Winter Blues: How to Navigate Seasonal Affective Disorder
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It’s wild to think that, in less than one month, summer will be over. Don’t let the near triple digit temperatures fool you – winter is coming! Being from Florida, I’m no stranger to heat all year long, so it was definitely an adjustment experiencing my first winter in the Midwest. The cold weather was obviously something I had to get used to, but the long months with barely any sunlight and darkness by 4pm were even more difficult to wrap my head around. And for some people, these changes in weather can have a significant impact on mood, leading to seasonal affective disorder (SAD).
According to the American Psychiatric Association, at least 5% of U.S. adults experience SAD with symptoms lasting 40% of the year. Symptoms generally coincide with the fall and winter months and begin to resolve in the spring, although in practice, I’ve seen them persist longer depending on weather fluctuations. It was something I didn’t really appreciate when living in Florida, which makes sense when we look at regional distinctions. There is a higher prevalence of SAD the farther you get from the equator, and it’s also seen more commonly in young adults (18-30) and women.
If you don’t happen to suffer from SAD, you may still feel a bit out of sync with your normal routine during the winter months. The gloominess and multiple feet of snow certainly don’t help with that. However, those suffering from SAD experience more profound sadness and dysphoria that can mirror symptoms more consistent with major depressive disorder. Symptoms often include a persistent low mood, decreased/loss interest in pleasurable activities, cravings for foods high in carbohydrates, increased sleep and daytime fatigue, feeling more restless or moving/speaking slower than usual, feeling guilty, difficulty concentrating and focusing, and having thoughts of death or suicide in more severe instances of SAD. An interesting point to make here is folks struggling with run-of-the-mill depression can also experience SAD, even if their symptoms are otherwise stable with medications and/or therapy.
The good news is treatment is relatively straightforward when properly assessed and diagnosed by a mental health provider. There are several strategies, but I generally recommend lightbox therapy +/- cognitive behavioral therapy in addition to increased physical activity within reason (easier said than done when you’re snowed in for a week). Lightbox therapy has very specific guidelines and isn’t as simple as sitting in front of the brightest light in your house (a common mistake I see people making when self-treating at home). I recommend the use of a lightbox that produces 10,000 lux of light and filter out most or all UV light to prevent damage to your eyes. I’ll have clients use it within 1 hour of waking up in the morning for 20-30 minutes. The lightbox should be placed between 1 and 2 feet from your face and your eyes should be open but not directly fixed on the light source (it’s perfectly fine to engage in other activities while it’s on such as reading or watching television). Generally, symptoms improve within 2 weeks. However, treatment should be continued for the duration of the winter months to prevent relapse. For clients who have a good sense on when their symptoms typically start in the fall/winter months, I’ll sometimes recommend starting lightbox therapy before the onset of symptoms to get ahead of them. For more serious cases that receive little to no benefit from lightbox therapy, I recommend antidepressant therapy and go down the typical treatment algorithm I would for major depressive disorder. In these cases, it’s important to screen for other mood disorders such as bipolar disorder to ensure treatment recommendations are appropriate – just because you experience depression in the fall/winter doesn’t mean it’s SAD 100% of the time, which is why it’s so important to get proper screening.
As we get closer to cooler weather and less sunlight, reach for that hot cocoa, pull out the thermals, and do a quick check on your mood. If things seem a bit lower than you’re used to, you very well could be experiencing SAD. With the right evaluation and treatment, it’s possible to enjoy the winter wonderland without the winter blues!
Until next time!
Dr. McCall
