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Symptoms
By Mayo Clinic Staff

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Fall and winter seasonal affective disorder (winter depression)

Winter-onset seasonal affective disorder symptoms include:
•Depression
•Hopelessness
•Anxiety
•Loss of energy
•Heavy, “leaden” feeling in the arms or legs
•Social withdrawal
•Oversleeping
•Loss of interest in activities you once enjoyed
•Appetite changes, especially a craving for foods high in carbohydrates
•Weight gain
•Difficulty concentrating

Spring and summer seasonal affective disorder (summer depression)

Summer-onset seasonal affective disorder symptoms include:
•Anxiety
•Trouble sleeping (insomnia)
•Irritability
•Agitation
•Weight loss
•Poor appetite
•Increased sex drive

Seasonal changes in bipolar disorder

In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania). This is known as reverse seasonal affective disorder. Signs and symptoms of reverse seasonal affective disorder include:
•Persistently elevated mood
•Hyperactivity
•Agitation
•Unbridled enthusiasm out of proportion to the situation
•Rapid thoughts and speech

When to see a doctor

It’s normal to have some days when you feel down. But if you feel down for days at a time and you can’t seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.

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DEFINITION:
By Mayo Clinic Staff

Seasonal affective disorder (also called SAD) is a type of depression that occurs at the same time every year. If you’re like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.

Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

CAUSES
By Mayo Clinic Staff

The specific cause of seasonal affective disorder remains unknown. It’s likely, as with many mental health conditions, that genetics, age and, perhaps most importantly, your body’s natural chemical makeup all play a role in developing the condition. A few specific factors that may come into play include:
•Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may disrupt your body’s internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
•Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in seasonal affective disorder. Reduced sunlight can cause a drop in serotonin that may trigger depression.
•Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.

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Mindfulness exercises: How to get started

Looking to start living in the moment? Find out how to use mindfulness exercises to develop a greater awareness of the world around you.
By Mayo Clinic Staff

If you’ve heard of or read about mindfulness — a form of meditation — you might be curious about how to practice it. Find out how to do mindfulness exercises and how they might benefit you.

What is mindfulness?

Mindfulness is the act of being intensely aware of what you’re sensing and feeling at every moment — without interpretation or judgment.

Spending too much time planning, problem-solving, daydreaming, or thinking negative or random thoughts can be draining. It can also make you more likely to experience stress, anxiety and symptoms of depression. Practicing mindfulness exercises, on the other hand, can help you direct your attention away from this kind of thinking and engage with the world around you.

What are the benefits of mindfulness exercises?

Practicing mindfulness exercises can have many possible benefits, including:
•Reduced stress, anxiety and depression
•Less negative thinking and distraction
•Improved mood

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Treatments and drugs
By Mayo Clinic Staff

The two main treatments for dysthymia are medications and talk therapy (psychotherapy). Medications appear to be more effective at treating dysthymia than psychotherapy when either is used alone. Using a combination of medications and psychotherapy may be slightly more effective.

Which treatment approach your doctor recommends depends on factors such as:
•Severity of your dysthymia symptoms
•Your desire to address emotional or situational issues affecting your life
•Your personal preferences
•Previous treatment methods
•Your ability to tolerate medications
•Other emotional problems you may have

Medications for dysthymia

Types of antidepressants most commonly used to treat dysthymia include:
•Selective serotonin reuptake inhibitors (SSRIs)
•Serotonin and norepinephrine reuptake inhibitors (SNRIs)
•Tricyclic antidepressants (TCAs)

Finding the right medication

SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. Which antidepressant or a combination of medications is best for you depends on your individual situation.

If you’re bothered by side effects, don’t stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off, and quitting abruptly may cause a sudden worsening of depression. Don’t give up until you and your doctor find a medication that’s suitable for you. Talk with your doctor or pharmacist about possible side effects to weigh the benefits and risks. In some cases, side effects may go away as your body adjusts to the medication.

When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control.

Antidepressants and increased suicide risk

Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry “black box” warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers.

Psychotherapy for dysthymia

Psychotherapy can help you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy coping skills and stress management. Psychotherapy can also help you:
•Learn to make decisions
•Reduce self-defeating behavior patterns, such as negativity, hopelessness and a lack of assertiveness
•Improve your ability to function in interpersonal social and work situations

You and your therapist can discuss which type of therapy is right for you, your goals for therapy, and other issues, such as the length of treatment.

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Tests and diagnosis
By Mayo Clinic Staff

If your doctor suspects you have dysthymia, exams and tests may include:
•Physical exam. The doctor may do a physical exam and ask in-depth questions about your health to determine what may be causing your dysthymia. In some cases, dysthymia may be linked to an underlying physical health problem.
•Lab tests. For example, your doctor may order a blood test called a complete blood count, do blood tests to check your folate and Vitamin D levels, or test your thyroid to make sure it’s functioning properly.
•Psychological evaluation. This evaluation includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis.

Checking for other conditions

Several other conditions have symptoms that may resemble dysthymia. Your doctor or mental health provider’s evaluation will help determine if you have dysthymia or another condition that can affect your mood, such as major depression, bipolar disorder or seasonal affective disorder.

Diagnostic criteria for dysthymia

To be diagnosed with dysthymia, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of dysthymia, the main indication for an adult differs somewhat from that of a child:
•For an adult, depressed mood most of the day for two or more years
•For a child, depressed mood or irritability most of the day for at least one year

In addition to that, you must have at least two of these symptoms, and they must cause distress or interfere with your ability to function in your daily life:
•Poor appetite or overeating
•Sleep problems
•Tiredness or lack of energy
•Low self-esteem
•Hopelessness
•Poor concentration
•Trouble making decisions