#12: Winter Blues No More: Your Guide to Seasonal Depression Relief
NOVEMBER 28, 2024
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In this episode, we explore seasonal depression, also known as seasonal affective disorder (SAD). SAD profoundly affects mood, cognitive functions, and physical health due to disruptions in circadian rhythms.
After highlighting symptoms and various risk factors, the episode dives deep into SAD management techniques, such as light therapy, antidepressants, cognitive behavioral therapy, exercise, balanced diet, proper sleep hygiene, and mindfulness practices.
[01:42] Understanding SAD: Symptoms and Causes
[05:15] Risk Factors for SAD
[08:35] Symptoms and Impact of SAD
[11:26] Light Therapy for SAD
[17:43] Other Treatments for SAD
[22:06] Lifestyle Changes and Self-Care
[30:04] The Importance of Social Support
Mentioned in this episode:
Free Journal Prompts for Depression
Luminette Glasses (use code ANNA15 for 15% off)
Transcript
ANNA: Today, we are talking about seasonal depression or seasonal affective disorder. Some people refer to it as the winter blues. My goal is to give you practical, actionable tips for managing this condition and for supporting your mental well-being throughout the winter months.
This topic is near and dear to my heart because I myself struggle with seasonal depression or seasonal affective disorder, which is also shortened to SAD, a very apt acronym for it.
SAD is not a standalone condition. It is recognized as a subtype of Major Depressive Disorder and Bipolar Disorder, and it typically presents with major depressive episodes in the fall or winter, and gets better by spring or summer, but it is important to mention that some people get depressed in summertime, and that's also considered to be seasonal affective disorder.
Today though, we are focusing on winter depression. Seasonal affective disorder transcends usual sadness, and it profoundly influences mood, cognitive function, and physical health as well. Research conducted in the U. S. reveals varying rates of seasonal affective disorder, ranging from 9.7 percent in New Hampshire, which is up north for those of you who are not from here, to 1.4 percent in Florida, which is down south.
On average, about 5 percent of Americans suffer from SAD. If you have seasonal affective disorder, you may experience symptoms like fatigue, low mood, feelings of worthlessness, and irritability. SAD presents with so called vegetative symptoms, like oversleeping, overeating, weight gain and carbohydrate craving during winter months.
By contrast, summer depression, though less common, may include symptoms such as insomnia, decreased appetite and weight loss. I think that's an important thing to know that winter depression feels different from year-round or summer depression. It's almost as if we slow down and hibernate during the winter months.
And SAD is linked to issues with neurotransmitters like dopamine, norepinephrine, and glutamate, although the exact cause is unclear. It definitely has to do with reduced exposure to light, and also with hormones, but again, there is no clear explanation of exactly how SAD happens.
So I feel like it's important to briefly explain circadian rhythms before we proceed further. Circadian rhythms are the physical, mental, and behavioral changes that we experience over a 24-hour cycle. Light and dark have the biggest influence on circadian rhythms, but food intake, stress, physical activity, social environment, and temperature also affect them.
Most living things have circadian rhythms, including animals, plants, and microorganisms. In humans, nearly every tissue and organ has its own circadian rhythm, and collectively they are tuned to the daily cycle of day and night. We have what's called a master biological clock, which is comprised of a large group of nerve cells that form a structure called the suprachiasmatic nucleus.
This structure does many things, including controlling the release of melatonin, which is a hormone that makes us sleepy at night. So we have this circadian rhythm, and we are deeply dependent on the cycle of day and night, light and darkness.
We know that reduced sunlight that starts in early fall disrupts the circadian rhythm, which then leads to a drop in serotonin levels and an increase in melatonin levels.
This impacts sleep patterns and mood regulation. As an aside, and many of you may know this already, serotonin is a neurotransmitter that affects mood, anxiety, and happiness by increasing nerve stimulation and electrical impulses in the brain. So a decrease in serotonin is not great for our overall mood.
And generally, you have higher levels of serotonin in the morning and higher levels of melatonin in the evening. So we think that the overall increase in melatonin in wintertime is a part of why people with SAD tend to feel sleepy during the day and tend to oversleep. Okay, I promised that that was the most technical part of this whole episode.
I hope you are still with me because now we are going to look at who is most affected by seasonal affective disorder.
First of all, remember that the American Psychiatric Association doesn't see SAD as a standalone disorder. Rather, it's a set of subtype of major depressive disorder or bipolar disorder.
So you are at risk for SAD if you have a history of one of those, or if your family has a history of depression or bipolar. I know that in my clinical practice, people with bipolar really tend to struggle in winter months. So I think SAD is really prevalent in that population.
Another risk factor is living further away from the equator. Remember how the rate of people with SAD was seven times higher in New Hampshire than in Florida? This is thought to be related to exposure to sunlight. The fact that sunlight won't be as intense the further away you are from the equator.
Another risk factor, and this is true not just for seasonal affective disorder, but for regular depression and even for anxiety, is living at altitude. So my Colorado people, this is us. A study of over 3, 000 medical students found that when they move from areas of low altitude to areas of high altitude, their symptoms of depression, anxiety, and suicidality increased.
Also, women are more likely to be diagnosed with SAD. And I say that we truly don't know whether that's because they're more likely to have it or just to be diagnosed with it. There's a whole issue with bias when it comes to diagnosing women with depression, while men who have depression suffer in silence, just because their symptoms tend to be atypical. But that's a topic for another time.
Young adults are more at risk of seasonal affective disorder. And the risk generally goes down with age. The age group most at risk is 18 to 30 years old. And children and teenagers can develop it too, but we don't see it as often.
So, to summarize, people most at risk for SAD are women, young adults, people who have a history of major depression or bipolar disorder, people who live further away from the equator, and people who live at higher altitudes.
I think it's important to mention that just because you get a bit SAD in winter months, it does not necessarily mean you have seasonal affective disorder. For example, there is such a thing as Adjustment Disorder with Depressed Mood. Adjustment disorder is diagnosed when something happens in your life that you're having an aversive reaction to, some kind of stressor that is depressing you and making you unwell.
Say for example, you have seasonal work and you always get laid off during the winter months. That might be something that causes depressed mood, but it's not necessarily seasonal affective disorder.
And since I talk a lot about trauma, I have to mention that for some people, stressors could be related to the winter holidays and spending time with their toxic family members. That alone can trigger traumatic memories that result in depressed mood.
Okay, let's look at the specific symptoms of seasonal affective disorder so that you can see that it's more than just feeling sad. Common symptoms include increased sleep and daytime drowsiness. Like I said, it's like we hibernate in wintertime.
Loss of interest and pleasure in activities you formerly enjoyed. Grouchiness and anxiety, feelings of guilt and hopelessness, excessive fatigue, decreased sex drive, decreased ability to focus, trouble thinking clearly, increased appetite, especially for sweets and carbohydrates. As a result, you also have weight gain, physical problems such as headaches, and social withdrawal and increased sensitivity to rejection.
That desire to withdraw socially is particularly problematic because social support is one of the factors that decreases the risk for depression. So you have somebody who can benefit from being with other people, but all they feel like doing is withdrawing and spending time alone. And winter weather makes it easier to isolate.
I know I'm not driving anywhere to go out with my friends when it's cold and snowing. So if you have that tendency to get depressed during the winter months, remember that you will need to put extra effort into still spending time with your friends even though you really won't want to.
I also want to mention the relationship between SAD and substance use, specifically alcohol use. People with SAD tend to crave carbohydrates, and that includes alcohol. A 2018 study from the University of Pittsburgh showed that alcohol consumption increases as hours of sunlight decrease and temperatures drop. People consume alcohol thinking that it will improve their depressive symptoms. And in the short term it might, but overall alcohol is a depressant that makes depression much worse.
Okay, so we've covered the symptoms and risk factors, now let's talk about practical tools for the management of seasonal affective disorder. Before we do that, let me give you this disclaimer. I am not a doctor. I am a psychotherapist. Anything that I mention on this episode, you should consult with your doctor to determine if it's a good idea for you or your loved one.
What I am telling you is not medical advice. It's simply for informational purposes. Now that I made that clear, let's continue.
The first treatment we will talk about is bright light therapy or just light therapy. This is actually the number one treatment recommended for seasonal depression. You may have heard of mood lamps. That's light therapy.
The idea is you expose yourself to bright light that specifically has blue light in it. The kind of light you're supposed to avoid right before bedtime because it signals to your biological clock Remember that clock? It signals to your biological clock that it's time to wake up and start the day.
Light therapy essentially mimics natural sunlight. Now I want to say this important word of caution that light therapy, if used improperly, can cause hypomanic episodes in people with bipolar. So please do talk to your doctor, like I mentioned before, you don't want to start this therapy on your own if you have a history of bipolar disorder, and you definitely want to follow the specific guidelines for it.
And the specific guidelines for light therapy is to administer bright light at an intensity of 10,000 lux, L-U-X, for 30 minutes daily, with treatments conducted during the early morning hours. Lux, L-U-X, is a measure of the light density, and it's important that your lamp has 10,000 lux, because that's what works best.
You should position the lamp at eye level, slightly off to the side, and it should be somewhere between 16 to 24 inches away from your face. The light should hit your eyes to penetrate your corneas, but you should not be looking directly at the lamp as it can be really bright. These lamps are available online through Amazon and other vendors.
They typically start at 20 and go up from there. But be warned, a lot of cheaper models may not deliver the proper light density of 10,000 lux. Sadly, they are not regulated by the FDA or any other governing body. You can actually download free apps on your phone that measure the light density and also make sure you read the reviews of the lamps before you buy them.
A common mistake when using light therapy is not sitting close enough to the lamp. Again, it needs to be 16 to 24 inches away from your face and also not using the right angle where the light doesn't hit your corneas. Another common mistake is not using the lamp for long enough. It needs to be on for at least 20 and up to 30 minutes, and you can expect to see a difference within two to three weeks.
For some people, it really only takes a week. For some people, it takes a bit longer. It's not an instant solution, although personally I do notice a burst of energy right after using it. And finally, you have to pay attention to the side effects since no treatment is perfect. So if you're experiencing any of the following, you want to stop and ask your doctor if you should continue, and that's headaches, nausea, dizziness, insomnia, tired eyes, and hypomania symptoms in people with bipolar disorder.
Now. If you want the benefit of light therapy without the inconvenience of sitting next to a lamp for half an hour, because honestly who has the time to do that in the morning, you can get these super nifty glasses that have built in lights.
They do the same thing that a mood lamp does, but they are portable and easier to position properly where the light hits your corneas. They can be worn during daily routines like getting ready in the morning, and they can fit over regular glasses.
This particular brand that I really like and use myself is Luminette, but there are other options out there. Of course you can expect to shell out more money for glasses like these, but you really have to ask yourself, how much is your mental health worth to you? SAD can be devastating to your life and productivity, so it might be worth it to you to purchase something like Luminette.
Unlike cheaper lamps, Luminette delivers the proper light density of 10,000 lux. I personally struggle with Seasonal Affective Disorder, and it's had a really negative impact on my life until I discovered Light Therapy for myself. And to be honest, none of the lamps I've tried work nearly as well as these Luminette glasses.
They really have been a game changer for me and I'm really grateful for this product. I will put them on first thing in the morning. They go right over my glasses. I'll make my coffee, take my dog outside, journal, check my email, do all of my morning routine while wearing the Luminette glasses. They really don't get in the way. They don't fall off my face, I'm just going about my daily routine while doing light therapy.
It's really an amazing product. There's even a research study showing that blue light exposure for half an hour in the morning improves sleep and PTSD symptoms, symptoms of post-traumatic stress disorder. I was honestly blown away when I saw that research study. I think that there is something remarkable about regulating our circadian rhythms and the effect that has on us.
So I will go ahead and put the link to Luminette glasses in the show notes. So you can check them out for yourself. And as a matter of fact, I will also give you a discount code you can use to get 15 percent off. You can use the code “ANNA15” at checkout to grab the discount. That's A-N-N-A-1-5.
And of course, if you don't want to buy a device for light exposure, you can just try getting more sunlight exposure during the day.
And keep in mind that the further you are from the equator, the less intense the sunlight will be for you. So you may need to spend quite a long time out. to get the effect. And of course, not everybody can do that, especially when it's cold outside. Another option for treating SAD is taking antidepressants, specifically Bupropion or Wellbutrin, which is the brand name for the drug.
A study from 2019 provided evidence that starting Wellbutrin treatment in the period from September to November, So, prior to when depressive symptoms start, resulted in a lower number of major depressive episodes during the winter months. So, it's important to know in advance that you have a tendency to feel depressed during winter and start the treatment early.
As far as therapy goes, one therapy modality that has been found particularly effective is Cognitive Behavioral Therapy for SAD or CBT-SAD. In one study, it was found to be just as effective as light therapy. In general, cognitive behavioral therapy for seasonal affective disorder challenges and uproots negative thought patterns, as well as helps individuals identify and engage in enjoyable activities.
The focus there is simply on proactively coping with wintertime. For example, a person with SAD may tend to view winter very negatively because of their symptoms. So a CBT-SAD therapist will work on that negative attitude. They also may use the principle of behavioral activation, where you are encouraged to find enjoyable activities and list them in order of difficulty.
Then focus on the easiest activities first before you go on to the more difficult activities. For example, you could work on petting your dog and showering before you start going on 30-minute walks and going out with friends, which is more difficult. CBT-SAD needs to have a condensed schedule to accommodate completion before spring begins.
So in that one study, they did two 90-minute sessions per week over six weeks. And one thing to note is that not many therapists are trained in CBT-SAD, and that the condensed schedule will make it quite expensive. I will mention here that regular cognitive behavioral therapy and other therapy modalities are likely to help as well. It's just that they aren't designed specifically for seasonal affective disorder like CBT-SAD is.
Another option for treatment is supplementation with vitamin D, but the efficacy of vitamin D as a standalone treatment for SAD remains inconclusive with mixed findings from research studies. It can definitely be used along with other treatments like light therapy, antidepressants, or psychotherapy.
You may already know that vitamin D is naturally produced in our bodies when we're exposed to sunlight, and the deficiency of vitamin D is correlated with higher levels of depression and anxiety. So you can always ask your doctor about getting tested for vitamin D levels. You should do that before starting supplements, although supplements for vitamin D are usually well tolerated.
You can also eat foods rich in this vitamin, which include salmon, tuna, egg yolks, portobello mushrooms, and there's also fortified milk, cereals, and orange juice.
In general, it's important to mention that a balanced diet rich in omega 3 fatty acids and complex carbohydrates can positively influence mood and energy levels for anyone, not just people with seasonal depression, but it is especially important for those of us who have SAD.
It's also important to note that vitamin D deficiency is associated with being elderly, having more melanin, or having darker skin, obesity, celiac disease, IBS, and lactose intolerance. So if you fall into those categories, it might be especially important to get tested for vitamin D levels.
The next treatment method we're going to talk about is exercise. I know, I know, this one makes people with depression groan, like how am I supposed to exercise and find the motivation to do it when I'm depressed? But the truth remains, exercise increases levels of serotonin, dopamine, and norepinephrine in the brain just like medications can.
As a matter of fact, exercise is one and a half times more effective than medications or cognitive behavioral therapy we talked about. And that same study found that longer exercise routines are actually less effective. So it's not a case of the longer and harder you go, the better it is. Short, moderate bursts of activity are best.
So just think about that. You can take meds that could have serious side effects. You can spend a fortune in therapy costs, or you can just go for a walk every day. It is recommended that adults get at least 150 minutes per week of moderate intensity activity. That means roughly 20 minutes a day. And I do think that the simplest form of exercise is walking.
And yes, it is harder to do in wintertime if you live somewhere where it snows a lot, but it's still doable. You can also get creative when it comes to exercise. Dancing counts, and who wouldn't want to dance a little bit while lip syncing into a pretend microphone? Even things like vacuuming and mopping the floor can count as exercise and you get a clean house as a bonus.
I also want to give a shout out to community rec centers. They usually have a pool where you can swim even in wintertime, and they have a variety of classes. Fitness classes come in all levels of difficulty, and they involve being with other people which helps our nervous system to upregulate.
Remember social support is linked to improved symptoms of depression. Not to mention, you usually get discounts if you are a resident of the area, and the price is generally very reasonable. I don't know why you only see older people in rec centers. They are a great, great resource. Okay, so exercise is important.
Let's also talk about healthy sleeping patterns. Remember how seasonal affective disorder can cause oversleeping?
Thus, maintaining a consistent sleep schedule is really important because that will help regulate your melatonin and serotonin levels. One thing you can do is wake up and go to bed at the same time every day, even if you can't fall asleep immediately. You can also reduce your exposure to blue light in the evening.
Like we talked about just like I talked about the glasses that can make you more awake with light, the Luminette glasses, well, you can also get glasses that reduce blue light. They have amber lenses, and they filter out blue light and they are about 20 bucks on Amazon. You can just look them up.
Another thing you can do for healthier sleep is to avoid napping. Napping is a big disruptor of nighttime sleep, and it increases your melatonin levels during the day, which is not ideal.
One thing we know about sleep is that you should keep your bedroom at a lower temperature for best sleep, somewhere around 68 to 70 degrees Fahrenheit or 20 degrees Celsius.
One nighttime routine that's been studied is to take a really hot bath about two hours before bedtime and then sleep in a cooler room. Something about raising your body temperature and then letting it cool off helps us fall asleep. A hot shower can have a similar effect, but you'd have to stay in it for a while, so long shower lovers, rejoice.
This is your time to shine. And finally, you should build a cozy and consistent nighttime routine. That starts with having dinner at a regular time and then having a bedtime ritual. Maybe you take that hot bath and then start wearing the blue light blocking glasses for the next two hours. And then you have a cup of chamomile tea and read a chapter or two of your favorite book before bed.
There's also a study that says the smell of lavender is really helpful in falling asleep.
So there you go. Wake up and go to bed at consistent times. Avoid napping and using screens at night. Build a bedtime routine. Consider cooling off your bedroom and taking those hot baths or showers and add the smell of lavender to your bedtime ritual.
All of that should help you regulate your sleeping schedule, which will help with winter depression. I would be remiss if I didn't mention that regular mindfulness meditation can decrease depressive symptoms. Last week, I did a whole episode on mindfulness and meditation, where I led a couple of mindfulness practices.
So check that out for more information. Here, I will just mention that mindfulness meditation is a form of meditation where you simply notice what's happening on the outside and on the inside. You notice your environment like sights and sounds and smells and you notice your thoughts and emotions all without judgment.
And meditation is not about sitting there with no thoughts. A lot of people think that and go, well, I can't do that. No, the truth is thoughts will always come. The key is just to notice them like an outside observer and not go down the rabbit hole of actually thinking them. That's it. Anyone can meditate and anyone can use mindfulness.
So just check out last week's episode to learn more. Another thing I want to recommend is journaling, and not just the kind of journaling that involves you writing about your day or your emotions, which is great, but a more practical kind where you track mood changes, your routine, and coping strategies.
You can also journal about your negative thoughts and sort of like play devil's advocate with yourself to challenge those thoughts. That's essentially what cognitive behavioral therapy does.
And if you need a little bit of help with journaling, I created just the thing for you. It's a list of 20 prompts for journaling specifically for depression.
Ten of them are general prompts that you can use to explore your depression and how it feels and what you can do about it. And the other 10 are prompts that you can use daily over and over again. And of course, you don't have to do all 10 every day. You can just pick your favorites or alternate between them.
It's important to mention that these prompts encourage self-compassion. Self-compassion has been shown in research to help with depression. So you definitely want to grab these, even if you've never journaled before, because you can just answer these questions in your mind and still get the benefit.
I will put the link to download these journaling prompts into the show notes.
Okay, we're almost at the end here. The last thing I will mention. It's the importance of support from loved ones and even from strangers. We know that social support is important for making depression better. It can really help alleviate the symptoms. And since people with SAD tend to isolate themselves in winter months, it's especially important to put more effort into finding support.
There are three support groups I want to mention. The first one is from the Anxiety and Depression Association of America. The second one is from NAMI, or National Alliance on Mental Illness. And the third one is from the Depression and Bipolar Support Alliance. All three have online support options so you can attend them from anywhere in the world.
I will put the links to these groups in the show notes so you can easily find them.
So let's put it all together. It's important to be proactive and build a routine that integrates the tools we discussed. Light therapy, antidepressants, vitamin D, psychotherapy, sleep hygiene, exercise, and mindfulness practices like meditation and journaling. You want to be prepared ahead of time. Remember how medication had to be started in September if you choose that route?
So you want to have this toolkit prepared and ready to go as soon as light starts to diminish during the day. Don't wait until you already feel depressed. You have to start early. I always tell my clients to strike while the iron is hot. Meaning to plan ahead while you still have the energy to do so.
As such, I want to encourage you right now to decide on at least one practice you will implement from today's session. Maybe it's light therapy or journaling or exercise. Decide on one thing and then just do it. And again, remember that you can download those free journaling prompts to make it easier on yourself.
I put a lot of thought into these prompts, and I have used them with clients with success, so I am confident you will find them helpful. Also remember that you can get 15 percent off Luminette glasses for light therapy with the code “ANNA15.”
And the last thing I want to do is encourage you to not give up if you have winter depression. The truth is, it is highly treatable if you follow the tips I gave you. With the right tools and support, you can start feeling much better.
The key is to be proactive and to do the things I mentioned. I totally get that it's hard to be motivated when you are depressed, but please know that you are not alone and that there is help out there.
Just be patient with yourself. Use self-compassion and make small, consistent efforts to maintain your wellbeing. I hope you leave feeling a little lighter and more empowered on your journey. Remember, healing takes time and you're exactly where you need to be. Take care of yourselves. And until we meet again, be kind to your heart.
