Seasonal Affective Disorder and the Role of Ketamine in Treatment
Seasonal affective disorder (SAD) is a distinct type of depression that surfaces during particular times of the year. It's most commonly experienced in the fall or winter, with changing daylight hours often being a trigger. This article aims to provide an in-depth look at SAD, its symptoms, risk factors, and treatments, with a particular focus on the role of ketamine in treatment.
Understanding Seasonal Affective Disorder
SAD is more than just feeling "down" during certain seasons. It's a legitimate form of depression and is not a sign of personal weakness or a condition that can be willed away.
Who is at Risk?
Typically, SAD begins to manifest in adulthood, with the risk increasing as one ages. It's not commonly found in people under 20 years of age. Interestingly, women are affected more often than men.
What Causes SAD?
The exact cause of SAD is not entirely clear. However, it's believed that shorter days and less sunlight during the fall and winter months may trigger a chemical change in the brain leading to depression symptoms. Particularly, the hormone melatonin, which the body produces more of when it's dark, has been linked to SAD.
Symptoms of Seasonal Affective Disorder
The symptoms of SAD can be categorized into two types:
Fall-onset: Also known as "winter depression," this type is characterized by symptoms of depression beginning in the late fall to early winter months and easing during the summer months.
Spring-onset: Conversely, this type, also known as "summer depression," involves symptoms of depression commencing in late spring to early summer and is less common.
The most common symptoms of SAD include:
Increased sleep and daytime drowsiness
Loss of interest and pleasure in activities formerly enjoyed
Social withdrawal and increased sensitivity to rejection
Irritability and anxiety
Feelings of guilt and hopelessness
Fatigue, or low energy level
Decreased sex drive
Decreased ability to focus or concentrate
Trouble thinking clearly and making decisions
Increased appetite, especially for sweets and carbohydrates
Physical problems, such as headaches, increased chronic pain, and gastrointestinal issues.
If you think you may be suffering from SAD, it's crucial to see a healthcare provider for a diagnosis. Early diagnosis and treatment are key to recovery due to the potential overlap of depression with other conditions such as exacerbation of underlying medical conditions, chronic pain, substance use disorder, and anxiety.
Treatment for SAD often varies and may include a combination of the following:
Exposure to sunlight: Spending time outside, especially increasing exposure to early morning light, can help relieve symptoms of SAD.
Physical activity: Increasing physical activity, even just getting out for a brisk 10-minute walk a few times a week can boost endorphins and naturally ease some symptoms of depression. Going for an early morning walk outdoors can give the added benefit of early morning light exposure to help decrease elevated melatonin levels and boost energy.
Light therapy: This involves exposure to a special light for 30-45minutes each day (usually just before sunrise and just before sunset) to trick the brain into experiencing a longer day. Light therapy is a longtime staple of treating SAD as it can help compensate for the lack of natural sunshine during the darker months. It is important to have a specialized super bright light box (about 10,000 lux), which is around 20 times brighter than regular indoor lighting and filters out any harmful UV rays, ensuring a safe experience for most people. It is important to note that if you have certain eye conditions, migraines, or take certain medications that make you more sensitive to sunlight, it's important to explore alternative treatments or consult a healthcare professional before starting light therapy.
Psychotherapy: Talk therapy can help change the distorted views you may have of yourself and the environment around you when you are experiencing a depressive episode. Seeing a therapist regularly is an important part of any mental health treatment regimen. An excellent resource to get connected with a local therapist is Zencare.
Traditional Daily Antidepressants: Prescription medications such as SSRIs/SNRIs, wellbutrin, and lamotrigine, can help correct the chemical imbalance that may lead to SAD. An excellent resource to get connected with a local psychiatrist or psychiatric nurse practitioner is Zencare.
Ketamine as a Novel Treatment Option
Recently, ketamine has emerged as a safe and highly effective treatment option for depression, including SAD. Ketamine is a powerful medication often used in anesthesia. However, in recent years, it's been discovered that in low doses, it can have a rapid and significant antidepressant effect, offering an alternative therapeutic approach when treating those with SAD.
Research has shown that ketamine works differently than traditional antidepressants. Instead of affecting the neurotransmitters serotonin or norepinephrine, ketamine works on a neurotransmitter called glutamate, which is involved in the formation of memories and the ability to learn, thus helping people break out of ingrained unhelpful patterns of thoughts and behaviors that can fuel depression. This mechanism of action is believed to be one of the reasons why ketamine can provide rapid relief from depression symptoms.
Ketamine can be administered in various ways, such as intravenously, intranasally, or sublingually (under the tongue). Studies have shown that all these administration methods can be effective in treating depression. However, the choice of method often depends on the individual patient's needs, the severity of their depression, and their response to other treatments. At PVD Ketamine & Wellness, we offer sublingual ketamine therapy due to its ease of administration, therapeutic efficacy, and versatility for both in office and at home use. For more information about our sublingual ketamine therapy, please refer to our blog post Understanding Sublingual Ketamine Treatment: A Comprehensive Guide.
At-Home Ketamine-Assisted Therapy
At-home Ketamine-assisted therapy (KAT) with psychosocial support and remote monitoring through telehealth platforms addresses major barriers to care, including the COVID-19 pandemic, transportation, and access to treatment for those who may have difficulty leaving home due to their symptoms. Similar to in-office sessions, this approach has shown rapid and significant antidepressant and anxiolytic effects comparable to in person treatment, but may not be appropriate for everyone.
Preventing Seasonal Affective Disorder
Preventing SAD involves initiating treatment before the typical onset of the fall or winter season when symptoms are most likely to surface. This preemptive treatment can include light therapy, psychotherapy, and the use of antidepressants, including ketamine. It can be important to stay ahead of your symptoms and start preventative measures early in the season to give yourself the best chance of avoiding a major depressive episode through the fall and winter.
Conclusion
Living with Depression and Seasonal Affective Disorder can be challenging, but understanding the condition and knowing the available treatment options, including ketamine, can make a significant difference. It's essential to remember that help is available, and you don't have to navigate this journey alone. If you think you may be suffering from SAD, and have had inadequate therapeutic effects with traditional treatment, we encourage you to schedule a free preliminary screening call with us to discuss whether adding ketamine therapy could be right for you.
References:
https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
https://www.sciencedirect.com/science/article/pii/S0165032722007625?via%3Dihub
