He thought it was the doldrums. But it seemed to happen every fall, when the quick summer of sunlight was replaced with the slow-motion months of boring gray.
The landscape was brown, the trees were bare and darkness appeared early.
Some people thought he merely had the blahs — a malaise that came with the approaching gloom of winter.
But it was a lethargy that Steve Sager couldn't explain.
"I felt like I was walking with lead boots, and it was not fun," he said.
Sager said symptoms would start with the onset of autumn "and really not lift until spring. And it wasn't just a feeling of being sluggish. Sometimes, it was extremely debilitating."
He felt fatigued, disinterested and depressed.
Sager said the malady began during his teen years and continued into adulthood.
"I remember going to doctors. But it was tough for them to figure out what it was," he shared.
His answer came some years ago when he participated in a National Institute of Mental Health study.
Sager had Seasonal Affective Disorder, or SAD.
"SAD is a type of depression," explained Julie Kugler-Bentley, a clinical social worker and nurse who is the employee assistance program coordinator for Meritus Behavioral Health Services.
The onset typically occurs in September and October and continues through April or May, she said. It's associated with the reduction to sunlight that happens during this time of year.
"Circadian rhythms change with the seasons," Kugler-Bentley noted. "And these impact our sleep/wake cycles."
In addition, melatonin levels, also associated with the sleep cycle, are impacted, as well as seratonin, a chemical strongly linked to depression, she said.
Kugler-Bentley estimated 5 percent of the population might suffer from SAD, with as much as 20 percent of the population experiencing some symptoms of the disorder. It is most common in geographical areas that are a greater distance from the equator.
SAD and depression share many of the same symptoms, Kugler-Bentley noted. (See sidebar)
"It's important that people suffering from even some of these symptoms seek the assistance of their primary health care provider or a mental health professional to have a complete assessment," Kugler-Bentley said.
SAD most commonly occurs in people ranging in age from 15 to 55.
"The older you are the less risk you have of developing the condition," she said. "The average age is 23 years. And SAD is up to four times more common in women than in men."
Once an individual has been diagnosed with SAD, Kugler-Bentley said the first step to treatment "is a thorough assessment of the symptoms to determine the most appropriate intervention for each individual."
Counseling with a licensed mental health provider is recommended, she added. "Employee assistance programs, healthy systems, community mental health centers and private practitioners provide mental health services in the community."
Medications used to treat depression also have proven to be effective in treating Seasonal Affective Disorder, Kugler-Bentley noted. "Since these medications take time to work, when treating SAD, they are often started before the change of seasons."
Additionally, broad spectrum light therapy, involving exposure to a specially designed light for at least 30 minutes a day, every day, throughout the winter months, might be recommended, she said.
Following his diagnosis, Sager, who is the former mayor of Hagerstown, said his primary treatment was a light box. But the early version that he used "was a clumpy modified 2-by-4 ceiling fixture. All of that has gotten much better over the years. My light box today is the size of a briefcase."
Sager said he also makes sure that all of his light bulbs are full daylight spectrum — both at home and in his office.
"It's not about the wattage, it's about the color correction," he noted.
He also takes medications that have been found to be helpful with SAD patients.
"All these things help," he said.
At the age of 58, Sager said he has spent more than 40 years "struggling with SAD."
"And there were some very tough years, including when I was mayor," he said. "I had something that couldn't be explained. But when I hooked up with NIMH, I began to get the help that I needed."
Kugler-Bentley said "managing stress is important in the prevention of SAD. Regular physical exercise is a key intervention in stress management and produces endorphins which impact brain chemistry in a positive way.
Getting outside, even on the coldest days, to increase exposure to natural light is helpful. Even sitting by a window during the day can help."
A good support network also is beneficial, she added.
Kugler-Bentley said alcohol and drug abuse can be associated with SAD "and if substance use is occurring, it's important for treatment to target these issues simultaneously in order to get the best results."
Because Seasonal Affective Disorder is a form of depression, Sager said for years, many people didn't feel comfortable discussing it.
"There used to be a stigma attached to depression," he said.
But Sager said he is more than willing to talk about Seasonal Affective Disorder with anyone who has questions.
"Even when I was mayor, I didn't try to hide it. I know what it's like to know that something is wrong and you can't get a diagnosis," he said. "It's a terrible feeling."
Symptoms of Seasonal Affective Disorder
Appetite changes. With SAD, there is an increase in appetite, particularly a craving for complex carbohydrates, with an associated weight gain.
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- Sleep disturbance. There often is an increased need for sleep (hypersomnia) and daytime sleepiness.
- Decreased energy, motivation and fatigue
- Lack of interest in pleasurable activities
- Social withdrawal
- Relationship problems
- Substance abuse