Admittedly, fall is my absolute favorite time of the year. The leaves are changing, the smells are soulful and the crisp air is a relief from the end of summer’s sun. The bright yellows, rich oranges and deep reds of the leaves can make a simple car ride feel nostalgic and magical. However, after the leaves fall and the smells give way to the bitter cold, many people are left feeling down and some even have symptoms of Seasonal Affective Disorder or SAD.
What is SAD?
SAD is the same as Major Depressive Disorder (MDD) however SAD is recurring and happens during specific times of the year. To be diagnosed with SAD you have to meet criteria for MDD and experience the symptoms regularly within the same time periods (usually during late fall and through winter) for at least 2 years.1
SAD usually occurs slowly starting in late fall and increases throughout the winter.2 It is most common in women (lucky us) and although it is more common in the cold months it can happen during the summer.2
Symptoms of SAD
Symptoms for MDD include:1
- Anhedonia which is a clinical term for losing interest in things and activities you once enjoyed.
- Feelings of hopelessness or worthlessness.
- Having low energy.
- Difficulty focusing and concentrating.
- Changes in your weight or appetite (usually an increase in both).
- Feeling tired or on edge.
- Sleep difficulties.
Symptoms for Winter Pattern for SAD include the above symptoms as well as:1
- Socially withdrawing from friends and family.
- Over sleeping and over eating.
- Craving sugars and carbohydrates.
It is not uncommon for people to experience some of these symptoms, especially if you live in cold climate away from the equator. For those who experience these symptoms in a mild or moderate way, you may have a milder form of the disorder known as subsyndromal SAD; more commonly known as the winter blues.3
Summer season affective disorder is less common but it does affect some people. Symptoms of summer SAD include:1
- Difficulty falling and staying asleep
- Feeling on edge or restlessness
- Poor appetite and weight loss
- Episodes of aggressive or violent behavior
Today we are going to focus on treatment strategies for winter SAD.
Risk Factors for SAD
You may be at greater risk for acquiring SAD if you:1
- Are female.
- Have a family history of depression.
- Have been diagnosed with depression or bi-polar.
- Are a young adult.
- Live far from the equator.
How does SAD get diagnosed?
Google and WebMD make it very easy for us to self-diagnose. In fact, my husband had himself convinced that he had lung cancer because he googled symptoms and believed he met criteria. He worked himself into a panic and ended up facing his fears and seeing a doctor about his symptoms. After a physical, bloodwork and chest x-ray I am happy to report that he has tonsil stones. Annoying yes, cancer no!
My point is that unless you are a medical professional try your best to avoid self-diagnosing. You will waste a lot of time and energy feeling worried and anxious over a reality that does not exist. Instead, schedule an appointment with your doctor and ask for a referral to a mental health professional. You can also find your own mental health professional through Psychology Today or by contacting your insurance provider. Check out my therapeutic resources page here.
It is easy to feel a false sense of empowerment when we are able to obtain information in under 3 seconds through the stroke of a few keys on a keyboard. We are also making ourselves vulnerable to experiencing anxiety and fear, misdiagnosis and not receiving treatment that we may need. Being able to memorize WebMD symptoms does not make us professionals.
Once you have been diagnosed by a medical professional (not a professional googler) there are several options that may help reduce your symptoms and they include light therapy, medication, talk-therapy and vitamin D. Let’s explore these options a little further starting with light therapy.
Light therapy has been used to treat SAD since the 1980’s and its purpose is to replace the sun’s rays that are lost in the fall and winter months through artificial light.1 Sitting by the light for 20-60 minutes a day can help reduce the symptoms of SAD.1 Although you don’t need a prescription to purchase a light for light therapy, it is recommended that you consult with a doctor or mental health professional for guidance as there are some side effects to this treatment. Headache and eye tension are side effects as well as mania which is a rare side effect according to the U.S. Library of Medicine.2 A medical or mental health professional can assist you in identifying the specifics of how to use the light, how far away to sit from it and the length of time suitable to your specific needs.
Medication may be a treatment option for you. Selective Serotonin Reuptake Inhibitors or SSRI’s are a common treatment option for SAD. SSRI’s can treat both depression and anxiety symptoms. It is important to talk to your doctor about your symptoms as well as health and family history to see if SSRI’s are suitable to you.
There are mixed findings about the effectiveness of Vitamin D in treating SAD. Today, Vitamin D supplements are not considered an effective SAD treatment on their own.1 Studies have indicated that Vitamin D levels may impact the development and maintenance of mental health disorders but just how much of a role Vitamin D plays in our mental health is unknown. Vitamin D deficiency may impact mental disorders including depression and it may also be an important nutrient for the mental and physical well-being of women.4 Research on Vitamin D is about as clear as the sky on an early winter day in the Midwest. However, that doesn’t mean that it should be ruled out as a treatment option. Talk to your doctor about the incorporation of Vitamin D supplements during the winter months to help combat the winter blues.
Cognitive behavior therapy (CBT) is a type of therapy that can be and has been applied to many different mental health disorders. CBT has recently been studied in the application of SAD with promising results. A study involving patients with SAD were divided into three groups: light therapy alone, CBT and CBT and light therapy combined. Research suggested that treating someone with CBT before the symptoms occur may have long-term mental health benefits.4
If you are looking for ways to improve your mood during the winter months I am going to outline some basic principles of CBT and skills that you may find helpful. This is not a substitute for mental health counseling and if you feel you are experiencing symptoms of SAD please obtain the services of a licensed counselor or psychologist.
If you break down the term Cognitive Behavioral Therapy you can get a better understanding of what it targets. Cognitive is the way we think and our belief systems and behavioral are the actions we take and choices we make. Cognitions are more hidden and subtle where a behavior is anything you can see or hear us doing. By intentionally focusing on our thoughts and behaviors during the cold months we can reduce our symptoms and improve our functioning.
By targeting behaviors we hope to combat the urge to hibernate and socially withdraw when it’s cold outside.3 By challenging our unhealthy ways of thinking we hope to change our mood from down and depressed to more optimistic and positive.
Changing our Thinking
After college I packed up my car full of duffel bags and moved from Michigan to Florida to spread my wings, soak up the sun’s rays and experience all the sublime offerings of a tropical climate. After lasting two and a half years in the sunshine state, I realized that soaking up the sun’s rays is not as easy as it sounds as I am a fair-skinned Irish gal and the tropical climate wasn’t as fulfilling as I had thought it to be. Don’t get me wrong, I love Florida; I met my husband in Florida, I had my oldest son in Florida and I made friends who are now considered family members in Florida. Florida holds a special place in my heart. However, what Florida doesn’t have is snow and seasons. Seasons were something I had grown accustomed to and despite the bitter cold of the winter months, I enjoyed.
My experience moving to Florida gave me a sense of gratitude and appreciation for living in a state that experienced change every 3-4 months. Décor, clothes and attitudes change along with the seasons.
In Florida, instead of having pine trees laced with Christmas lights Florida had palm trees. Instead of the reflection of Christmas lights on the snow it was the reflection of Christmas lights on the sand. To Floridians and other tropical climaters, that is completely normal and fulfilling. For me, it felt different and it felt like I was missing something. When I am struggling with getting through the winter months in Michigan I try to remind myself how lucky I am to experience snow as well as the beauty of the 4 seasons.
I try to remind myself that without the cold and snow I wouldn’t be able to witness the miracle of the leaves changing colors. Without winter I would miss the soul-filling excitement that comes with the first warm day in early spring that thaws the ground below. Another thing I try to remember is that winter does not last forever! That is helpful to me when it is mid-February and my pale skin hasn’t seen the sun in over 3 months!
Try, with intention of course, to identify the benefits of the winter months. Remember, recognizing the pros of winter doesn’t mean there aren’t any cons. Focusing on the positives can make the negative aspects of winter more tolerable.
Pros can include possible snow days for the kids and for you and the cozy, comforting clothes that are only appropriate in subzero temperatures. They can include thinking about pleasurable activities like skiing, snowboarding, ice skating, snow angel making, snow ball throwing, hot chocolate drinking and cozying up by the campfire; activities that help us feel warm and secure. Try to identify the beauty in the winter, particularly the falling of snowflakes and mounds of snow.
In summary, cognitions to help reduce your depressive symptoms can include:
- Reminding yourself that winter time is only temporary.
- Understanding that you have made it through several winters in the past and you will make it through this one.
- Recognizing that winter is necessary for spring and fall.
- Thinking about positive memories created in past winter months.
- Focusing on future pleasurable winter activities.
- Identifying the beauty in nature and the landscape in the winter.
- Finding gratitude in being able to experience different climates throughout the year.
The behavioral component requires an intentional focus on behaviors that have been proven to reduce depressive symptoms. Behaviors can include monitoring and reducing the amount of sugar you eat and drink on a daily basis, eating healthy foods rich in nutrients, adhering to your medication regime, exercising regularly by setting a goal for the number of days you want to exercise and consistently achieving that goal. Reaching out to friends and family members to stay current and up to date with one another’s lives.
Making it a point to engage in social activities whether that be going to church, to the grocery store or to a friend’s get together can help with our urge to isolate and hibernate in the winter. Isolation and hibernation can exacerbate depressive symptoms and simply getting out of the house and being around others can reduce feelings of sadness and loneliness.
Finally, engaging in one pleasurable activity a day can help us tolerate the negative effects of the winter months. This is where we can really be creative. There is no limit to what these activities can consist of. Intentionally doing things that are pleasurable is a main component to many therapies and is a research-based intervention. Positive activities combat negative emotions such as depression and they increase positive emotions such as happiness and joy.5
Pleasurable activities can cost money or they can be free. They can be independent activities or they can involve others. Make sure that you are paying attention to the activity and the positivity in it. Without intentionally focusing on enjoyment we are making ourselves vulnerable to missing out on it. For example, if I take my kids sledding and I focus on my hands getting cold and the grey gloomy sky instead of the laughter I hear coming from my children and the warm cup of hot chocolate in my hands, I am missing the pleasure that activity has to offer.
Try to make it a point to engage in one pleasurable activity a day. Be intentional with your attention and focus on the positives of that activity. Participate in the activity fully (with your mind, body and soul) to really experience joy and happiness. That can be tough to do, especially when we are feeling down and it is 20 degrees outside. When you notice yourself going somewhere else mentally, bring your attention back to the activity at hand.
In summary, behaviors that can help combat SAD include:
- Eating healthy and limiting sugar.
- Drinking enough water.
- Taking our medication.
- Engaging in one activity a day that evokes feelings of happiness and joy.
- Intentionally focusing on and participating in the pleasurable activities daily.
- Getting out of the house by running errands and attending community events.
- Scheduling activities with friends and loved ones.
These are suggestions that have been researched and proven to help combat negative emotions including depression. They are not a substitute for professional intervention. Talk to a professional if you are struggling with symptoms of depression. Bottom line is you don’t have to suffer through the cold winter months. There are options available to you.
1.The National Institute of Mental Health. (2016). Seasonal affective disorder.
2.U.S. Library of Medicine. (2018). Seasonal affective disorder.
3.American Psychological Association. (2013). Seasonal affective disorder sufferers have more than just the winter blues.
4.U.S. National Library of Medicine. (2010). Vitamin D and depression: Where is all the sunshine?
5.Linehan, M. M. (2015). DBT Skills Training Manual. New York, NY: The Guilford Press.