Nearly 10 per cent of Canadians ages 12 and older have a mood disorder (1). One definition of mood disorder is a general emotional state or mood that interferes with one’s ability to function. Major depression disorder (MDD), anxiety and bipolar disorder (BP) are the commonly thought of mood disorders. However, are you aware that seasonal affective disorder, a form of depression, is also a mood disorder?
While mood changes brought on by the seasons have long been part of human nature, (think of the “winter blues)”), the more formal term, seasonal affective disorder (SAD), was coined by researchers at the National Institutes of Health in 1984. The researchers noted a seasonal pattern of depression in themselves they theorized was linked to reduced sunlight during the winter months.
Why is a better understanding of SAD important for underwriters? After all, it sounds almost normal to get a little down when the long, darker days of winter set upon us. Who wouldn’t be a little blue during this time? One key is to understand that SAD is a subtype of major depression or bipolar disorder. This fundamental point emphasizes that this condition is not a separate condition and requires the careful attention and underwriting scrutiny given to any case of known mood disorder in the insurance applicant. Let’s look at some of the distinguishing features of this condition.
The hallmark feature of SAD is recurring episodes of major depression, mania or hypomania that occur seasonally and then remit (2). Once the seasonal pattern of onset and remission is established, the diagnosis is confirmed. Though we think of SAD as a winter-only impairment, seasonal can include spring-summer onset (3). This is counterintuitive, but very real to the afflicted. This pattern is also known as summer depression. In addition to a different seasonal onset period, spring-summer SAD is characterized by insomnia, reduced appetite and weight loss. The better-known fall-winter form of SAD generally reports the opposite symptoms: more sleep, carbohydrate craving and weight gain. The ties that bind both forms are the various symptoms that serve as the diagnostic criteria for major depressive disorder. These include but are not limited to the following: depressed mood and a markedly diminished pleasure in all or most activities most of the day or nearly every day, fatigue or energy loss, a diminished ability to think or concentrate and/or feelings or worthlessness.
The above symptoms serve to remind us that SAD can be a serious illness depending on severity. In its’ most severe form, it can impair ability to work and almost all aspects of day-to-day functioning. Like all cases of depression, including bipolar disorder, the risk of suicide may be elevated and careful review of the medical file is necessary to assess for this most catastrophic of outcomes.
Treatment for SAD is very much in keeping with major depressive disorder (4). This includes antidepressants and psychotherapy with one notable addition; light therapy. Bright light therapy, artificial bright white light administered one or more times and up to 4 hours daily can be very effective in treating SAD. This has been the case for well over 30 years and a recent meta-analysis (a grouping of various studies on a similar subject), confirmed the efficacy of bright light therapy (5). Combined with more traditional treatments for depression and attention to modifiable factors like sleep hygiene, daily walks outside and aerobic exercise, seasonal affective disorder can often be managed. A welcome ray of light for this potentially serious condition.
- Government of Canada. Mood disorders, by age group. Statistics Canada. September 8, 2021.
- Kurlansik, Stuart and Ibay, Annamarie. Seasonal Affective Disorder. American Family Physician. December 1, 2012.
- Galima, Samuel, Kowalski, Adam and Vogel, Stephen. Seasonal Affective Disorder: Common Questions and Answers. American Family Physician. December 1, 2020.
- Truschel, Jessica. Depression Definition and DSM-5 Diagnostic Criteria. Psycom. September 25, 2020.
- Cambioli, Luca, Dold, Markus, Friedrich, Michaela-Elena, Jager, Fiona, Kasper, Siegfried, Komorowski, Arkadiusz, Lanzenberger, Rupert, Pjrek, Edda and Winkler Dietmar. The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials. National Library of Medicine. October 1, 2019.
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