Lupus and Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD), sometimes called, the “winter blues,” can affect almost anyone this time of year. However, this form of depression can be particularly challenging for those living with lupus. Read on to find out more about the complex relationship between SAD and lupus, and learn some simple ways to “brighten” one’s outlook!
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Introduction: The 30-Second Overview
What is SAD?
Seasonal affective disorder (SAD), is a common form of depression, affecting about 5% of the U.S. population each year. That’s at least 17 million people! As the name suggests, it occurs at specific times of the year, and is related to the changes of the seasons. About 90% of SAD occurs in the fall and winter, and is often called the “winter blues.” The other 10% strikes in the spring and summer.
For the majority of those with SAD, colder temperatures and shorter, darker days trigger changes in their mood and emotions, decreasing their ability think clearly, and sometimes increasing their feelings of fatigue and pain. They just feel “out of it” and have an even harder time getting out of bed.
The less common seasonal affective disorder of the spring and summer, triggered by longer days and hot weather, affect a person’s emotions in different ways, such as increasing anxiety, trouble sleeping, poor appetite and restlessness.
Why is this important for those living with Lupus?
Studies have found that lupus actually increases the risk for seasonal affective disorder. It is also particularly important for lupus patients because:
- The symptoms of SAD can aggravate the symptoms caused by SLE, such as the depression that understandably comes with having with an incurable, unpredictable, and chronic disease like lupus.
- SAD can mimic or even hide the lupus symptoms, which in turn can make it that much harder to diagnose changes in a person’s lupus or to judge the effects of treatments.
- If a person is diagnosed with SAD, many of the medications and lifestyle choices that help with this condition can also be very effective in treating systemic inflammation and some of the similar symptoms caused by lupus.
For all of these reasons, it is important for those with lupus to know about seasonal affective disorder – how it can be diagnosed and how it can be treated. Read on to learn more!
Note; If you or anyone you know is suffering from serious depression or symptoms of SAD, contact a healthcare provider or mental health specialist. If identified and treated early, a good deal of suffering can be avoided!
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The Science of SAD
SAD is not the same as other kinds of depression, and its causes are still not well known. However, it is clear that seasonal, changing light levels can significantly affect the brain chemistry – in particular the levels of three chemicals that influence one’s mood – melatonin, serotonin, and vitamin D.
Melatonin: Sunlight directly influences a person’s internal clock (circadian rhythm) by regulating the production of melatonin, the brain hormone that controls the sleep-wake cycle. Especially in the morning, when a person is exposed to sunlight, specifically the blue part of the spectrum, it inhibits the production of melatonin by the pineal gland in the brain. This encourages the person to remain awake and alert. In the evening, as light levels dim, the pineal gland increases melatonin levels and this prepares the brain for sleep. This is why melatonin is taken by many as a sleep aid.
If there is not enough light to turn off the melatonin, the sleep cycle is disrupted and this may lead to SAD.
Serotonin: People with SAD have significantly lower levels of serotonin, another brain hormone that influences mood, memory, the ability to think and learn – as well as many other regulatory functions like digestion. As it turns out, serotonin is also needed by the pineal gland to produce melatonin. So, a reduction in both is doubly bad for a healthy sleep cycle.
Factoid: The precursor to serotonin is tryptophan, an amino acid that has been inaccurately blamed for causing sleepiness after eating turkey on Thanksgiving. Clinically, it has actually been shown to be an effective, if mild, antidepressant!
Vitamin D: This important vitamin is actually produced by the skin when it is exposed to the sun. Even just a few minutes of sunlight can produce enough vitamin D to last all day. Of course, short days and lack of time in the sun often results in vitamin D deficiency and low vitamin D has been linked to both SAD and increases in lupus activity.
It is amazing to think that something as simple as just getting the right amount of healthy sunlight can mean so much for healthy sleep, a good mood and all the other mental and physical benefits they bring!
Symptoms
All forms of seasonal affective disorder resemble those of other kinds of depression. They can compound the symptoms of that those living with lupus already feel – the depression, anxiety, pain and fatigue that come with a chronic, unpredictable and often debilitating disease like SLE. These symptoms last for weeks if not months and include:
- Persistent sadness or “empty” feeling;
- Lack of energy and feeling “run down;”
- Difficulty concentrating or remembering;
- Feeling of hopeless or helplessness – even guilt;
- Physical aches and pain or digestive problems without a clear cause;
In the winter, these can lead to other symptoms, like:
- Hypersomnia (sleeping too much) and the deire to “hibernate;”
- Overeating “comfort food” – in particular those heavy in carbohydrates
- Withdrawal from socializing and isolation
In the summer, different symptoms may arise, such as:
- Insomnia (trouble sleeping);
- Poor appetite – even weight loss;
- Anxiety;
- Restless or aggressive behavior.
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Diagnosis
It can be difficult to diagnose seasonal affective disorder because these symptoms can be caused by many other condition. This is a challenge for physicians and patients alike. A thorough evaluation will generally include:
- A physical exam that takes into account all of the possible causes that may be attributed to lupus alone.
- Lab tests will include complete blood counts and test for thyroid functioning which can also attribute to seasonal affective disorder.
- A psychological evaluation may be necessary diagnose specific types of depression. There are even questionnaires designed to differentiate SAD from other forms of depression.
Treatment and Other Options
Phototherapy or Bright Light Therapy (BLT) has been commonly used to treat fall/winter SAD since the 1980’s. It usually involves daily exposure to a lamp that provides a kind of artificial light that simulates the sun. This, hopefully, resets the pineal gland, increasing serotonin levels. As a first line of treatment, it is widely considered effective.
The Mayo Clinic suggests this advice when using light therapy boxes:
- Always follow manufactures recommendations and the advice from your healthcare provider.
- The lamp should provide about 10,000 lux of light with a range of between 16 and 24 inches from the face.
- It should produce no UV light, so that it does not increase the risk of a lupus flare.
- Exposure should begin within the first hour after waking up and last between 20 and 30 minutes.
- Do not stare into the light directly.
- Let our healthcare team know if and when you feel any change in mood or other symptoms.
Lifestyle Changes: Knowing the triggers for SAD and avoiding them or at least adapting to them can also be effective. Some things to consider include:
- Make seasonal changes something to celebrate, not just dread!
- Maintain a healthy diet, and regular exercise in lighting and temperatures that resemble the seasons that you prefer.
- Make sure to take enough vitamin D daily and include vitamin D levels as part of scheduled blood tests.
- Limit your night time exposure to TVs, computers and smartphones at night. These screens radiate light from the blue/green end of the spectrum that can throw off melanin and serotonin levels at the wrong time of day.
- Regularly check weather forecasts to predict and prepare for when conditions are at their worst.
- Try to keep to a consistent sleep cycle.
- Therapy and counseling can be very helpful in talking through the challenges of SAD and other emotional strains on living with lupus.
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In Conclusion:
The impact of seasonal affective disorder for people with lupus can be complex. SLE patients have a higher risk for developing SAD, and it can have a devastating impact on their quality of life. It can even make treating lupus symptoms more difficult. Yet, there are so many ways to overcome SAD and the other kinds of depression that those with lupus suffer. It is important to take emotional challenges seriously, and communicate openly with healthcare providers. Sometimes, it might just be as simple as shedding a little light on your problems … we suggest a slightly blue-colored light!
Again, if you or anyone you know is suffering from serious depression or symptoms of SAD, contact a healthcare provider or mental health specialist. It can be treated. Remember, you and they do not have to deal with SAD alone!
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References
Moul, D.E. (1992). Light exposure in a subset of patients with lupus erythematosus. Archives of Internal Medicine, 152(9). doi:10.1001/archinte.1992.00400210149032
Mayo Clinic Staff (2021, December 14). Seasonal affective disorder (SAD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
Mayo Clinic Staff. (2022, March 30). Seasonal affective disorder treatment: Chossing a light box. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298
National Institute of Mental Health. (n.d.). Seasonal Affective Disorder. Retrieved December 2, 2023, from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
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Author: Greg Dardis, MS
Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University and the American College of Healthcare Sciences. His focus has been human biology and physiology with an interest in autoimmunity. Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.
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