Feeling SAD: Diagnosing and treating the winter blues

Jan. 22, 2020 / By Karla VonEschen, MS, CPC, CPMA

I live in the Midwest, and every year around this time I can feel the winter blues coming on. It’s been really cold since November and we’ve had plenty of snow, so I don’t spend as much time outdoors. In addition to the cold and snow, the days are shorter and like many people, I wake up in the dark and by the time I finish work it’s dark. These phenomena can contribute to a condition known as SAD or Seasonal Affective Disorder. 

Seasonal Affective Disorder is a type of depression that comes and goes with the seasons, usually starting in the late fall and early winter and subsiding during the spring and summer. This condition can occur in the summer but is much less common than winter episodes of SAD. According to the National Institute of Mental Health, SAD occurs four times more often in women than men and is more prevalent in those who live farther away from the equator. This makes sense for those with reduced sunlight and shorter days. In addition, younger adults are more at risk for SAD than older adults, and SAD is more common in those who already struggle with depression or bipolar disorder. 

While the exact cause of SAD is not known, research has shown serotonin regulation, melatonin over production, and reduced production of vitamin D may all contribute to this seasonal problem.  I like to simplify things and just say those of us in winter weather locations spend too much time cooped up hibernating and don’t get enough sunlight. 

So, what are some of the more common symptoms of SAD? While reading up on this topic, I found the differences between summer SAD and winter SAD interesting. Symptoms for winter pattern include:

• Low energy
• Overeating
• Weight gain
• Craving carbohydrates
• Social withdraw or feeling like hibernating
• Excessive daytime sleepiness

Summer pattern symptoms include:

• Restlessness
• Trouble sleeping
• Agitation
• Anxiety
• Poor appetite with weight loss
• Episodes of violent behavior

Treatment for SAD isn’t complex and, in some cases, can be as simple as visiting your local drug store. Light therapy, or light boxes, have shown to be very effective for treating SAD. Light boxes replace the reduced natural sunlight with bright, artificial light. Medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) to treat depression have also been effective along with cognitive behavioral therapy.

Generally, diagnosis coding for SAD will fall under chapter 5 in the ICD-10-CM code book (Mental, Behavioral, and Neurodevelopment disorders), under either the F34- or F39- categories for those who seek treatment.

The good news for most of us is that SAD is nothing more than a seasonal nuisance that can be fairly easy to treat and goes away once the season starts to change and the sun stays around a bit longer. As for myself, I think I’ll bundle up and take a winter walk in the sunshine!

Karla VonEschen is a coding analyst at 3M Health Information Systems.

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