Seasonal affective disorder: 4 ways to treat the ‘winter blues’
As winter approaches and daylight gets shorter every week, many people begin to feel “down” or talk about the “winter blues.” That’s just part of life. For some people, though, their mood changes are more serious. If that sounds like you, you may be experiencing seasonal affective disorder.
If you have experienced winter SAD in the past, it isn’t too late for treatments to enhance or stabilize your mood and to get a jump on preventing symptoms as next winter approaches.
What are the symptoms of SAD?
Seasonal affective disorder can lead to persistent sad, anxious, or “empty” moods most of the day, nearly every day, for at least two weeks. Other symptoms include:
- Hopelessness
- Pessimism
- Irritability, frustration, or restlessness
- Feeling guilty, worthless, or helpless
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Difficulty concentrating or making decisions
- Changes in sleep
- Changes in appetite
- Physical aches or pains
- Digestive problems that do not have a clear physical cause and do not go away with treatment
- Thoughts of death or suicide, or suicide attempts
SAD can strike in summer as well as winter. For winter-pattern SAD, additional symptoms can include:
- Oversleeping
- Overeating, particularly with a craving for carbohydrates, leading to weight gain
- Social withdrawal (“hibernating”)
Seasonal affective disorder is much more common among women than men. In terms of the seasons, summer SAD is less common than winter SAD.
SAD becomes more common in people living farther north. It is more common in states like Alaska than in Florida. It’s also more common in people with depression or bipolar disorder.
People with SAD tend to have other mental disorders, such as eating disorders, ADHD, anxiety, or panic disorder. The condition can also run in families. SAD may be more common in people who have relatives with other mental illnesses, such as depression or schizophrenia.
Examining the chemistry of SAD
People with SAD, especially in winter, have less of the mood-regulating brain chemical serotonin. Sunlight helps maintain normal serotonin levels, but fewer daylight hours in the winter may contribute to decreased serotonin levels.
Vitamin D is believed to support serotonin production and metabolism. Lower vitamin D levels in people with SAD may also contribute to lower serotonin levels.
Individuals with either or both summer and winter-pattern SAD show abnormal levels of melatonin, a hormone that is important for normal sleep−wake cycles. People with summer-pattern SAD tend to have abnormally low melatonin levels, which disturb sleep and cause symptoms of depression. People with winter-pattern SAD produce too much melatonin, leading to oversleeping.
How to diagnose SAD
The diagnosis of SAD is based on a detailed medical history and thorough psychiatric evaluation. Your doctor may also suggest some tests to rule out other medical conditions. Mental health professionals use question-answer-type tools to evaluate and assess the disorder.
4 ways to treat seasonal affective disorder
- Light therapy
- Psychotherapy
- Antidepressant medication
- Vitamin D
Light therapy and vitamin D are common treatments for winter-pattern SAD. Psychotherapy and antidepressants are used for diverse types of depression, including winter and summer-pattern SAD. No treatments are specific to summer-pattern SAD. Talk to a healthcare provider about the potential benefits and risks of the various treatments.
Light therapy has been the standard of care for winter-pattern SAD since the 1980s. The treatment consists of exposure to a very bright light box for 30 to 45 minutes daily, usually first thing in the morning. Treatment is administered from fall to spring.
Psychotherapy (i.e., counseling) can help people with SAD by teaching them new ways of thinking and behaving. Cognitive behavioral therapy (CBT) is about challenging and changing unhelpful thoughts and behaviors to relieve depression and anxiety. CBT has been adapted for SAD (known as CBT-SAD).
CBT-SAD is usually conducted in two weekly group sessions for six weeks. It focuses on replacing negative thoughts related to the season, such as thoughts about the darkness of winter, with more positive thoughts. CBT-SAD also incorporates behavioral activation, a process that helps people identify and schedule pleasant activities to offset the loss of interest typically experienced in the winter or summer.
Antidepressants can be effective for SAD either alone or in combination with psychotherapy. Antidepressants work by changing the way that the brain produces or uses certain chemicals involved in mood or stress. Antidepressants usually take four to eight weeks to work. Problems with sleep, appetite, and concentration often improve before mood lifts. You may need to try several medications to find the one that works best.
Since SAD is associated with disturbances in serotonin activity, antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are sometimes used to treat symptoms. These medications can significantly lift a person’s mood.
The U.S. Food and Drug Administration (FDA) has approved bupropion, an antidepressant, in an extended-release form. It can prevent the recurrence of SAD when taken daily from fall through early spring.
Vitamin D deficiency may be present with winter-pattern SAD. In these people, vitamin D supplements may help improve symptoms.
Talk to a healthcare provider about any dietary supplements and prescription or over-the-counter medications you are taking. Vitamin D can interact with some medications.
If you or someone you know is having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988, or chat at 988lifeline.org. In life-threatening situations, call 911.
Source: StudyFinds
Dr. Coleman is a graduate of the University of New Mexico School of Medicine and holds a BA in journalism from UNM. She completed her family practice residency at Wm. Beaumont Hospital, Troy and Royal Oak, MI, consistently ranked among the United States Top 100 Hospitals by US News and World Report. Dr. Coleman writes on health, medicine, family, and parenting for online information services and educational materials for health care providers.
Image: Photo by Teona Swift from Pexels
