Summertime Get´s You Down?

Everyone may face the blues at some time. It is normal to feel sadness, gloom, or weak energy at times. But depression differs from the regular bout of emotion. Depression can cause you to lose interest in activities you’ve always enjoyed, withdraw from loved ones, and create a prolonged feeling of hopelessness. Sometimes, these mood changes begin and end when the seasons change.

What is Seasonal Affective Disorder (SAD)?

Seasonal affective disorder (SAD) is a type of depression that is characterized by symptoms that occur at the same time each year. Many people feel “down” or have the “winter blues” when the days get shorter in the fall and winter and feel better in the spring when longer daylight hours return.

But in the UAE, Saudi Arabia and Middle East, the condition may exist in reverse, a research team from Zayed University in Dubai as well as King Saud University in Riyadh stated.

SAD in the Middle East

Studies show that summer SAD is more common than winter SAD in countries near the equator. SAD affects 4 to 6% of the population in Saudi Arabia. Usually, SAD becomes more prevalent as the days get shorter and colder, but about 10% of people experience it in reverse with the arrival of summer.

Rising temperatures and humidity, as well as longer days, could be contributing factors. Overexposure to sunlight during the summer months can cause alterations in the body’s internal clock or circadian rhythm, as well as changed brain chemistry.

Furthermore, changes in daily routines, such as staying indoor all day, not connecting with friends at school or university, limiting outside activities like sports, and shifting bedtime, sleep, or mealtime, may all trigger depressive symptoms.

What causes SAD?

Studies suggest that both forms of SAD relate to altered levels of melatonin — a hormone important for maintaining the normal sleep−wake cycle. People with winter-pattern SAD produce too much melatonin, which can increase sleepiness and lead to tiredness and low energy. In contrast, people with summer-pattern SAD may have reduced melatonin levels which worsen sleep quality.

People with SAD also have reduced levels of the brain chemical serotonin, which helps regulate mood. Research suggests that sunlight affects the levels of molecules that help maintain normal serotonin levels. Shorter daylight hours — or staying inside climatized or darkened rooms during hot months — may prevent these molecules from functioning properly, contributing to decreased serotonin levels in the winter or during long indoor periods.

In summary, both serotonin and melatonin help maintain the body’s daily rhythm tied to the seasonal night-day cycle. In people with SAD, changes in serotonin and melatonin disrupt normal daily rhythms. As a result, they can no longer adjust to seasonal changes in day length, leading to sleep, mood, and behavior changes.

Vitamin D deficiency may exacerbate these problems because vitamin D is believed to promote serotonin activity. In addition to vitamin D consumed in food, the body produces vitamin D when exposed to sunlight on the skin. With less daylight in the winter or less outdoor activities during the hot summer period, people with SAD may have lower vitamin D levels, further reducing serotonin activity.

What are the signs and symptoms of SAD?

SAD is more than just the winter blues or summer drowsiness. As a condition, it is a type of depression distinguished by a recurring seasonal pattern, with symptoms lasting approximately 4–5 months of the year. Not all people with SAD experience all of the symptoms listed below.

This list is not intended to be used for self-diagnosis. If any of the symptoms listed below apply to you, consult your doctor.

Symptoms of depression can include:

• Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
• Feelings of hopelessness or pessimism
• Feelings of irritability, frustration, or restlessness
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy, fatigue, or feeling slowed down
• Difficulty concentrating, remembering, or making decisions
• Changes in sleep or appetite or unplanned weight changes
• Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
• Thoughts about death or suicide or suicide attempts

For summer-pattern SAD, additional symptoms can include:

• Trouble sleeping
• Poor appetite, leading to weight loss
• Restlessness and agitation
• Anxiety
• Aggressive behavior

Be aware:
The depression associated with SAD is not related to the calendar.

Holiday stress, as well as predictable seasonal changes in work or school schedules, family visits, and other factors, is not the same as seasonal affective disorder.

How is SAD treated?

Treatments are available to support people with SAD. They fall into four main categories that can be used alone or in combination:

• Light therapy
• Vitamin D
• Psychotherapy
• Antidepressant medication

Light therapy and vitamin D are treatments for winter-pattern SAD, whereas psychotherapy and antidepressants are used to treat depression in general, including winter- and summer-pattern SAD.

However, vitamin D deficiency is a growing issue around the globe and is highest in the Middle East North Africa region. Whereas, the sun is the primary source of vitamin D, people in the Middle East, including the UAE, typically avoid sun exposure due to the high temperatures especially in the summer period. Therefore. around 90% of people in the UAE experience vitamin D deficiency, and this prevalence is continuously increasing. This, checking the vitamin D level may be reasonable also for summer depression on hot countries.

In case you or a loved one are affected by SAD, talk to a health care provider about the potential benefits and risks of different treatment options and which treatment is best for you.