Seasonal affective disorder: What it is, and how to manage during the winter months
An overview of seasonal affective disorder, also commonly known as the "winter blues," from a report from the U.S. National Library of Medicine National Institute of Health and input from Dr. Andrew McLean, who is the Psychiatry and Behavioral Science Department chair at the University of North Dakota School of Medicine and Health Sciences.
DICKINSON, N.D. — When sunlight decreases during the winter season, days become dark rather quickly for those who live north of the equator. Otherwise known as the “winter blues,” individuals affected by this change may experience feelings of sadness and a loss of energy, especially during December, January and February — which is around winter solstice and when daylight is brief.
Seasonal affective disorder (SAD) is a recurrent major depressive disorder with a seasonal pattern that starts typically in the fall and continues during the winter months, according to an article published by the U.S. National Library of Medicine National Institute of Health. SAD, or “winter blues,” can cause depression in the spring or early summer.
Symptoms include sad mood and low energy. According to the U.S. National Library of Medicine National Institute of Health, those most at risk for SAD are female, younger individuals, those who have family histories of depression, bipolar disorder or SAD.
People who live along the northern tier of the United States also have a higher incidence of SAD, according to Dr. Andrew McLean, who is the Psychiatry and Behavioral Science Department chair at the University of North Dakota School of Medicine and Health Sciences.
“Another misconception is that because people feel down in the winter, it is because of SAD,” McLean said. “It can be related to relational issues, anniversary issues, etc. … SAD often includes significant ‘vegetative’ changes relating to sleep, energy, appetite, in addition to mood changes.”
From a medical overview article by the U.S. National Library of Medicine National Institute of Health, “People with seasonal affective disorder have difficulty regulating the neurotransmitter serotonin, a neurotransmitter believed to be responsible for balancing mood. In one study, people with SAD had 5% more SERT, a protein that assists with serotonin transport, in the winter months than in summer.
“SERT transports serotonin from the synaptic cleft to the presynaptic neuron, so higher SERT levels lead to lower serotonin activity, thus causing depression. Throughout the summer, sunlight generally keeps SERT levels naturally low. But as sunlight diminishes in the fall, a corresponding decrease in serotonin activity also occurs.”
Typically treatment for SAD includes antidepressant medications, light therapy, Vitamin D and counseling.
“For those with regular schedules, getting up in the morning, getting a good ‘pulse’ of morning sunlight is important in helping maintain one’s circadian rhythm. Try to maintain routines such as exercise, eating habits, etc. … Be aware of the stressors that this time of year can bring,” McLean said.
Though some people believe that regular indoor lighting will take care of SAD, McLean said that is an insufficient method to treat SAD. When SAD lamps are used, McLean recommends a brightness of 10,000 lux.
“If one is planning to use a SAD lamp, it is recommended that they consult with a professional,” he explained. “While these lamps are relatively safe, they also can have certain side effects, and some individuals may be more prone to those than others. In addition, certain antidepressant medications are approved for SAD treatment. Psychotherapy, particularly types which also pay attention to 'social rhythms' can be helpful.”
During the holiday season, it’s also important people take into consideration their own mental health, McLean noted.
“Being aware that while the holidays can be enjoyable for many, they are a change from the routine, which can nonetheless be stressful; understand that this change in routine can impact both you and those around you,” he said.
Not only can family dynamics can be a struggle for people during the holidays, but people who have issues such as those relating to diet and substance abuse can have challenges in maintaining their well-being, McLean noted.
“The inability to exercise as much as one does at other times of year can be a factor in the winter; COVID has certainly given us a year-round example of how many people struggle with ‘cabin fever,’” he said. “For many, holidays are joyous; for many they are stressful; being aware of one’s own realistic expectations are important.”