Is SAD Really a Disorder, Or Just a Part of Life?

Triggers…the end of the summer and early fall are full of triggers. While fall began just last week, I find it hard to think of fall as a “beginning.” I know I am not alone, but that is of little comfort to me, as I still must writhe my way through the waves of anxiety and other disquieting reactions that greet meet me every year starting in late summer and kicking into high gear in September and October.

Friends have teased me for years about my ostensibly gloomy attitude toward fall, as this so-called disorder — Seasonal Affective Disorder, or SAD — has been with me throughout my life. “But the foliage is so gorgeous!” they say in disbelief. “The air is so crisp and clean!” Yeah, the leaves are gorgeous and the air is crisp and clean. But what happens after that? The leaves turn brown and ugly, the light gets murky then disappears, and the air turns frigid.

While summer ends in September, for me, “real” summer ends in mid- to late July, when the assault of back-to-school commercials and ads begins, followed by local cues like schedule changes: The town pool, which had been open until 8, now closes at 7. Other outdoor activities end earlier or cease altogether. Football practice begins, though it’s too hot for kids to handle arduous drills in uniform, and every field is dotted with sweating teens in their helmets and jerseys.

August gets lost in a hail of triggers, as subtle as hollow-point bullets. First, the increasingly earlier sunsets seem to come at a faster clip. Then there’s the actual shifting of light — the lower position of the sun in the sky. Lightning bugs, which provided sparkle through most of the summer, are gone, replaced by the previously intermittent and now relentless chirping of crickets, the loud and jarring screeching squeal of cicadas, the dulling and browning of greenery, the “helicopter” pods from maple trees, the melancholy fragrance of light-green tree pollen wafting through the air, the heavier breezes that now, instead of bringing a welcome relief, cause a chill — or, in my case, a shudder. Even my musical cravings start to change, veering toward more melancholy artists like Simon & Garfunkel, reserved, whether consciously or not, for this time of year.

When I first heard about SAD, I felt a slight sense of relief. Approximately 4 to 6 percent of Americans suffer from the “disorder,” and, according to Harvard Health, roughly a half-million people are diagnosed with SAD annually—and there are many more who aren’t diagnosed.

About four years ago, I decided that I wanted to write about SAD, and I didn’t want to mess around — I went straight to the source, to world-renowned psychiatrist and author Norman E. Rosenthal, MD, who is credited with “discovering” and naming SAD in the early 1980s. It was Rosenthal’s landmark bestseller, Winter Blues, published in 1993, that first drew real attention to the cluster of symptoms he identified as Seasonal Affective Disorder. (It’s my guess that people have suffered from anxiety caused by the change of seasons since the dawn of human life.) 

In fact, it was Rosenthal’s own winter blues that inspired him to conduct research on mood disorders and the seasons at National Institute of Health. “I realized that, when I first came to the States from South Africa, I started to be slower, less productive, and less creative,” Rosenthal recalled when I interviewed him for an article on SAD for Westchester Magazine in 2014. “I had never lived far from the equator, so I was completely unfamiliar with the short, dark days of winter. When summer came, everything was easier and better.”

But SAD is more than just feeling “down” because it’s cold and dark. “The decrease in sunlight causes biological changes in the brain that are responsible for the depressive symptoms,” Howie Schrage, MD, a psychiatrist in private practice in Mount Kisco, told me when I interviewed him for the same article. “The brain’s biological internal clock is affected by the decrease in sunlight,” causing the brain to overproduce the hormone melatonin and to under-produce the neurotransmitter serotonin, both of which, says Schrage, can cause depressive symptoms. “There is also a hereditary component to SAD” and the further north a person lives from the equator, the more susceptible they are to SAD. 

People who develop SAD can have symptoms typical of clinical depression — including daily depressed mood, loss of interest in usual activities, feelings of hopeless, suicidal thoughts — but, Schrage told me, there are symptoms that “are more unique to SAD, including irritability, increased appetite with weight gain most likely caused by carbohydrate cravings, fatigue, oversleeping, and increased sensitivity to rejection.” Rosenthal agreed.

So what can you do other than to wait with bated breath for June? “Light therapy is an effective treatment,” said Schrage, and most people will benefit from it. “In my practice, I’ve seen its users benefit greatly. Exposure to light from a light box on a daily basis can diminish or eliminate symptoms within several days to two weeks or longer.” Of course, psychotherapy can be helpful, and both doctors agree that exercise is important. Still, “whether by going outdoors on a sunny winter day or using lamps and light boxes indoors,” said Rosenthal, “people need to get more light.”

I agree with both doctors — at least about the fact that getting more light helps many of us feel better. At least a little (regardless of how much light I get, I know when it’s fall and I know when it’s spring). Interestingly, winter doesn’t bother me as much as fall, because I know that, despite the cold and darkness, spring is on the horizon. Yes, the malaise that often coincides, for many of us, with the darker days of autumn is a component of this “disorder.” But I prefer to think of as a Natural Human Seasonal Reaction.