Ask The Therapist

Question:   Although I used to enjoy this time of year, I find myself struggling with what feels like depression. I’ve noticed that these feelings seem to lift when the days start to get longer and there’s more sunlight. Is this really considered depression?  

It sounds like you’re describing Seasonal Affective Disorder (SAD), commonly referred to as the winter blues. SAD is a major depressive disorder that has a recurring seasonal pattern, lasting approximately 4-5 months.  A less common form of SAD occurs in spring or early summer and lasts until fall. The distinction between major depressive disorder and SAD is the element of time. In order to be diagnosed with major depressive disorder, one must have experienced symptoms for at least two weeks. SAD requires that one experiences symptoms over the course of two fall/winter seasons. Seasonal Affective Disorder, by and large, affects those that live furthest from the equator, as they experience shorter days and less sunlight during the fall and winter seasons.  

 According to the National Institute of Mental Health (NIMH) 2014, research suggests that SAD results from “reduced activity of the brain chemical serotonin, which helps regulate mood.” Sunlight plays a part in maintaining normal serotonin levels, but in people with SAD, the process that regulates serotonin does not function properly.  

 It is estimated that 10 million Americans are affected by SAD, with women being four times more likely than men to be diagnosed with this condition. The age of onset is usually between 18 and 30 years old.  SAD is more common in those with a major depressive disorder, or Bipolar, due to the recurrent  depressive symptoms. Some individuals dealing  with SAD have symptoms severe enough to impact their quality of life and require hospitalization.  

 The common symptoms associated with fall/winter SAD include:

  • Feelings of hopelessness and sadness
  • Thoughts of suicide
  • Hyper-somnia or oversleeping
  • Change in appetite, cravings for sweet or starchy foods
  • Weight gain
  • Legs and arms feeling heavy
  • Low energy level
  • Decrease in physical activity
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Increased sensitivity to social situations
  • Avoiding social situations

It’s important to note that symptoms will vary among those with SAD; however, disruptions in sleep are present with both fall/winter and summer SAD. Having a good sleep regimen contributes to one’s overall health, helping to balance one’s mood and emotions. This is something that I often talk with clients about in my practice, as one of my incredibly wise mentors once told me, “sleep is restorative.”   

In an article entitled, Seasonal Affective Disorder (SAD) in College Students: More than the Winter Blues, 2021, Jan Hall shared how this disorder can impact college students. With the shift from having a regular routine in high school and getting up early, to staying up late to study and socialize, this schedule can contribute to sleeping in and not getting enough Vitamin D from sunlight. Hall goes on to state that it’s important to maintain a regular bedtime, ensure balance and routine with daily activities and responsibilities, attend to one’s emotional and physical health, consider light therapy, and visit on-campus healthcare facilities if necessary.  

In her article entitled, Lifestyle Methods to Cope with Seasonal Affective Disorder, 2014, Lauren MacDonald shared several tips to cope with SAD. She suggested regular exercise to help improve mood, enhance positive feelings and increase energy level, making social plans to stay connected with friends and family, let sunlight into your home whenever possible, avoid overloading on carbohydrates,and make time for self-care.  

If symptoms persist and become concerning, it may be necessary to consult with a healthcare professional. Treatment for SAD can include a combination of light therapy, vitamin D nutritional supplements, antidepressants, and counseling. With fall/winter SAD being associated with a lack of sunlight, broad-band light therapy, which imitates outdoor light, is often used as a treatment option.   Those with SAD tend to have a Vitamin D deficiency, so the use of Vitamin D supplements may help improve their symptoms. Due to the change in serotonin activity associated with SAD, antidepressant medications (selective serotonin reuptake inhibitors) may also be used to treat symptoms.  

Cognitive Behavioral Therapy (CBT) is a type of talk therapy aimed at helping people learn how to cope with difficult situations; CBT also has been adapted for people with SAD (CBT-SAD)”, NIMH, 2014. The focus of CBT-SAD is on replacing negative thoughts associated with winter with positive thoughts. In addition, individuals are encouraged to “identify and schedule pleasant, engaging indoor and outdoor activities to combat the loss of interests they typically experience in the winter,” NIMH, 2014.  

Symptoms of SAD may be exacerbated during the COVID pandemic as limited opportunities to socialize during the holiday season, and people spending more time indoors cuts down on one’s exposure to sunlight. Those who have not experienced SAD may be vulnerable to it during the pandemic. The Vail Health Foundation, 2020, recommends getting exposure to sunlight by spending time in your backyard or going for short walks in your neighborhood, using Zoom or social media to stay connected to friends and family, and practicing mindful meditation to treat depressive symptoms.  

In closing, I would like to leave you with the following quote by Rachel Carson, “There is something infinitely healing in the repeated refrains of nature – the assurance that dawn comes after night and spring after winter.”  

By Gladys Smith

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