In the United States, depending on the geographic region, the prevalence of seasonal affective disorder (SAD) is 0 percent to 10 percent, according to research published in Progress in Neurology and Psychiatry.
This same study says that about 5 percent of Americans experience SAD each year.
Those with seasonal affective disorder may be more susceptible to substance abuse disorders.
Knowing more about this possible dual diagnosis is important for both patients and health care providers.
Seasonal affective disorder is classified as a depressive condition. When the days start to get shorter in late fall and throughout the winter, this reduction in sunlight can cause some people to experience depression. While the exact cause of this condition remains unknown, experts say that it is most often seen in young people, women, and people who are far from the equator, according to MedlinePlus.
Doctors and researchers have a few theories about what might cause SAD, according to the Cleveland Clinic. Some are:
Several symptoms someone might experience when they have seasonal affective disorder include:
The intensity varies greatly. For some people, the symptoms are more of a nuisance; for others, they can be disabling.
Researchers have linked SAD to an increased risk of substance use disorder. The links are the same ones that people have made between other forms of depression and substance abuse. In the United States, about 20 percent of people with depression or another mood disorder also have a substance or alcohol use disorder, according to the Anxiety and Depression Association of America.
What causes a person with SAD to also develop a substance or alcohol abuse disorder is not fully understood. Research suggests that some people might have a specific gene that heightens their chances of developing a mental illness as an adult if they were frequent marijuana users during childhood, according to the National Institute on Drug Abuse. So there could be a correlation between substance abuse as an adolescent and mental illness as an adult.
It is believed other genes might have an influence. Certain factors may encourage the genetic changes that could increase the risk of addiction and mental illness comorbidity. These may include trauma, stress, or other environmental factors.
Some people might attempt to cope with the symptoms of seasonal affective disorder by self-medicating with alcohol or drugs. This can often cause the symptoms of SAD to worsen over time. While the temporary effects the substances provide are rewarding, the person often experiences greater depression when the drugs wear off. This leads to a deepened cycle of abuse in an attempt to bring the good feelings back, according to research published in Current Opinion in Pediatrics.
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People who are experiencing depression might self-medicate with various substances, such as alcohol, cannabis, opioids, and psychostimulants.
Alcohol is a common drug of abuse among people with depression. In small amounts, alcohol may temporarily reduce depression and anxiety symptoms, making someone feel more social and happier. However, with regular use, alcohol can result in addiction, an increased risk of suicide, and worsening depression symptoms, according to the Arkansas Foundation for Medical Care Inc. (AFMC).
Psychostimulants include various drugs, such as amphetamines and cocaine. These drugs induce energy and a feeling of euphoria that may provide a reprieve from the symptoms of SAD. However, both of these drugs can lead to addiction. Amphetamines also increase the risk of stroke.
Cocaine can cause major cardiovascular damage, and deaths associated with cocaine often happen because of sudden heart failure. This drug can also worsen the symptoms of depression, according to research published in the Journal of Clinical Psychiatry.
Among all illicit drugs used by people with depression, cannabis is the most commonly used, according to the United Nations Office on Drugs and Crime.
Some people believe that marijuana may benefit depressive symptoms; however, research published in Psychological Medicine concluded that using too much marijuana can actually make depression symptoms worse.
Opioids include drugs like heroin and prescription narcotic painkillers, such as oxycodone, codeine, and hydrocodone.
The research on opioids and depression goes both ways. Some research shows that using these drugs increases a person’s risk of developing anxiety, depression, and bipolar disorder, according to research published in Psychological Medicine.
Other research shows that being depressed may put a person at risk for using opioids as a way to self-medicate. When these drugs are combined with depression, it can contribute to a vicious cycle of continued drug abuse. The person may feel better while high on opioids, but as the drugs process out of the body, they feel much worse than before they used.
It is recommended that people battling seasonal affective disorder and a substance or alcohol use disorder be treated for both conditions at the same time. This ensures that all of the person’s mental and physical needs are addressed.
Seasonal affective disorder is often treated with antidepressant medications, light therapy, and talk therapy. There is some overlap between SAD treatments and addiction treatments, especially in regard to traditional talk therapy. Oftentimes, the symptoms of one disorder contribute to the formation or intensity of the other disorder. In this case, depression likely prompts the individual to attempt to cope by using drugs and alcohol.
“Cognitive behavioral therapy is often used to help people recognize and avoid their destructive behaviors and thoughts, according to the American Psychological Association.”American Psychological Association
This works for both seasonal affective disorder and addiction. Clients learn how to recognize how their thoughts affect their actions. If they positively influence their thoughts, they can learn to manage triggers to use drugs and alcohol. Likewise, they can influence their thoughts in a manner that promotes a healthier mood rather than spiraling into negative thinking.
Light therapy usually involves a lightbox that a person sits in front of for about 20 minutes per day. The light is similar to sunlight except the person is not exposed to the harmful ultraviolet rays that the sun emits. Light therapy provides symptom improvement for most people within one to two weeks, according to the American Psychiatric Association.
Those who experience both SAD and a substance or alcohol use disorder might also benefit from other forms of behavioral therapy such as:
This type of therapy helps people to decrease self-harming behaviors. Examples include suicidal thoughts, suicide attempts, or urges, as well as drug abuse.
This is a type of residential treatment that someone stays in on a long-term basis. It helps residents to focus on resocialization.
This treatment takes an individualized approach by helping the person to get active in their community so that they develop a sense of purpose.
This therapy uses prizes or vouchers to reward people who exhibit healthy behaviors.
People who experience SAD should not hesitate to consult with a health care professional. Controlling the symptoms of this disorder could potentially reduce the risk of a simultaneous substance use disorder. People with a substance use disorder should consider a program that can treat both conditions.
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Substance Abuse Disorders. Anxiety and Depression Association of America from https://adaa.org/understanding-anxiety/related-illnesses/substance-abuse
(August 2018) Comorbidity: Substance Use Disorders and Other Mental Illnesses. National Institute on Drug Abuse from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses
(April 2012) Psychiatric Disease and Drug Abuse. Current Opinion in Pediatrics from https://www.ncbi.nlm.nih.gov/pubmed/22327950
(January 2016) Alcohol Worsens Depression; Depression Worsens Alcohol Abuse. AFMC from https://afmc.org/afmc-healthspot/alcohol-worsens-depression-depression-worsens-alcohol-abuse/
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(March 2014) The Association Between Cannabis Use and Depression: A Systematic Review and Meta-Analysis of Longitudinal Studies. Psychological Medicine. from https://www.ncbi.nlm.nih.gov/pubmed/23795762
(June 2012) Mood and Anxiety Disorders and Their Association with Non-Medical Prescription Opioid Use and Prescription Opioid-Use Disorder. Psychological Medicine from https://www.ncbi.nlm.nih.gov/pubmed/21999943
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(June 2013) Breaking Free from Addiction. American Psychological Association from https://www.apa.org/monitor/2013/06/addiction.aspx