By Lea Nguyen
Your alarm goes off in the middle of your deep sleep. You think, “What time is it?
Where is the sun?” as you fumble to find your phone in the dark. It’s exactly 6:30
am, the time you set your alarm, and you feel as if you only slept for a mere
handful of hours. Feeling groggy and hazy, you stretch under the covers and think
to yourself if you can snooze for another five minutes…maybe ten. You can’t muster
up the energy to get to where to have to be – let alone even dress for the bitter
weather. Any task has become menial, time-consuming, and energy-draining.
You’re wishing for it to be summer again, feeling the wind chills through the cracks
of your window. You pull back the comforter over your head to escape the morning
for just a few extra minutes. It’s that time of year again: seasonal affective disorder
(SAD), also known as seasonal depression, is in full swing.
If you’re not familiar with the winter blues, SAD is a form of clinical depression, a
recurrent major depressive disorder that rises and falls with the temperature and
exposure to daylight. It typically begins in the late fall or early winter and settles in
the spring or summer and occurs for at least two consecutive years. It affects up to
10% of people in the United States, depending on where you live (9% in Alaska; 1%
in Florida). SAD is more common in women, occurring four times more often in
women than in men. Symptoms include:
Feeling depressed most of the day, nearly every day
Losing interest in hobbies or activities you once enjoyed
Experiencing changes in appetite or weight (typically with carbohydrate cravings, overeating, and weight gain)
Having problems with sleeping too much (hypersomnia)
Feeling lethargic, sluggish, or fatigued
Withdrawing socially or isolating
Having difficulty concentrating
Feeling hopeless, guilty, or worthless
Having thoughts of not wanting to live
If you or someone you know is in immediate distress or is thinking about hurting
themselves, contact the 988 Suicide and Crisis Lifeline by dialing or texting 988. You
can also use the Lifeline Chat on the 988 Suicide and Crisis Lifeline.
What causes SAD?
Research results have been inconclusive in understanding what causes SAD. A
study has shown that those with SAD may have reduced production of the brain
chemical serotonin, which helps to regulate mood. Sunlight controls the levels of
molecules that regulate serotonin levels, but for people with SAD, this regulation
does not function properly, leading to a decrease in serotonin activity. Additionally,
people with SAD may also have difficulty with overproduction of melatonin, a
hormone that responds to darkness by causing sleepiness. As winter days become
shorter and darker, melatonin production increases, resulting in people with SAD
feeling sleepy and lethargic. With melatonin peaking later and lingering for longer
into morning waking hours, it makes it harder to wake up, leaving you to feel
groggy for most of the day. Because you don’t reach peak wakefulness until later in
the day, it’s harder to fall asleep when it’s time for bed.
This perpetuates a cycle of inadequate sleep, fatigue, and exacerbating depressive
symptoms. Both serotonin and melatonin help regulate our body’s circadian
rhythms, which is the physical, mental, and behavioral changes that follow a
roughly 24-hour cycle. Circadian rhythms are regulated by our biological clock,
which reacts to environmental lightness and darkness. For people with SAD, the
changes in serotonin and melatonin levels disrupt normal daily rhythms. It has also
been found that their circadian signal that picks up a seasonal change in day length
seems to be timed differently, making it difficult for their bodies to adjust, leading
to sleep, mood, and behavioral changes.
Vitamin D is believed to affect serotonin activity, and Vitamin D deficiency and
insufficiency have been associated with depressive symptoms. With less exposure
to daylight in the winter, people with SAD may have lower levels of vitamin D which
may further hamper serotonin activity.
Negative thoughts and emotions about the winter and its associated stressors and
limitations are common among people with SAD. Some negative thoughts can
include the anticipation of functioning poorly. For example, you might think, “I’m
going to start feeling bad again around this time of year.” The negative cognitions
and emotions combined with biological effects seem to create a self-fulfilling
prophecy.
How can we put an end to the winter blues?
If you think you have seasonal depression, consult with a mental health
professional before deciding on a treatment plan. Treating SAD is not a one-size-
fits-all program.
1. Self-Care
Self-care is hard on its own. Sometimes, all you want to do is get back in bed and
binge-watch your favorite show until it’s actually bedtime. But times like these are
when it’s important to practice mental resistance. The root of self-care is to be able
to grow. Comfort feels safe for us, but comfort can hinder growth. Experiment with
what routine of self-care is accessible and manageable for you.
Sleep: Encourage yourself to sleep 15 minutes earlier than the day before. Small
progress is better than no progress. Practice a consistent pre-sleep routine to
adapt your body for bed. Build an unwinding routine, such as drinking herbal tea,
reading a few pages of a book, or meditating before bed. It may be tempting to
turn on Netflix, but your dreams are more interesting than that episode you’re
about to re-watch!
Mindfulness and/or meditation: A little meditation is like a reset button for your
brain. It quiets your anxiety, lifts your mood, and gives you the motivation to tread
through this winter. Sometimes, practicing meditation is extremely hard to do by
yourself. Try guided meditation through Headspace and Insight Timer.
Go on a 10-minute walk: Get out of your comfort zone and brave the cold
purposely. A dose of the outdoors can help boost your mood. People with SAD may
have lower levels of the brain chemical serotonin in winter than others; getting
natural light boosts serotonin which is a hormone that plays a key role in
maintaining mood balance.
Exercise: Regular exercise releases “feel-good” neurotransmitters, endorphins and
serotonin, in the brain. Whether it’s walking briskly, skiing, running, or doing yoga,
any type of physical exercise that you enjoy and stick with can be helpful.
Eat nourishing food: Overeating and craving carbohydrates are common symptoms
of SAD. Incorporating a diet high in proteins, vegetables, unprocessed foods, and
complex carbohydrates contains nutrients that can positively affect mood.
2. Antidepressant Medications
SAD, like other types of depression, is associated with disturbances in serotonin
activity. Antidepressant medications, including selective serotonin reuptake
inhibitors (SSRIs), are an effective treatment for SAD. Commonly used SSRIs include
fluoxetine, citalopram, sertraline, paroxetine, and escitalopram (Lexapro).
Bupropion (Wellbutrin), another type of antidepressant medication, has been
approved by the U.S. Food and Drug Administration that can prevent the
recurrence of seasonal depressive episodes when taken daily from the fall until the
following early spring.
Medication can affect people in different ways, so it is important for you to work
with a mental health professional to develop a treatment plan that meets your
needs and concerns to find whether medications are the best possible treatment.
3. Light Therapy
Knowing that decreased daylight affects SAD symptoms, you can receive your daily
dose of bright light through light therapy, which mimics outdoor light. Bright light
therapy (BLT) or phototherapy has been a mainstay treatment, proven to suppress
melatonin production and increase wakefulness and alertness. You can sit in front
of your light box first thing in the morning during your morning routine for 20 to 60
minutes a day. When searching to purchase a lightbox, ensure that it filters out
ultraviolet (UV) rays, is full-spectrum (meaning it closely mimics natural morning
light), and has at least 10,000 lux of cool-white, fluorescent light. The Winter
Depression Research Clinic at Yale School of Medicine recommends several
clinically-vetted lamps on its website. Before beginning light therapy, BLT should be
consulted and guided by a health professional to monitor adverse side effects and
contraindications.
4. Counseling
Therapy can help you break down problems that seem overwhelming and shift
faulty or unhelpful ways of thinking to help you cope with difficult situations.
Identifying, challenging, and changing the negative thoughts related to the winter
months could have long-term benefits after even just doing it once, which protects
you from SAD season after season.
It’s normal to feel down, but if you feel significantly depressed for days at a time
and can’t seem to muster the energy or motivation to engage in activities you used
to love or in tasks that help you get through the day, consider reaching out for
support. Our therapists at Haven Mental Health Counseling specialize in counseling
for depression, including Cognitive Behavioral Therapy (CBT) and Somatic Therapy
from a trauma-informed lens, to help you explore the root causes of depression,
recognize and process difficult feelings, and develop tools to help you manage
depression and all things that contributes to it. With guidance and compassion, we
can help you along your journey toward calmness, hope, and happiness.
Remember, all things must pass, including the travesty that is winter.