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Seasonal Affective Disorder in Older Individuals

By Marvette Lowrie, RN, MSM (Hons.), LNHA

Perhaps life would be blissful if we were all temperamentally even-keeled with no mood swings, and seasonal changes had no effect on our psyche. It would be wonderful not to have days when we are feeling down or sluggish, with little desire to do much. However, life is certainly not that simple. It throws us all kinds of curveballs, and we are forced to adapt to changesor to deal with their detriment. As the season changes and winter comes around, staff and residents alike may lose their motivation to pursue meaningful activities. In fact, 4-6 percent of individuals may experience winter depression. This article explores the causes and classic symptoms of Seasonal Affective Disorder otherwise called SAD, its medical management, and suggested lifestyle changes for elevating the mood.

SAD, A subtype of Major Depression
According to the Mayo Clinic, Seasonal Affective Disorder (SAD) is a subtype of major depression attributable to a lack of sunlight in the winter months, perhaps directly linked to shorter days and corresponding less daylight. SAD is fairly predictable in its course, as it begins and ends at the same time every year. Generally, symptoms start in the fall and continue through the winter months well into the early part of spring. Chemical changes in the brain and disrupted body rhythms in the fall and winter months coupled with limited outdoor activities are believed to contribute to SAD.

Classic Symptoms of SAD are like those of Major Depression

  • Decrease energy level
  • Fatigue
  • Oversleeping
  • Appetite changes and a craving for sweets or foods witha high starch content
  • Increase in weight
  • Heavy feeling in arms or legs
  • Difficulty concentrating
  • Irritability
  • Increased feeling of social rejection or isolation
  • Tendency to avoid social situations
  • Feeling depressed for most of the day, nearly all-day
  • Feeling hopeless or worthless
  • Thoughts of death or suicide

Medical Intervention
Although it is normal to have days when you or the residents you care for feel down, when such feeling lingers for days at a time and it becomes increasingly more difficult to do activities normally enjoyed, it may be time for medical intervention. In fact, as stated by the Mayo Clinic, it is especially important to seek medical help if there is a change in sleep pattern or appetite, or expression of feelings of hopelessness, suicidal thoughts, or a turn to alcohol for comfort and relaxation.

In addition to taking a thorough medical history, the doctor will likely order lab tests such as a complete blood count (CBC) or a thyroid glandtest to make sure it is functioning properly. The doctor will also check for signs of depression and make a referral to a specialist, such as a Psychologist, for a course of Psychotherapy.

Where symptoms of SAD are severe, some people have benefited from Antidepressant therapy. One example of a widely used antidepressant is Wellbutrin XL, which is an extended-release medication. Some doctors may start patients on this medication before their symptoms typically begin each year and have them continue it beyond the time their symptoms normally subside.

Psychotherapy is another option for thetreatment of SAD. It generally helps you or the resident to identify and change negative thoughts and behaviors that may be making you feel worse. Additionally, it is important to learn healthy ways to cope with SAD and learn how to manage stress.

Tips for dealing with SAD
While fall/winter depression can be a SAD state of affair, here are a few suggested cost-effective tips:

  • Make the environment sunnier and brighter by opening blinds and letting inas much natural light inside aspossible.
  • Trim hedges or tree limbs that block sunlight.
  • Sit in areas with natural light (e.g., close to a window).
  • Go outside for walks (even if it is cold).
  • Each lunch outside (fresh air always helps).
  • Begin or increase exercise and physical activity, which are both helpful for stress and anxiety relief. Being more fit may elevate the mood and create a feeling of self-worth.
  • Listen to meditation tapes.
    Other suggestions
  • Enroll in a yoga class.
  • Pamper yourself with massage therapy.
  • Purchase a Light Therapy Box. Light therapy, otherwise called phototherapy, mimics the natural outdoor light and is believed to cause a change in the chemicals in your brain that are linked to mood. Take note that before you purchase a light therapy box, speak with your doctor about the best one for you.
  • Alternative treatments, such as herbal remedies and supplements, may help; however, do not neglect to speak with your doctor first, as some alternative treatments may not be safe if you or your residents have other medical conditions, or they may interact with certain medications.

Chemical changes in the brain and disrupted body rhythms in the fall and winter months coupled with limited outdoor activities may contribute to SAD, both in long-term care staff and residents. However, be happy knowing that there are proven ways to lessen and/or manage the symptoms. Seize every opportunity you can to go outdoors with the residents and be invigorated by fresh air and sunlight. Even on cold, cloudy days, natural light is better than huddling up indoors. According to an article by Sandra Hoban, Managing Editor at Long-Term Living Magazine, “Sunlight is far more beneficial for body rhythms than indoor lighting.”

Caring for others begins with caring for yourself, so do not brush off that yearly feeling as just the “winter blues” that you must tough out on your own. Be proactive and take steps to keep your mood and motivation steady during the winter months and all year long.

  1. https://www.aahealth.org/programs/behav-hlth/adult/sad
  2. http://www.ltlmagazine.com/article/winter-depression-elderly-can-be-sad
  3. https://www.aahealth.org/programs/behav-hlth/adult/sad
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