What is seasonal affective disorder and how can it affect PCOS?

As the days grow shorter and colder, a decline in energy levels is not unusual. But what happens when these feelings continue to persist and affect daily behavior? In this article, we will be discussing seasonal affective disorder and the impact it has on polycystic ovary syndrome (PCOS).

Seasonal affective disorder (SAD) impacts approximately 5% of the population and is a type of depression that typically lasts from late fall until spring (1). People who experience depression are more likely to experience SAD and the condition is four times more common in females than males (1, 2). But what exactly does this have to do with PCOS? 

People with PCOS are 3 times more likely to have depression and/or anxiety, which could inadvertently put them at a higher risk of having SAD (3). Managing a chronic, complex condition like PCOS is hard enough on its own, but it’s even more difficult if you are struggling with mental health. Below are the topics that we will be discussing to help you navigate managing your mental health and PCOS during these winter months.

• What are the symptoms of SAD? Who does it affect?
• What is the connection between SAD and PCOS?
• What are common treatments for SAD?
• What are some ways to manage my PCOS if I have SAD? 

What is SAD and what are the symptoms?

As mentioned, SAD is a type of depression that is related to the changes in season, most commonly throughout the fall and winter months (1). Some people may experience SAD during spring and summer, but this is much more rare (2).  

Although it is unclear what exactly causes SAD, research suggests that people with this disorder may be prone to reduced serotonin activity. Serotonin is a neurotransmitter that helps regulate mood, and sunlight is a component that helps maintain regular serotonin levels.Thus, a lack of sunlight during the winter months may cause serotonin levels to fall further (4). 

Since SAD falls under a subtype of depression, many of the signs and symptoms coincide with major depressive disorder including the following (4):

• Feelings of sadness and / or depression most of the day, nearly every day
• Anxiety
• Extreme fatigue and lack of energy
• Feelings of hopelessness or worthlessness
• Trouble concentrating
• Feeling irritated or agitated
• Limbs that feel heavy
• Loss of interest in usually pleasurable activities, including withdrawing from social activities
• Changes in appetite (overeating or under-eating) 
• Sleeping problems
• Thoughts of death or suicide

 *If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

Who does SAD affect?

SAD affects 5%-7% of adults in the United States.It tends to be even more common for females, those who live farther north, and those who have major depressive disorder or bipolar disorder (4). Additionally, people with SAD are more likely to have other mental health struggles including eating, panic, or anxiety disorders.

What’s the connection between SAD and PCOS?

More research is needed to explore the direct connection between SAD and PCOS, but there is significant research that shows people with PCOS are more likely to experience feelings of anxiety, depression, and more likely to develop an eating disorder (3). These elevated risks may also put people with PCOS at a higher risk to develop SAD. 

If you have SAD and PCOS you may find it difficult to upkeep your regular routine during this time, especially when it comes to nutrition, movement, sleep, and stress management. Rather than feeling guilt or shame about these changes, it can be helpful to understand that the body goes through seasons just like our external environment. Don’t be afraid to adjust your routine to better serve your mental and physical health. 

If you suspect you have SAD, be sure to speak with your provider for a thorough evaluation to rule out other causes for the symptoms you are feeling. 

What are the treatments for SAD?

There are a few common treatments that are frequently recommended for those with SAD. The following treatments can be used alone or in combination (1, 4). 

• Light therapy: Sitting around a very bright light box for 30-45 minutes a day can help with SAD.
• Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that effectively treats SAD and has the longest-lasting effects for the disorder.
• Antidepressant medication: Providers may recommend medication for depression in conjunction with other forms of treatments like light therapy. Speak with your provider about possible side effects of medication for your condition and if it is safe to take with any other current medications that you are taking.
• Spend time outdoors: If a bright light box is not accessible for you, take advantage of the sunlight when you can and spend more time outdoors.
• Vitamin D: Some research shows vitamin D supplements may help improve your symptoms when paired with other forms of treatment. Be sure to speak with your provider before starting any supplement regimen.

How can I manage PCOS if I have SAD?

In addition to finding a treatment listed above that suits your lifestyle, you may have to tweak your PCOS management strategies. Below are some things to keep in mind.

Keep your nutrition balanced

What you eat can not only impact your physical health, but your mental health as well. Research shows that a diet high in refined sugars and processed foods can worsen brain function and mood disorders, such as depression (5). Additionally, an excess of refined sugars and processed foods can drive up inflammation and insulin resistance, which directly impacts PCOS and catalyzes symptoms. Thus, focusing on a balanced, whole food diet that incorporates whole grains, vegetables, fruits, fiber, healthy fats, and lean protein is recommended (6).

Although it may be harder to find the energy to meal prep and shop for groceries, you can explore different meal delivery options to have all the ingredients you need for the meals you’ve chosen sent directly to your door. If that is not feasible, opt for one-pot meals where you can easily toss ingredients into a pan or pot and can last you a few days. To learn how to simplify your meal prep, check out this blog article.

Incorporate gentle movement

Following your usual workout routine may feel overwhelming during this time and you may feel like you do not want to move at all. However, movement is an integral part of relieving PCOS symptoms and produces feel-good endorphins that can boost your mental health (7). Try opting for more gentle forms of movement like yoga or pilates that can be done in the comfort of your own home. Learn more about the benefits of PCOS and yoga here.

Prioritize rest and manage stress 

Stress, specifically chronic stress, is a huge driver of inflammation and can cause cortisol dysfunction. This imbalance can exacerbate PCOS symptoms and feed into a vicious cycle that also affects mental health. That’s why stress management and rest is crucial for both PCOS and SAD. Whether it be 1:1 therapy, meditation, naps, a hot bath, or a combination of the bunch, put yourself first and prioritize things that improve your emotional wellbeing. While support from friends and family is important, don’t be afraid to say no to social gatherings if you feel you need time to recharge. Read more about the importance of rest and PCOS here.

Seek professional help

We previously mentioned the benefits of CBT for SAD, but we want to emphasize the importance of seeking professional help if you are struggling with your mental health. Managing a chronic condition like PCOS is not easy and is especially difficult if your emotional wellbeing is also suffering.

Talking to a therapist or counselor can give you valuable insight and tools on how you can navigate those challenges. If 1:1 counseling is not accessible or you prefer having a support group with individuals who share similar challenges, consider joining group therapy. It can be beneficial to hear the experiences of others and validate that you are not alone in how you are feeling.

Pollie’s care team is here to help you find the resources you need. Reach out to our team if you want to find help finding a therapist or therapy group.

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References

1. U.S. Department of Health and Human Services. (n.d.). Seasonal affective disorder. National Institute of Mental Health. Retrieved October 21, 2022, from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder 
2. American Academy of Family Physicians . (2000, March 1). Seasonal affective disorder. American Family Physician. Retrieved October 24, 2022, from https://www.aafp.org/pubs/afp/issues/2000/0301/p1531.html 
3. Brutocao, C., Zaiem, F., Alsawas, M., Morrow, A. S., Murad, M. H., & Javed, A. (2018). Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine, 62(2), 318–325. https://doi.org/10.1007/s12020-018-1692-3
4. Seasonal Depression (seasonal affective disorder). Cleveland Clinic. (2022, April 10). Retrieved October 24, 2022, from https://my.clevelandclinic.org/health/diseases/9293-seasonal-depression 
5. Selhub, E. (2022, September 18). Nutritional psychiatry: Your brain on food. Harvard Health Publishing. Retrieved October 24, 2022, from https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626 
6. Hoeger K. M. (2006). Role of lifestyle modification in the management of polycystic ovary syndrome. Best practice & research. Clinical endocrinology & metabolism, 20(2), 293–310. https://doi.org/10.1016/j.beem.2006.03.008
7. Woodward, A., Klonizakis, M., & Broom, D. (2020). Exercise and Polycystic Ovary Syndrome. Advances in experimental medicine and biology, 1228, 123–136. https://doi.org/10.1007/978-981-15-1792-1_8

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