If the wintertime tends to bring about bipolar depression, seasonal affective disorder (SAD) could be to blame.
Q. What is seasonal affective disorder, and how does it affect people with bipolar?
Seasonal affective disorder (SAD) refers to a pattern of symptoms or episodes that appears to align with the seasons. SAD is not a diagnosis on its own, just the description of a pattern; for example, getting depressed in the fall or winter two seasons in a row would constitute a pattern.
Anyone can experience changes in mood that are affected by the season. We associate these phases with variations in sunlight: Most of us feel more cheerful on a warm, bright, sunny day than on a cold, cloudy, dim winter afternoon.
In people with bipolar, SAD is more commonly found in individuals with bipolar 2 disorder, who often report a slow malaise setting in during the fall that remits in early spring with abounding relief and a surge of impulsive energy. While the symptoms may be sufficient to qualify for a depressive or hypomanic episode, often they are “subthreshold” in frequency and intensity. But for the bearer of such symptoms, the misery of the dark, dreary winter is barely tolerable, and the exuberance of spring is colorful and intense.
Q. What about “reverse SAD”? How might spring or summer bring on symptoms of mania?
Every spring, we note an increase in the occurrence of mania and hospital admissions compared to other times of the year. Exactly why spring and summer bring on symptoms of mania in some individuals with bipolar disorder and not others is not known.
Spring and summer bring more sunlight. Light has a physiological effect on brain functioning and is helpful in treating depression. Treatment of depression can result in mania. While this logic does not prove that more sunlight results in mania in some individuals, there are strong clinical associations and indicators that support this premise.
Not every exposure to increased sunlight in the spring will cause manias to emerge; however, in the face of many risk or susceptibility factors, the change of seasons and variations in the amount of light are certainly thought to contribute to an emerging mania, at least in some people.
Q. What treatments are available for bipolar that follow a seasonal pattern?
The best treatment for bipolar disorder involves a good relationship with a care provider who is familiar with your symptom pattern and able to recognize emerging problems and risk factors. Any mood changes you may experience during the season are important data for your provider, so it is important that you stay in close communication with them during such times of change.
For depressive symptoms in the fall, your provider may suggest the use of a lightbox and regular exercise in addition to the medical and psychological management of bipolar disorder. Spring mania can be very tricky: When is an upswing in mood an emerging manic episode as opposed to normal joy and delight at the return of warm, sunny days?
RELATED: Why Does My Bipolar Worsen as the Seasons Change?
The critical problem with mania is that as your mood escalates, your self-perception and insight dissipate. You can very rapidly become convinced that you are just fine and that your actions — actions that others may consider indiscreet or risky — are perfectly reasonable.
Enlisting a family member or friend to provide ongoing feedback on your health and stability is helpful. Ask them to be honest and direct with you if they note any worrisome changes in your mood or behavior that might suggest mania. A manic episode can have profound personal, social, and vocational implications — early intervention is crucial and life-saving.
Whether your bipolar disorder is affected by the seasons or not, the importance of maintaining a healthy lifestyle year-round cannot be overstated. Recognize your risks and devise a plan with your care provider to minimize them.
Printed as “Ask the Doctor: Feeling Better about SAD,” Spring 2014