Sharon Heckman, 45, would describe herself as genuinely happy, enthusiastic and creative most of the time. Yet during the fall and winter months, she begins feeling a sense of foreboding, perhaps triggered in part by the onset of cooler weather, less natural sunshine and a general discomfort at the prospect of another holiday season.
Diagnosed with borderline personality disorder and mild depression, Heckman's drastic dips in moods during fall and winter weren't completely unexpected. Her counselors had told her she was more vulnerable to other forms of depression since neuro-psychotic disorders often run in multiple forms.
"I'd battled depression most of my life," she said. Yet she often brushed off the melancholy that seemed to hit almost immediately following the last traces of summer and worsened as the holiday season approached.
"I thought I just had the holiday blues," she said.
Heckman was diagnosed in 2004 with Seasonal Affective Disorder (SAD), a form of depression that affects more than half a million Americans. Often co-existing with other neurological disorders, SAD is diagnosed when the patient begins to notice deeper and longer lasting valleys in their moods that typically happen around the same time each year.
According to the Mayo Clinic, seasonal affective disorder is a type of depression that occurs regularly during certain seasonal periods, like fall and winter or spring and summer, and leaves the sufferer feeling moody and exhausted. Heckmann reported losing interest in things she once enjoyed and becoming withdrawn and isolated for the same period each year.
Symptoms of SAD include any of the following in addition to recurring and consistent moodiness during the same time every year (fall/winter and spring/summer):
Changes in weight (significant gains or loss)
Loss of interest in activities once enjoyed
While the specific causes of SAD are unknown, it is believed that genetics, age and body chemical makeup all contribute to the disorder. Other contributing factors, particularly for those who suffer from fall and winter SAD, might include disruptions in the following:
Circadian rhythm (biological clock), might be disrupted by the absence of sunlight, particularly in northern states, confusing the body's natural awareness of sleep and awake periods. This disruption may lead to feelings of depression.
Serotonin levels may drop during the winter months due to a decrease in sunlight. Drops in serotonin can also lead to feelings of depression.
Melatonin levels may become unbalanced, playing a role in sleep and mood patterns.
Dawn Wever, the community based care coordinator for Baycare Behavioral Health in Brooksville, works with all sorts of depressive disorders. Seasonal affective disorder is just one of many her patients battle, often in a dual-diagnosis situation with clinical depression, bipolar disorder, and other neurological issues.
As a licensed mental health counselor for five years, Wever has found that most of her patients who suffer from depression are typically women. But depression can hit any gender, she said.
"In depression in general we find through research that there are more women who report depression than men. But there are a lot of reasons for that. Usually women are more comfortable asking for help with emotional problems than men. So the numbers may be skewed simply because of the reporting differences," she said.
In addition, Wever has found that those who suffer from SAD also have acute disorders, stemming from clinical depression, bipolar disorder, or anxiety, to name just a few. "Most of the patients we see that suffer from seasonal affective disorder also suffered from at least one major depression in their lifetime," she said.
Therefore, patients who seek treatment for SAD are often already being treated for some other disorder. "And we treat the depressions the same way."
Around the holidays, there is a definite increase in depressive symptoms, Wever added.
Symptoms of SAD may present themselves during the fall and winter because of a lack of sunlight, which may affect the production of certain mood hormones. "Depressions stem from chemical imbalances in the brain," Wever explained. "But there are environmental triggers as well."
For instance, an individual may be prone to having mental health disorders but never have symptoms, while another may experience symptoms after the onset of a major event. Wever gave an example in the story of an individual she'd met recently who suffers incredible lows during the holidays. "He lost his grandfather on Christmas Eve," Wever explained, "and a lot of friends on Christmas Day during the Vietnam War."
Life traumas, therefore, can compound the symptoms of depression during the holidays, she said, particularly if they happened during that season.
Depression in general starts out slowly, Wever explained, and tends to get worse over time. And often the symptoms will go undiagnosed until they become obvious to someone who knows the person and begins to recognize significant changes in mood or behaviors.
Denial, she said, is a big reason why many don't seek treatment when symptoms are mild. And when they become more pronounced, the individual might have acclimated, thinking they can manage their symptoms on their own.
Yet if left untreated, symptoms will continue to get worse.
Warning signs of depression should be taken seriously and might include any or all of the following:
Suicidal thoughts or behavior
Problems at work or school
Seasonal affective disorder is treated the same as any other depression, Wever said, which might include counseling, coping techniques and drug therapy. "Research has shown that counseling and medications together result in the best treatment outcomes."
Yet some patients, because of stigmas attached to depression and medications, opt out of drug therapies and seek only counseling. "They just want someone to talk to," Wever said, "and that's fine."
Seasonal affective disorder, particularly in northern states, might also include light therapy as a treatment. Also called phototherapy, the patient uses a specialized therapy box that exposes them to bright light, mimicking outdoor light that appears to cause a change in the brain chemicals linked to mood.
Light therapy generally starts working within two to four days with few side effects.
Those affected can also lighten their environment by opening the blinds, trimming tree branches that block sunlight, or by sitting closer to the window while at home or in the office. They can also use outdoor exercise to expose themselves to more natural lighting.
Depression is likely an ongoing reality for those who suffer, Wever said, but can be controlled by keeping regular counseling appointments and being proactive in their own treatment. For those who experience an increase in symptoms around the holidays or during the fall and winter months, becoming vigilant in learning and applying coping techniques is an effective way to manage those symptoms in addition to their regular treatments.
Wever, who has been with Baycare Behavioral Health for five years, was inspired by a 12-year old girl who had tried to take her own life. "I was working at Oak Hill hospital at the time and was asked to sit with her during my shift," Wever recalled. "I learned so much about her and about how much was needed in this area for mental health."
Her biggest rewards, she said, come from helping people realize there is hope and they don't have to suffer alone.
Baycare Behavioral Health is located at the Hernando Today Plaza at 15299 Cortez Blvd.; Brooksville. They can be reached by phone at (352) 540-9535. Visit their website at www.baycare.org.