had more sleeping problems in winter). Icelanders also have remarkably low instances of SAD. Even more surprisingly, people of Icelandic descent living in Canada have a lower prevalence of SAD than non-Icelandic Canadians in the same area [PDF].

5. Not everyone in a region is affected the same way.

SAD is reported to affect four times as many women as men, and a recent pilot study indicated vegetarianism may also be associated with SAD. The researchers found that:

“The percentage of SAD patients among Finnish vegetarians was four times higher than in the normal population. The percentage of vegetarians among the SAD patients in a Dutch outpatient clinic was three times higher than in the normal population. In the Dutch population, the seasonal loss of energy, in particular, is related to vegetarianism.”

Some factors may confound the data (for example, it’s possible vegetarians are more likely to forgo antidepressants, so there are more of them in outpatient facilities), but the researchers say the findings suggest a link. In fact, one theory for Iceland’s low SAD rate suggests that Icelanders’ fish-heavy diet may have a protective effect (and Icelanders living in Canada might be sticking with their traditional foods).

6. We don’t know what causes seasonal affective disorder.

While scientists haven’t figured out what factors cause SAD, the most popular theory is the phase shift hypothesis: That, due to later sunrises and earlier sunsets, the body’s circadian rhythms sometimes get out of whack with its sleep/wake cycles, like a several-months-long jet lag. It’s also possible that people with winter SAD can’t regulate serotonin or they overproduce melatonin, and the imbalance alters circadian rhythms.

7. Luckily, seasonal affective disorder is treatable.

For years, the gold standard of SAD treatment has been light therapy. The process involves sitting near a light box for around 30 minutes after you wake up. Your eyes are open, but not looking directly at the light, meaning the therapy can be done while watching TV, reading a newspaper, or having breakfast.

But researchers warn again self-treating with light therapy—it can negatively affect people with bipolar disorder or eye problems. And, light boxes must be made specifically for treating SAD. Many commercially available light boxes release predominantly UV light, and SAD boxes should release as little UV as possible.

More recently, research has been looking into Cognitive Behavioral Therapy (CBT)—a technique that alters negative thoughts to manipulate emotions and behaviors, like changing your thinking from “I hate winter” to “I prefer summer.” With CBT, some researchers have seen fewer recurrences, less-severe symptoms, and higher remissions compared to light therapy users. Antidepressants are also prescribed for SAD.

8. SAD may have once been an evolutionary advantage.

In the 1981 Washington Post article, the SAD sufferer commented that she “should have been a bear” because “bears are allowed to hibernate, and people aren’t.” As the years went on, some proposed that the symptoms of winter SAD—sleeping more, being less active, and eating fattening foods—could be a vestigial hibernation instinct. Many dismissed that explanation, but in the early 2000s things began to change. A Russian study found that women without depression and with non-seasonal depression consumed around the same amount of oxygen, while women with winter depression consumed less [PDF]. Doctors began to think SAD exists today because it once offered some evolutionary benefit for humans surviving winter.

One proposed benefit is reproduction. People with winter SAD are lethargic in winter but generally active in spring and summer, which increases the probability of procreation in those seasons. If a child is conceived between May and September, that means a high probability of being born between February and June, which some researchers propose would increase chances of survival before winter kicks in. Meanwhile, Robert Levitan at the University of Toronto “consider[s] SAD to be an evolutionary disorder, an energy-conserving process that is no longer helpful in modern society. While in modern times it’s not good for us to slow down too much in the winter, or to gain lots of weight, this probably helped our ancestors survive in the ice age.”

12 Creative Ways to Spend Your FSA Money Before the Deadline

stockfour/iStock via Getty Images
stockfour/iStock via Getty Images

If you have a Flexible Spending Account (FSA), chances are, time is running out for you to use that cash. Depending on your employer’s rules, if you don’t spend your FSA money by the end of the grace period, you potentially lose some of it. Lost cash is never a good thing.

For those unfamiliar, an FSA is an employer-sponsored spending account. You deposit pre-tax dollars into the account, and you can spend that money on a number of health care expenses. It’s kind of like a Health Savings Account (HSA), but with a few big differences—namely, your HSA funds roll over from year to year, so there’s no deadline to spend it all. With an FSA, though, most of your funds expire at the end of the year. Bummer.

The good news is: The law allows employers to roll $500 over into the new year and also offer a grace period of up to two and a half months to use that cash (March 15). Depending on your employer, you might not even have that long, though. The deadline is fast approaching for many account holders, so if you have to use your FSA money soon, here are a handful of creative ways to spend it.

1. Buy some new shades.

Head to the optometrist, get an eye prescription, then use your FSA funds to buy some new specs or shades. Contact lenses and solution are also covered.

You can also buy reading glasses with your FSA money, and you don’t even need a prescription.

2. Try acupuncture.

Scientists are divided on the efficacy of acupuncture, but some studies show it’s useful for treating chronic pain, arthritis, and even depression. If you’ve been curious about the treatment, now's a good time to try it: Your FSA money will cover acupuncture sessions in some cases. You can even buy an acupressure mat without a prescription.

If you’d rather go to a chiropractor, your FSA funds cover those visits, too.

3. Stock up on staples.

If you’re running low on standard over-the-counter meds, good news: Most of them are FSA-eligible. This includes headache medicine, pain relievers, antacids, heartburn meds, and anything else your heart (or other parts of your body) desires.

There’s one big caveat, though: Most of these require a prescription in order to be eligible, so you may have to make an appointment with your doctor first. The FSA store tells you which over-the-counter items require a prescription.

4. Treat your feet.

Give your feet a break with a pair of massaging gel shoe inserts. They’re FSA-eligible, along with a few other foot care products, including arch braces, toe cushions, and callus trimmers.

In some cases, foot massagers or circulators may be covered, too. For example, here’s one that’s available via the FSA store, no prescription necessary.

5. Get clear skin.

Yep—acne treatments, toner, and other skin care products are all eligible for FSA spending. Again, most of these require a prescription for reimbursement, but don’t let that deter you. Your doctor is familiar with the rules and you shouldn’t have trouble getting a prescription. And, as WageWorks points out, your prescription also lasts for a year. Check the rules of your FSA plan to see if you need a separate prescription for each item, or if you can include multiple products or drug categories on a single prescription.

While we’re on the topic of faces, lip balm is another great way to spend your FSA funds—and you don’t need a prescription for that. There’s also no prescription necessary for this vibrating face massager.

6. Fill your medicine cabinet.

If your medicine cabinet is getting bare, or you don’t have one to begin with, stock it with a handful of FSA-eligible items. Here are some items that don’t require a prescription:

You can also stock up on first aid kits. You don’t need a prescription to buy those, and many of them come with pain relievers and other medicine.

7. Make sure you’re covered in the bedroom.

Condoms are FSA-eligible, and so are pregnancy tests, monitors, and fertility kits. Female contraceptives are also covered when you have a prescription.

8. Prepare for your upcoming vacation.

If you have a vacation planned this year, use your FSA money to stock up on trip essentials. For example:

9. Get a better night’s sleep.

If you have trouble sleeping, sleep aids are eligible, though you’ll need a prescription. If you want to try a sleep mask, many of them are eligible without a prescription. For example, there’s this relaxing sleep mask and this thermal eye mask.

For those nights you’re sleeping off a cold or flu, a vaporizer can make a big difference, and those are eligible, too (no prescription required). Bed warmers like this one are often covered, too.

Your FSA funds likely cover more than you realize, so if you have to use them up by the deadline, get creative. This list should help you get started, and many drugstores will tell you which items are FSA-eligible when you shop online.

10. Go to the dentist.

While basics like toothpaste and cosmetic procedures like whitening treatments aren’t FSA eligible, most of the expenses you incur at your dentist’s office are. That includes co-pays and deductibles as well as fees for cleanings, x-rays, fillings, and even the cost of braces. There are also some products you can buy over-the-counter without ever visiting the dentist. Some mouthguards that prevent you from grinding your teeth at night are eligible, as are cleaning solutions for retainers and dentures.

11. Try some new gadgets.

If you still have some extra cash to burn, it’s a great time to try some expensive high-tech devices that you’ve been curious about but might not otherwise want to splurge on. The list includes light therapy treatments for acne, vibrating nausea relief bands, electrical stimulation devices for chronic pain, cloud-connected stethoscopes, and smart thermometers.

12. Head to Amazon.

There are plenty of FSA-eligible items available on Amazon, including items for foot health, cold and allergy medication, eye care, and first-aid kits. Find out more details on how to spend your FSA money on Amazon here.

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U.S. Postal Service Issues 'Healing' Stamp to Help Americans Struggling With PTSD

USPS
USPS

Showing your support for military veterans and others afflicted with post-traumatic stress disorder, or PTSD, is now just a lick away. This week, the United States Postal Service (USPS) released a new Healing PTSD stamp, with proceeds going toward the assistance and treatment of service members and civilians struggling with emotional and psychological symptoms brought on by a troubling life event.

The front of the stamp, which features a green plant growing from a pile of fallen leaves, is intended to symbolize healing. The stamp is what the USPS refers to as semipostal, which is postage that sells for a premium in order to raise funds for causes thought to be in the public interest. The Healing PTSD edition is 65 cents, or 10 cents more than a regularly-priced first-class stamp. That money, minus the postage paid and the reimbursement of reasonable costs acquired by the Postal Service, will be distributed to the U.S. Department of Veterans Affairs and routed to the National Center for PTSD.

The first semipostal stamp was issued in 1998 and was intended to raise money and awareness for breast cancer research. A stamp for Alzheimer’s research followed in 2017. Semipostal stamps are intended to be sold for no more than two years at a time.

The Healing PTSD stamp is available at local post offices and on USPS.com.

[h/t Task & Purpose]

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