Are you a SAD nurse?

How to cope with Seasonal Affective Disorder in the nursing world 

Millions of people suffer from Seasonal Affective Disorder (SAD), a transient mood disorder brought on by decreased levels of natural light in the shorter days and longer nights of the fall and winter. This year, researchers expect an even higher prevalence of SAD in a population still reeling in the wake of stress left by the COVID-19 pandemic.

Nurses and nursing students are particularly susceptible to developing SAD due to the long hours we work and the level of burnout already being experienced in our field. Let’s take a look at what SAD is (and isn’t), what nurses can do to prevent it, and what to do if you think you’re already experiencing it. 

A SAD state of affairs

As people who live farther from the equator know all too well, they are exposed to less sunlight in the fall and winter months. During these seasons, it’s not uncommon for feelings of sluggishness to increase. These urges—to stay homebound and withdraw from one’s social life—are colloquially referred to as the ‘winter blues.’ SAD, by comparison, is a more persistent and invasive form of this disruption. 

Also known as ‘seasonal depression’ SAD was first described by Dr. Norman Rosenthal in the 80s. Predictably, Dr. Rosenthal and his research colleagues found that 10% of New Hampshire residents experienced SAD, as compared to only 1.5% of Floridians. The predominant symptoms are similar to clinical depression and include decreased mood, periods of anxiety, hypersomnia, weight gain from overeating, as well as plunging energy levels. With a distinct onset in the fall and a complete remission by late spring, SAD is differentiated from clinical depression by its seasonal occurrence.

Young adult females with a family or personal history of depression are most at risk for developing SAD. One’s job requirements—having to begin work early in the morning, working long hours, having a windowless work environment, and working under intense deadlines—contribute additional layers of risk. In other words, nurses, it seems, have a particular propensity for developing SAD. 

To know it, is to dodge it

Theories to explain SAD hypothesize that fluctuating hormone and neurotransmitter levels are to blame for SAD’s occurrence. Indeed, both excessive melatonin production and serotonin dysfunction have been linked to SAD. This helps to explain the compelling urge to sleep and the pervasive flat mood that SAD sufferers report experiencing. It also makes a strong case for utilizing prevention strategies to combat SAD from developing in the first place.

Of course, healthy eating, heart-pumping exercise, and adequate sleep are the cornerstones of anyone’s self-care baseline. But, purposefully tending to our mental wellbeing can go a long way towards warding off SAD, too. For nurses, that means bolstering our social connections,  spending time engaged in activities we love, and keeping our work schedules manageable. For those already prone to depression, that may look like an extra therapy session or two as fall approaches, or a prophylactic medication adjustment before the daylight hours wind down.

See the light

Other theories to explain the development of SAD implicate circadian rhythm dysregulation due to decreases in the eye’s sensitivity for natural light. In these cases, irregularities in  melanopsin, a retinal pigment, are thought to be influenced by gene abnormalities. In these cases, no amount of self-care would ward off the onset of SAD. What does work, however, is refreshingly simple—morning light exposure.

Light therapy, as defined by the American Psychological Association, involves sitting under a bright light (devoid of ultraviolet rays) for 20-45 minutes every morning during the fall and winter months. Light boxes that emit 10,000 lux can be purchased specifically for the treatment of SAD. For those with a known history of SAD, experts recommend beginning light therapy prior to any symptom onset. If you suspect that you may have SAD, paying attention to bodily cues, like increased anxiety and irritability, and/or changes in mood, like feeling lonely or noticing poor concentration can tip you off on when to begin light therapy.

The mechanisms driving SAD are theoretical at best, but the effectiveness of light therapy to offset the loss of natural light during the cooler months definitely points to melatonin as a culprit. Light halts melatonin production, which increases your mental alertness. That in turn promotes appropriate energy expenditure during the day when you need it most, and allows you to have restful and quality sleep. Supplementing with light therapy, therefore, fine tunes your sleep-wake schedule and helps to prevent the oppressive daytime sluggishness so common in SAD.

Other means of treating SAD include diagnosing underlying vitamin D deficiency. Lower levels of sunlight exposure decrease your body’s ability to make its own vitamin D. Before taking any vitamin supplement, it’s prudent to have your levels checked. (Nurses, you might be interested to know this fun fact: when taking vitamin D3, you should always take vitamin K2 with it. Vitamin D3 pulls more calcium from the foods we eat and vitamin K2 helps to move it along into our teeth and bones where we can use it, and out of our vasculature lest we develop arterial microcalcification.)

Extra buffers for nurses when it comes to SAD

If you’ve been dreaming of escaping away to somewhere warm and sunny, consider this your sign to get away in the name of mental health. Executing a vacay with a friend or two to a sunny locale (sorry, getaways with family qualify as ‘trips,’ not vacations) knocks down every environmental risk-factor for developing SAD by a peg or two. 

Taking a much-deserved break from work: check. Daily light therapy: check. Social relationship-fortification: check. Vitamin D production booster: check. Meditating on an actual beach beats hiding from winter in your bedroom with a sound machine, 10/10. 

As nurses, we know that an ounce of prevention beats a pound of cure. We can’t expect to craft an effective mental health strategy when winter’s melancholy is pressing down on us. Remember, stress is extra burdensome for those who experience SAD, so stay vigilant, and spread the word—because when the sun comes back around several months from now, we need every nurse here to welcome it.