Seasonal affective disorder and menopause

As you pour another cup of coffee and look out at a grey sky and drizzling rain, feeling cheerful can be a struggle. Six percent of the US population has a diagnosed Seasonal Affective Disorder (SAD). And another 14% says they experience SAD symptoms. But I’m betting the number of us who get the “winter blues” is actually much higher. Plus, there may be a link between SAD and menopause.

SAD is a category of depression

According to the National Institute of Mental Health, SAD is a type of depression that ebbs and flows with the seasons. It typically starts in late fall as hours of sunlight diminish and then goes away during spring and summer months.

SAD isn’t a stand-alone condition. In order to receive a SAD diagnosis, you have to meet the full criteria for a major depression coinciding with specific seasons for at least two years. Symptoms of major depression include:

• feeling depressed most of the day, nearly every day
• feeling hopeless or worthless
• having low energy
• losing interest in activities you once enjoyed
• having problems with sleep
• experiencing changes in your appetite or weight
• feeling sluggish or agitated
• having difficulty concentrating
• having frequent thoughts of death or suicide

Is it SAD or winter blues?

Common symptoms of winter-onset SAD include:

• change in appetite, especially craving sweet or starchy foods
• weight gain
• fatigue
• sleeping more than normal
• difficulty concentrating
• irritability and anxiety
• increased sensitivity to rejection
• avoidance of social situations
• loss of interest in the activities you used to enjoy
• feelings of guilt or hopelessness
• physical problems such as headaches

I don’t know about you, but as I read down the list, I check off multiple things I experience more often during winter than summer. Is it mild depression, or is it “winter blues?” Does it matter?

Winter blues clearly aren’t as much of a health threat as full-on SAD depression. But they’re not something you should pooh-pooh or ignore. Winter blues prevent you from living your best life during several months of the year.

Who gets SAD?

Risk factors for Seasonal Affective Disorder are:

• being female – SAD affects four times more women than men
• living far from the equator – for example, 1% of people in Florida have SAD, compared to 9% in New England or Alaska
• family history – or SAD or other depression
• having depression or bipolar disorder – symptoms may worsen with seasonal change
• younger age – younger adults are at higher risk than older ones. Even children and teens have been diagnosed with SAD.

As discussed above, you can use the list to consider whether you fit any of the risk categories. Even though you might escape clinical SAD depression, you still should acquaint yourself with the symptoms and stay aware of how you feel.

What causes SAD?

Although the exact cause of SAD depression is unknown, research points to some clues. These include hormonal changes that can occur with seasonal change.

Serotonin regulation impairment

People with SAD may have problems regulating serotonin, a key neurotransmitter involved in mood. One study found that people with SAD have 5% more setotonin transporter protein in winter. The transporter protein’s job is to recycle serotonin back into the pre-synaptic neuron. But an excess of the protein leaves less of this important neurotransmitter available at the synapses.

Overproduction of melatonin

Darkness causes our bodies to increase melatonin production, so we naturally want to sleep more. It helps our circadian rhythms to adjust to shortening days in the winter. But for people with SAD, an overproduction of melatonin can cause them to feel sleepy and lethargic all day long.

Not enough Vitamin D

I’ve posted elsewhere about the importance of Vitamin D as you age. Vitamin D is also thought to play a role in serotonin activity. Thus a Vitamin D deficiency may be associated with clinical depression symptoms.

What’s the link between SAD and menopause?

Lots more research is needed to fully understand menopause, including menopausal depression. As one scientific paper says euphemistically, “The constellation of endocrine patterns accompanying menopausal depression remains incompletely categorized.”

But scientists have documented potential links between menopause and seasonal affective disorder. They haven’t yet demonstrated that menopause increases your risk for SAD. But SAD and menopause share many similarities.

Menopausal women at higher risk for depression

As many as 40% of menopausal women experience depression.

If you’re in perimenopause, it’s common to find yourself feeling more irritable, sad, negative or restless. And it’s hard to know whether this is just a temporary thing or a more serious mental health problem.

An eight-year study looked at women with prior history of depression as they entered the menopausal period. Researchers found that these women faced four times higher risk of depression during perimenopause than women who had no prior history of depression. Moreover, this group was twice as likely have menopausal depression severe enough to meet criteria for a Major Depressive Disorder.

Fluctuating hormone levels affect serotonin production

Rapid mood swings during perimenopause result from fluctuating levels of estrogen and progesterone. Estrogen, for example,  stimulates the neurotransmitter serotonin. Progesterone has a calming effect.

The interactions are complex, but many scientists believe that imbalances in serontin levels can lead to depression.

Serotonin is also a precursor to melatonin, so serotonin imbalances can throw off your body’s production of melatonin. And you need melatonin to regulate your sleep cycles.

Melatonin production decreases in midlife

Hormone fluctuations during perimenopause aren’t the only thing affecting your melatonin levels. Melatonin production overall slows down in midlife. This has a complex effect on circadian rhythm regulation.

Disruptions in melatonin production are thought to be a cause of sleep disturbance in perimenopausal women. People with SAD tend to over-produce melatonin, causing them to feel lethargic during the day.

But there may also be a link between the irregular melatonin levels of perimenopause and feeling tired “at the wrong time.” Especially if a lack of sunlight triggers your body to produce melatonin during the day.

SAD and menopause pass the duck test

You know the saying: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.”

Whether a woman has “mild SAD” or “winter blues” may not be a helpful distinction, especially for perimenopausal women. The similarities between how you feel during perimenopause and how you might feel on a grey winter day are simply too many to ignore.

I’m not a scientist. But I am a post-menopausal woman who’s experienced mild SAD depression. My symptoms started during perimenopause. So on the basis of my own experience, I think there’s a link between SAD and menopause.

Key treatments for SAD

There are three main types of treatment for seasonal affective disorder.

Light therapy

Light therapy has been used to treat SAD since the disorder was identified in the 1980s. In fact, 60 to 80% of SAD sufferers benefit from light therapy.

You sit in front of a light box that mimics natural sunlight for about 20-60 minutes per day, usually in the morning. Exposure to the light seems to affect brain chemicals that alter your mood.

SAD light boxes used to be large and unwieldy. Now they come in more convenient sizes, even in rechargeable units. I use one like this*, and I like it a lot. It’s rechargeable and emits blue light, which causes less glare. But there are many more options available at lower and higher price points.

Furthering the connection between SAD and menopause, a new treatment for perimenopausal sleep disturbances involves light therapy. With the same type of light box you use to treat SAD.

Psychotherapy

If you have symptoms of depression, talk therapy might make a real difference in your mood. Ask friends and look for a therapist who can help you navigate your thoughts and feelings. Even a limited number of sessions with a trained counselor might get you over the hump toward feeling more like yourself again.

Medication

As a category of depression, SAD is also treated with anti-depressants, specifically SSRIs (Selective Serotonin Reuptake Inhibitors). Some SSRIs have been approved to treat SAD in particular.

Not surprising, doctors also may prescribe anti-depressants to help women deal with perimenopausal symptoms.

More ways to ease seasonal depression

Besides pursuing more formal treatment options, you also can help yourself weather the winter blues by taking care of your health. For example:

Exercise

Just like with other forms of depression, getting moving helps you feel better. (It’s also a good way to work off the effects of your carb cravings!)

Embrace the light

Open your shades, go for a walk outside. Anything you can think of to expose yourself to natural sunlight as much as possible.

Stick with a schedule

Try to wake, eat and sleep at the same times, even if your natural circadian rhythms are off. If you have trouble falling asleep at night, try melatonin or a soothing aromatherapy fragrance.

Keep a journal

Spend 10-20 minutes reflecting on the day’s events, your mood(s) and so on. For some, this can be an excellent way to release and relax. It also can give you data to recognize patterns between events and how you feel.

Practice relaxation

Try yoga, meditation or another relaxation practice. Practices like mindfulness meditation can help reduce stress and anxiety that are often associated with depression.

Take a vacation

I like this suggestion! It may sound self-indulgent, but getting away to someplace warm and sunny can lift your mood. Plus you can enjoy anticipating your vacation, planning to go away when everyone else is going back to work. Maybe even buying something summery, like a straw tote bag. Lots of possibilities!

SAD and menopause: my perspective

While I’ve never experienced a major depression, I’m definitely acquainted with the milder version. Moreover, I usually feel worse in winter and better in summer. Do I have a case of “winter blues,” or is it mild SAD depression? I don’t really care what you call it: I just know I don’t feel my best when the days are short.

As a post-menopausal woman, I still find winter hard. But it’s not as hard as it was during my perimenopausal years. So personally, I  believe that perimenopausal women’s fluctuating hormone levels make them more susceptible to SAD.

I’ve also learned that taking care of my health helps me weather the dark time of year.

• Use a SAD light on rainy days especially
• Watch my sugar intake: the more I eat, the more I want!
• Get regular exercise, walking or playing tennis outdoors whenever I can
• Meditate and pray
• Travel. I’m still basking in the memories of two weeks in South America over the winter holidays

The light is coming

The miracle of the seasons is that they repeat, year after year. So even if you’re feeling down on a cold, grey, rainy day, take heart. The vernal equinox is coming. And the summer solstice will follow.

Dark times help us savor the light ones. Life is good.

Live your best midlife!

Images via: Pixabay, Pexels