Abigail Strubel, MA, LCSW, CASAC
Sneaky SAD
How Seasonal Affective Disorder sneaked up on me, symptom by symptom.
Abigail gets fooled. The fall of 2015 was the warmest and brightest on record in New York, and winter depression seemed a distant thought. As I remarked in a New York Times interview, though, “The people who have benefited until now are going to crash, and they will do it very quickly.” It did turn cold and dark in January, and, yes, people crashed … but not as fast as crash implies. Before the depression hits, you’re noticing a parade of symptoms that culminate in the crash. Below, self-observant Abigail writes the textbook case report. —Michael Terman
In early November 2015, I set up my light box and waited for SAD to strike. I even took the AutoMEQ self-assessment on cet.org to determine the optimal time to use it. But strangely, I was only hit with one symptom, terminal insomnia — which isn’t even a typical symptom of SAD, but which plagues me after every autumnal time change.
After trying various natural remedies, in December I caved and began taking a mild sleep aid prescribed by my doctor. After few weeks of solid sleep, I skipped the pill one evening and noticed that I still slept through the night. “Great,” I thought. “This year I’m giving SAD a pass!”
Unfortunately, SAD snuck up on me, symptom by symptom, until I could no longer ignore it.
LACK OF ENERGY
In January 2016 — just last month! — I started noticing that I was having trouble getting up in the morning, even though I was sleeping through the night. This was puzzling, since I was still brimming with enthusiasm for the wonderful job I started in November. I expected to spring out of bed when the alarm rang, not hit the snooze button. I wasn’t going to bed late, so I was surprised to feel so tired after a full night’s sleep.
I added a few cups of green tea throughout the day to my usual two cups of coffee in the morning, and felt slightly more alert. I also stopped taking my nightly dose of melatonin, since its overall effects are sedating. That helped, too — but only briefly. Soon I found myself not only dragging myself out of bed, but almost dozing through the afternoons.
At first I attributed some of my lethargy to the turkey sandwich I frequently order for lunch, but I also felt sleepy without any extra tryptophan (the amino acid in turkey that is theorized to induce sleepiness).
I tried to brainstorm reasons for my listlessness. At my last check-up, my doctor drew blood for lab work and later informed me that I was slightly anemic. He didn’t sound concerned or order more tests, so I more or less shrugged it off.
“How anemic am I?” I wondered. “Should I take iron?”
But my nail beds are a healthy pink — when you’re anemic, they pale to a bluish-white — and I wasn’t fainting or having nosebleeds, other typical anemia symptoms. I was just… really, really tired most of the time.
Before I went to the drugstore to stock up on iron supplements, another symptom hit and distracted me.
CARBOHYDRATE CRAVINGS
Sitting at my desk one January morning, I was overwhelmed with a craving for cake. Something dense, sweet, floury that you could sink your teeth into. Reviewing spreadsheets or typing up a presentation, my mind would wander, fantasizing about the enormous muffins I used to buy at a job I held more than 10 years ago. The muffins were so big, they were actually difficult to bite into; eating them wasn’t pretty, but it was tremendously satisfying.
I hated that job, but buying a hot cup of coffee and an enormous banana-walnut or cranberry muffin made going to work a bit sweeter. I hadn’t thought about those muffins in more than 10 years — yet they became an almost daily fantasy. I’ve always had a sweet tooth, but this craving had the force of a powerful instinct. Sleep, breathe, eat muffins.
I began buying muffins on my lunch break; after a healthy bowl of soup or turkey sandwich, I’d dive into a muffin and a big cup of coffee (the green tea wasn’t keeping me alert enough through the afternoon, and I didn’t want to fall asleep in front of the people I work with).
These were smaller muffins, though, and I never felt quite satisfied. If I skipped the muffin, later I’d find myself daydreaming about demolishing cake like a lion who has brought down an antelope.
The annoying thing about cravings is that satisfying them only leads to stronger cravings. No matter how many muffins I brutalized, I still wanted more and more. Refined flour is low in fiber, so while a muffin might fill you temporarily, the satisfaction doesn’t last.
More importantly, too much sugar is bad for your teeth, weight, and mood. Although sugar crashes aren’t as drastic as cocaine withdrawal, they’re still perceptibly disruptive to your emotional balance. But I don’t think sugar was responsible for the final SAD symptom.
DEPRESSION
Although I’m a bit shy, I’ve made a real effort to be outgoing at work. I say “good morning” and “hello” to everyone, whether or not I know them. (In my defense, it’s a very large agency.)
This might seem obvious to a lot of you, but for me it took some effort. The rewards, however, were tremendous. Smiling is a natural mood elevator, a bit of folk wisdom that’s been born out by research. Smiling at so many people every day was making me feel more cheerful.
But gradually, without realizing, I stopped smiling and greeting my co-workers as I passed them in the corridors. I felt awkward and uncomfortable; I couldn’t meet their eyes.
SOCIAL WITHDRAWAL CAN BE A SIGN OF DEPRESSION
Then one morning I woke up and felt jangly. I couldn’t seem to get up, make coffee, get dressed. I couldn’t face the thought of going to work, sitting through meetings, reviewing case notes and developing training materials. Normally I breeze through those tasks on autopilot; that morning, deciding what color tights to wear was overwhelming. Anxiety and difficulty concentrating: two more signs of depression.
What could be wrong? I wondered. I love this job. I like almost all of my co-workers, and I’m comfortable with the population of clients we serve. Why would I be anxious or muddled?
I have seasonal affective disorder (SAD). That’s what’s wrong. It just didn’t hit me all at once this season. Amazing how a condition you’ve had for years can still surprise you. I usually expect to feel depressed and lethargic in mid-November; this year, it took me longer, but I got there eventually.
The good news is, I have a light box and I know how to use it. Unfortunately, according to my self-assessment I needed to get up at 6:00 am to use it, but I’ll do whatever it takes to feel better. So I reset my alarm clock and started using the light box, initially 15 minutes and increasing the dose as needed. After about five days, it was easy to get out of bed and start my day. I didn’t worry about falling asleep during long afternoon meetings, and making eye contact and smiling at my co-workers was comfortable again.
The muffins of this city, however, are still in grave peril.
