Coping with Seasonal Depression: More Than the ‘Winter Blues’


By Permanente Medical Staff

For many people, winter’s colder weather and shorter days do not mean holiday bliss, walking in a snowy wonderland, or happy nights by the fire. Instead, winter signals the onset of seasonal depression, known as Seasonal Affective Disorder (SAD).

An estimated 20 percent of the population suffers from SAD, with woman four times more at risk than men to be affected, according to the National Institutes of Health (NIH). Symptoms typically begin in late fall and taper off in spring and summer. Though far less frequent, some people may experience spring and summer SAD.

What is SAD?

Far from a case of the “winter blues,” SAD is a condition that should be taken seriously and those suffering should seek treatment. Symptoms may include a loss of interest in activities; low energy; ongoing feelings of depression, guilt, or hopelessness; challenges with sleeping and concentration; and changes in appetite and mood, such as increased agitation or sluggishness. SAD may begin with mild symptoms, but as the season progresses, these symptoms can become more severe.

The season can dictate the symptoms. In the fall and winter, sufferers may get too much sleep, crave carbohydrates, feel tired, and “hibernate” or withdraw from social interactions. Spring and summer SAD sufferers typically have trouble sleeping and eating and feel anxious or agitated.

Age, geography, and family history count, too. SAD usually affects young adults more than it does older people. The farther north or south from the equator, the more common the occurrence of SAD, due to the decreased sunlight of winter and summer’s longer days. Your odds of experiencing SAD increase if a blood relative has it or another form of depression.

What causes SAD?

No one knows exactly what causes this condition, but your circadian rhythm (physical, mental, and behavioral changes that follow a daily cycle) plays a critical role. Fall and winter bring reduced levels of sunlight, which may disrupt your body’s internal clock and lead to feelings of depression. Less sunlight also means a drop in the brain chemical serotonin, a neurotransmitter that affects mood.

Seasonal change also can create an imbalance in the body’s level of melatonin, a hormone that helps to control daily sleep cycles and mood. The darker it is outside, the more melatonin the body produces.

Treatment for SAD

During the fall and winter, especially during the holidays, it’s not uncommon to experience a period of sadness or to feel “down” for a few days. But if those feelings persist, and you are having trouble sleeping or eating and are no longer enjoying your normal activities, see your doctor. SAD is a treatable mental health issue. If left untreated, symptoms may worsen, causing suicidal thoughts, problems at work and home, substance abuse, or other mental health disorders such as anxiety or eating disorders.

Once SAD is diagnosed, treatment may include phototherapy (light therapy), medications, and psychotherapy (talk therapy).

With phototherapy, one of the first-line treatments for SAD since the 1980s, people use a special light box that mimics natural outdoor light. The patient sits a few feet from the box, usually during the first hour after waking up, to “soak in” the bright light – typically for 20 to 60 minutes, depending on your doctor’s instructions. A high-quality light box filters out ultraviolet rays and exposes a person to 10,000 lux of cool-white fluorescent light: 20 times greater than ordinary indoor lighting. Another type of light therapy uses sunrise simulation, where a dim light is used while the patient is asleep and becomes brighter as dawn approaches, like the sunrise.

The benefits of light therapy are its quick results – generally people see improvement within a few days to weeks – and few side effects. It’s also convenient, as it can be done at home. If you think you could be a candidate for phototherapy, talk to your doctor about light box options and instructions on how and when to use a light box.

Antidepressant medications may be helpful in alleviating severe symptoms, though it may take several weeks or different medications to notice a change in mood, and there are side effects. A doctor’s care is essential for the administration of antidepressants.

If you have a bipolar disorder, it is critical that you inform your doctor, since both phototherapy and antidepressants can trigger mania. Those with a bipolar disorder are prone to seasonal changes, which may bring about depression in the fall and winter and mania or hypomania (a less intense version of mania) in spring and summer.

Psychotherapy, also known as talk therapy or cognitive behavioral therapy, helps those suffering from SAD to identify negative thoughts and behaviors and learn effective coping mechanisms. Keeping stress under control is an important part of managing SAD symptoms. Guided imagery; meditation; other mind/body relaxation techniques such as yoga or tai chi; and regular exercise (especially outdoors) are beneficial.

One emerging area of research for treatment of SAD focuses on whether or not people with SAD produce less Vitamin D due to less exposure to sunlight or diet. While studies to date have shown mixed results, researchers continue to explore the role of Vitamin D in serotonin activity and how Vitamin D supplements may help alleviate SAD symptoms.

For more information about depression, including a podcast about managing holiday depression, visit MAPMG’s Staying Healthy pages.

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