It is no secret that Torontonian winters can be hard. Short days, freezing dorm rooms, and long waits for the streetcar in the snow are all frustrating enough on their own. Dragging yourself away from the fire to get to the pub on a Friday night can be a Herculean task for anybody, especially when the thermometer reads -20C outside.
It seems somehow counterintuitive that a drop in temperature, something that could be easily remedied by a hot chocolate or a warm blanket, causes so much turmoil that for some simple activities such as waking up for class or meeting a friend for coffee are rendered very difficult or even impossible. For some U of T students, this is a fact of life three months of the year.
It is likely that you are starting to notice a prevalence of the words ‘seasonal affective disorder’ (SAD) come up increasingly in conversation. Although one third of Canadians report feeling worse off in the winter, for a small portion of the population the common experience of feeling ‘down’ when it’s cold outside turns into a full-blown and extremely debilitating disorder that shares some similarities with depression.
SAD is diagnosed by a medical professional but it has also taken on a colloquial meaning for those who suffer through winter weather rather than enjoy it. In an environment that pressures people to go out and be productive in both your social and academic life, it is understandable when tired students turn to clinical terms with a self-explanatory name to make sense of their otherwise unexplained lack of motivation. According to the Canadian Mental Health Association (CMAH), only two to three per cent of Canadians experience SAD in their lifetimes. As with many mood disorders and mental illnesses, understandings of SAD differ between the public, the patients, and the medical community. We spoke to several SAD-suffering students and mental health professionals to work through the facts and myths surrounding this cryptic disorder.
The truth about SAD
As with depression and other mood disorders that can result in depressive episodes, simply feeling ‘down’ is not the same as having SAD. “[I]t’s characterized by a fairly distinct set of symptoms, and those symptoms include not necessarily a sad mood,” says Dr. Robert Levitan, Cameron Wilson Chair in Depression Studies, and professor in the departments of psychiatry and physiology at U of T.
Although SAD and depression are similar, there are important differences between the two disorders.
Levitan explains that while SAD is characterised by oversleeping and carbohydrate cravings, many people with non-seasonal depression will experience insomnia, loss of appetite and loss of weight. “[SAD] is somewhat of a different syndrome when you look at the overall number of symptoms and it doesn’t always necessarily involve sadness,” he adds, “so typically what we see is more that patients lose their motivation and energy. I would look at [SAD] almost as related to energy regulation as I would just a pure mood disorder.”
Although Levitan gives a fairly clear definition, between SAD the disorder, and having sad feelings, the differences remain somewhat ambiguous. Students living with SAD report distinct and often debilitating symptoms.
Polly*, a U of T undergraduate student, describes how her SAD causes lethargic symptoms that affect her schoolwork during the winter semester.
“ …[N]o matter how important [my homework] is, it can be like a 20 page paper and I’m just like ok later. [Later] never comes.”
For Polly, the disorder has led to problems with her social life and self-worth in addition to school work.
“I think in second year and third year [my SAD] was the worst, because that’s when it got like the darkest. I was just never leaving the house and I didn’t fully understand why,” she says.
“I tried to just like attribute [my symptoms] to other things, and there was all this imagined pressure. I was like ‘oh well it’s because I’m not succeeding that’s why I’m not happy’ or like ‘[I] haven’t done anything with my life yet, that’s why I’m not happy’ and it was just a lot of excuses.”
Ali* is a fourth-year psychology student who describes similar difficulties: “I guess I’ve been experiencing the effects [of SAD] probably pretty much since I came to Canada,” he says, “I usually just experience a lot of lethargy, like it’s hard… for me to get going in the morning.”
The lack of sunlight causes Ali particular difficulty. “It’s hard for me to get motivated and do anything throughout the day, and it can be really hard for me to [prevent] my sleep cycle [from going] out of whack very quickly when I just don’t get enough sunlight.”
Lack of motivation left Ali confused and helpless prior to diagnosis. One result of this was devastating academic consequences.
“Actually that’s how I sort of in retrospect realized that I was having problems with SAD,” Ali reflects, “in first-year… my motivation to get out of bed and go to school plummeted, and basically just wasn’t there anymore.” he explains.
Ali nearly failed high school, and failed his first year of university as a result of his SAD.
An evolutionary process
It is not clear how the complicated relationship between the brain and the body affect the onset and treatment of mental illnesses — a puzzle which continues to challenge researchers and health care professionals. Thatsaid, most mental illnesses can be recognized from physical symptoms; mental states are heavily influenced by diet, exercise, and environment. Levitan believes that environmental factors may have a greater impact on SAD than other mood disorders. “If you think about your day-to-day biology and mood, it’s profoundly affected by light and dark cycles,” he says. “They’re a fundamental aspect of nature, of biology, and life on the planet.”
Levitan explains that his research on SAD has led him to believe that the way our bodies have evolved is more connected to our geographical location than we may expect.
According to Levitan “we all have body clocks within us, and those body clocks are very sensitive to changes in light.” Levitan believes that the root cause of SAD may lie in the body’s attempt to regulate energy given these natural ‘clocks.’
This could also explain why fatigue and carbohydrate cravings are a common symptom of SAD. “I think that when the fall [and] winter comes there are changes [in the body] to help us adapt to the winter time that perhaps during the ice age were very very helpful to us in terms of conserving energy and avoiding problems,” he adds, “and so I sort of see SAD as a natural process that has an evolutionary significance.”
A contentious disorder
As is often the case when it comes to mental illness physicians do not all agree on the definition — or indeed, the origin — of SAD.
The overlap of SAD symptoms with regular depressive symptoms contributes to why there are disagreements surrounding this disorder.
Dr. Edward Shorter, Jason A. Hannah professor of the history of medicine in the Faculty of Medicine at U of T, and a cross-appointed professor of psychiatry, goes so far as to say that SAD may not even exist.
“Let me make a few little points: I don’t think SAD is a legitimate form of depression,” he says in a phone interview with The Varsity. “I think it’s a kind of construct that [has] been imposed on the world of affective [mood] disorders.”
Shorter considers the depressive symptoms caused by SAD to be legitimate, but is not convinced that the disorder stands on it’s own. He believes that it is more likely that regular depression provoked by difficult experiences that some individuals undergo in the winter.
“Depression can be profoundly biological experience, to be more likely trigger[ed] by your genes or some terrible personal crisis,” he says. “Or whether the sun is shining that particularly February day.”
Levitan, however, sees SAD differently. “It definitely exists,” he states. “It’s just that you have to see a lot of patients with depression to understand the difference between somebody with a true seasonal depression versus somebody who says they’re seasonal but probably aren’t.”
He goes on to emphasize that — despite the overlap in SAD symptoms with those of depression —he believes that SAD is distinguished by the measurable physical changes that it causes.
“What we use clinically is not just the patient’s report,” he says, “but then we’ll get into the symptoms over a long period of time and consider other factors. In our research we’ll also do brain scans or we’ll look at actual measures of [patients’] biology and see whether there are changes that match our models.”
Although the most effective way to categorize SAD still remains unclear, the medical community has agreed on a temporary classification outlined in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). The DSM is the main standardized text that North American doctors use to diagnose all kinds of mental illnesses. ‘Seasonal affective disorder’ is coined in the fourth edition of the text, known as the DSM-IV. In the fifth edition of the DSM (the DSM-5), SAD is now classified as a sub-disorder under depressive disorders.
SAD no longer stands alone in the DSM but researchers agree that the harm it could cause is real, and serious.
“Real depression is characterized by anhedonia — the inability to experience pleasure,” Shorter says. “That means you don’t get pleasure from your children or grandchildren. You don’t get pleasure from working out. You don’t get pleasure from anything.”
Finding treatment, getting through
Antidepressive drugs such as Zoloft and Prozac are the general practitioner’s ‘go-to’ solution for many problems involving depressive symptoms; specialists, however, are beginning to believe that medication is not the only form of treatment for SAD.
One type of non-chemical treatment for SAD gaining popularity is light treatment; the CAMH SAD clinic notably uses devices
A SAD Lamp. NADEZDHA WOINOWSKY-KRIEGER/THE VARSITY
called ‘SAD lamps’ to treat their patients. The lamps are specially designed to imitate the light of the sun; they do so by radiating light at the exact same wavelength. Shorter credits the effectiveness of SAD lamps, largely, to the placebo effect. Levitan, on the other hand, sees things differently.
“The specific way it works is still not completely understood,” Levitan says, “[but] I see it very much as a stimulant… not unlike a psychostimulant drug that boost the levels of different systems in your brain so that they’re functioning normally.”
Levitan again refers to the biological and environmental sources of SAD. “If you think about it, every day in the morning you wake up, that’s a profound change in your biology,” he explains. “You’re going from a state of sleep to a state of activity, and so light speeds that up…[and] that’s difficult to do on the short days of fall and winter.”
“I think all of us to some extent are sensitive to light in our environment, and using very very bright lights… at just the right time of year in the right individuals, I think corrects essentially a tendency to be in a state of low arousal which leads to the sleep problem of fatigue and the overeating.”
Support for this theory may be found in the usage of SAD lamps to treat jet lag, Levitan suggests. “Jet lag is, when you think about it, in some ways is similar to [SAD],” he says, “it’s just something that happens very quickly when your body is out of sync with respect to the day and night cycle.”
Along with regular sunlight, or imitative sunlight, proper nutrition may also be key in combating SAD. There have been several studies in recent years indicating that SAD might be a consequence of not having enough vitamin D in the body — a deficiency from which many North Americans are believed to suffer.
Some have even suggested that seasonal changes in sunlight affect the circulation of vitamin D3 — the chemical responsible for keeping us energetic and motivated — the lack of which results in the symptoms of fatigue and lethargy.
One group of Danish researchers performed a double-blind trial in 2014, where one group of SAD patients were given vitamin D supplements and another group were given a placebo. The group that took the vitamin D scored higher on a standardized depression test known as the Hamilton Depression Rating Scale — a bleak result for supporters of vitamin D as a SAD treatment. The link, however, was only established after participants had taken the supplement for a period longer than 12 months. On top of that, only 34 participants completed the study.
A 1999 study performed by the Union Memorial hospital in Baltimore indicated that vitamin D is a far more effective treatment for SAD than light therapy, with a 74 per cent and a 34 per cent positive result respectively. This study, however, was only conducted on 15 participants and used a ‘randomized control’ method but did not make use of a placebo.
Despite turbulent evidence, the vitamin D SAD treatment idea has caused a large stir among the psychology as well as nutrition communities, and many SAD sufferers have already taken it upon themselves to self-medicate using this method. “I actually have a SAD lamp [at home]…but mostly these days I find that just taking large doses of vitamin D keeps me ‘up’,” says Ali.
Ali says that he “stumbled onto” vitamin D when a doctor prescribed it to him, and he credits this discovery with immense improvement in his life.
“It seems kind of weird that a couple of pills that you can get for a couple of dollars was one of the reasons I like failed my first year and you know lost thousands of dollars doing that,” Ali adds. “But yeah, shit happens.”
Fourth-year English student Anya Zaporozhchenko, also cites vitamin D as a simple, cheap remedy for students with SAD.
She also emphasizes the importance that students with SAD treat their disorder as they would any other illness. “I think it’s important to take time for self-care. Maybe schedule something indoors with your friends, even if you have work,” she says. “You know, you gotta pick a night to do something indoors and cheer yourself up a little bit.” Zaporozhchenko also discusses how important it is for U of T students to fight mental health stigma and treat SAD as a reality faced by many, rather than something we need to be ashamed of.
For Zaporozhchenko, openness and understanding within the U of T community is integral to helping SAD sufferers manage their illness. “It’s nice to even be able to talk about things,” she says. “It sounds so silly, but it’s nice, even when I’m talking to my friends who also struggle with mental health issues. Even when you say ‘try this medication, I tried it. These are the side effects that I got’…[M]aybe, there’s a new hobby that keeps you motivated a little bit. It’s nice to be able to talk about that sort of thing.”
Though antidepressive drugs, vitamin D supplements, morning light therapy, nutrition, and exercise have all been referenced by mental health professionals as effective treatments, it is clear that none are universal.
Students have taken note, meanwhile, that SAD lamps and vitamin D supplements are both accessible to patients who may not have access to psychiatric health care and those without a diagnosis.
Students helping students
Due to the confusion within the medical mental health community surrounding SAD, the denial from many parents and educators about its existence, the extent to which it affects student lives, and the societal stigma that is still always present many students have found it necessary to take SAD treatment into their own hands. For example, last year Auni Ahsan, Victoria College Director at the UTSU, launched a SAD lamp campaign with funding from Vic Student Projects, a program where Victoria College student initiatives can obtain financial support.
Ahsan successfully procured $785 dollars to purchase three SAD lamps, that students can borrow from the Victoria College Students’ Administrative Council (VUSAC) office for free at any time. He says he got the idea from a post on the U of T subreddit, in which a student noted that other universities had SAD lamps available on campus.
“I think that something really prominent about seasonal affective disorder is that it’s both like underdiagnosed and underrepresented,” Ahsan says. “A lot of people suffer from symptoms of it or even the clinical diagnosis of it, but [are] not really … aware of it.”
Ahsan believes that awareness of SAD and accessibility to treatment go hand in hand. “I think that a big part of the campaign, or a big part of getting SAD lamps, is you need to have the lamps here,” he explains. “And you need to start having a campaign about awareness for the fact that students might be suffering from this issue, so that they become more aware of it and more willing to use the resources that are here.”
Ahsan explains the method behind SAD lamp use: “The basic idea is that you sit next to this lamps for thirty minutes every day…like 12 to 14 inches away, you can be like eating cereal or like doing homework at the same time, and you’re supposed to do it every day.”
Levitan agrees that the free availability of SAD lamps is a great resource. “I think it’s a wonderful idea,” he says of the initiative. “The advice I have is that early [in the day] is better…you can still benefit later [in the day], but often the way it works is to reset your biological clock so that you’re waking up earlier, and that ability to wake up earlier is often what makes people feel a lot better.”
He also explains the most effective way to use the lamps, “I would say a half an hour is good; [students] can study while they use the light…the light should be in front of them but they shouldn’t be staring right at it.”
After realizing the simplicity and usefulness of the SAD lamp program, Ahsan decided to extend it to the greater St. George population, and brought the idea to the UTSU in 2015. He obtained funding for the UTSU to buy four additional SAD lamps, which are currently available for use in the basement of the UTSU office.
Ryan Gomes, UTSU VP internal explains that a poster awareness campaign to advertise the lamps is underway. “I expect [the posters] to reach out all over campus, hopefully from as far as here at VUSAC to all the way down at Bahen,” says Gomes. “Because I think that this is a disorder that affects people all across campus.”
Both Gomes and Ahsan recognize the importance of solidarity when it comes to mental illnesses within the community. Even for those who not diagnosed with SAD, there are many U of T students who may suffer from winter blues.
“There’s no harmful side effects from the SAD lamps for the most part anyway,” Ahsan concludes. “But like my hope is that more people will become aware of the fact that these sorts of mental illnesses can affect you on a really small scale, affect your school performance, or affect your social life, and can take the steps to get better. And we hope we can help with that.”
*Names changed at individuals’ request
With files from Clara Osei-Yeboah
Correction (February 10th, 2016): An earlier version of this article listed an incorrect acronym for the Canadian Mental Health Association.
