Seasonal Affective Disorder and Back Pain: What’s the Connection?

SAD is a form of depression, and back pain can be a very real symptom of this disorder.

First there’s the lethargy. Then the cravings for carbohydrates. Then the low, heavy mood. These are things that can take place for many as soon as the first leaves and snowflakes fall. It’s Seasonal Affective Disorder (SAD), a form of depression that 10 million Americans experience during the fall and winter months.

Oh, and your back? That can be just as miserable as the rest of you. As recent studies have pointed out, depression, like SAD, can be intrinsically linked with pain—particularly back pain.

Seasonal Affective Disorder and back painSAD and back pain often go hand in hand.

“While many shrug it off as winter blues, this depression has a bigger impact on our daily life,” says Zlatin Ivanov, MD, who is double-board certified in psychiatry and neurology and practices in New York City.. Although the exact cause of SAD isn’t readily known, says Dr. Ivanov, it seems to be related to the level of sunlight a person receives.

“SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. As seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. SAD is more common in people living far from the equator where there are fewer daylight hours in the winter,” he says.

Read on to learn how depression and back pain are interconnected and what you can do to alleviate your pain and feel better during the winter months.    

How Are Depression and Back Pain Connected?

“Body aches, including and especially backaches, are a common symptom of depression, and research has shown that people with severe depression actually feel pain more intensely than others,” Dr. Ivanov says.

As with any form of depression, SAD included, pain and depression are closely related. There can also be a question of, “Which came first? The depression or the pain?”

Depression can cause pain—and pain can cause depression. Sometimes they are in a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain,” Dr. Ivanov says.

He adds that unexplained physical symptoms like back pain or headaches are often the first or only sign of depression. Whether the pain or depression came first, the two are undoubtedly coupled.

Dr. Ivanov details, “As researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.”

Another cause that can bring on depression-related pain? A lack of exercise.

“It is important to note that depression itself may cause the type of fatigue that prevents you from exercising and working your core muscles. This puts added stress on the discs, joints, and ligaments in your back, making you more susceptible to low back pain and muscle strains,” Dr. Ivanov says.

At the end of day, no matter which condition you experienced first, pain can wear you down over time and impact your mood. And as Dr. Ivanov says, everyone experiences pain at some point, but for those with depression, pain can become particularly intense and hard to treat.

What Are the Symptoms of SAD?

The big difference between SAD and chronic depression is that SAD is limited to roughly the same time each year and tends to only persist during the low-light, winter months. Generally, a person experiencing SAD experiences the symptoms commonly associated with depression. These can include:

  • Depressed mood
  • Weight gain
  • Appetite increase
  • Cravings for carbohydrates
  • Excessive sleep or drowsiness
  • Hopelessness
  • Loss of interest in things previously enjoyed

“In order for someone to be diagnosed with SAD, they would have to experience at least two years of symptoms that become worse during a specific time of the year and the seasonal depressive episodes must significantly outweigh the nonseasonal episodes,” Dr. Ivanov notes.

And as mentioned, pain can be a major part of SAD and depression overall. “SAD can be related to chronic pain conditions, just as depression can,” Dr. Ivanov says.

He also shares that if you’re dealing with chronic pain in your daily life, SAD should be on your radar.

“Many SAD patients complain of pain, and two small studies suggest that some patients with chronic fatigue syndrome may also show signs of SAD,” he says. “These signs may be related to low levels of Vitamin D, which is associated with anxiety and depression in fibromyalgia patients.”   

How to Treat SAD

Dr. Ivanov states that there are four major types of treatments for SAD, which may be used separately or combined. They include:

  • Medication: “Typical medications used to treat SAD are the so-called SSRIs—Selective Serotonin Reuptake Inhibitors,” Dr. Ivanov says. “The FDA has also approved the use of Bupropion, another type of antidepressant, for treating SAD.”
  • Light Therapy: This can replace the diminished sunshine of fall and winter through daily exposure to a bright, artificial light box. Dr. Ivanov recommends sitting in front of the light box first thing in the morning on a daily basis from early fall until spring. Most light boxes filter out ultraviolet rays and require 20 to 60 minutes of exposure to 10,000 lux of cool-white fluorescent light.
  • Psychotherapy: “Cognitive behavioral therapy (CBT) is a type of psychotherapy that is effective for SAD,” Dr. Ivanov says. “It relies on basic techniques of CBT such as identifying negative thoughts and replacing them with more positive thoughts.”
  • Vitamin D: “Low blood levels of vitamin D were found in people with SAD,” Dr. Ivanov explains. Talk to your doctor about the ideal level of vitamin D you should take through daily supplements to combat your SAD.

Focus on Pain and Backaches

“When you understand how thoroughly pain and depression are interconnected, it makes sense to treat both conditions as part of your integrative plan of care,” Dr. Ivanov says. He says that treatments for people with back pain who display signs of depression may include:

  • Psychological counseling
  • Relaxation training
  • Behavioral therapy
  • Regular light aerobic exercise, “which stimulates serotonin levels in the brain and the release of feel-good endorphins to relieve both depression and pain.” Dr. Ivanov also advises checking with your doctor before starting a new exercise program.
  • Low-dose antidepressants, adding, “Such medications can reduce depressive symptoms as well as back pain because of the way they work to inhibit the reuptake of neurotransmitters like serotonin and norepinephrine within the brain that are associated with a person’s mood and pain perceptions.”

See What Works for You

“There is no one cure that could help all people that suffer from SAD and back pain,” says Dr. Ivanov. “For different people, different treatment plans and combinations work. The key is to not settle to live with the physical and mental suffering. Eventually, you will find what works for you. Healing is always a very individual and complex journey and you are the key without even knowing it. The task for your doctors is to work collaboratively. Eventually, you will know what makes you feel better.” 

Updated on: 10/13/20
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Does Back Pain Have You in a Funk?

Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a small percentage of studies have investigated the relationship between these conditions.
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