Winter Blues: Managing Your Mental Health This Winter

Winter blues are quite common, affecting at least 14% of the population in the U.S. This may not sound like much until you realize that number equates to well over 45 million people. While winter blues may sound somewhat trivial, it has the potential to evolve into a more serious type of depression called SAD (Seasonal Affective Disorder). Seasonal affective disorder, or SAD, is a severe enough seasonal mood condition that it is recognized in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a type of major depressive disorder. Nearly 5% of people in New York City alone experience SAD and suffer from its depressive symptoms. Studies have found that moving north can increase the chance of winter depression and ultimately developing seasonal affective disorders. Even prolonged visits to a northern location raise the risk for the development of common signs and symptoms associated with SAD. The question then, is: How are people with SAD affected by this winter sadness and what can be done to manage the risk factors?

What Are the Winter Blues?

The winter blues is a slang or casual term given to seasonal affective disorder in its milder state. While many people interchange the two, SAD is a much more serious condition than what one would call winter blues, and may even require mental health treatment and a patient care plan. Many people experience some sort of mood change during the winter months because of the shorter days and limited sunlight exposure. These mood shifts often manifest themselves as mild low mood, lack of interest in usually pleasurable activities, and diminished motivation. Mild winter blues often resolves itself after more days in the sun, as daylight hours increase, or at the end of the fall and winter seasons and the start of spring and summer.

What is SAD?

SAD is a form of recurrent major depression with a seasonal pattern. It can affect a person’s energy, appetite, concentration, and a sense of pleasure. Weight gain, weight loss, low energy, and feeling depressed are all common side effects of seasonal affective disorder. People with this disorder have been shown to have decreased serotonin levels. Serotonin is a mood-balancing neurotransmitter. Such people also seem to have increased melatonin production, which can contribute to feelings of lethargy and overactive sleep patterns, common indicators of the development of a mood disorder.

What Are the Symptoms of SAD?

Much like any other mental illness, a person suffering from SAD displays specific symptoms that can help lead to an appropriate diagnosis. What differentiates SAD symptoms from those of other disorders, however, is that they are usually only present for about four months out of the year—when the seasons change, as do the symptoms that people experience. And that, in itself, is the most telling sign. The other  most common symptoms are:

• Withdrawal from friends and family
• Increased carbohydrate craving
• Prolonged depression
• Impaired levels of concentration
• Feelings of hopelessness
• Decreased energy
• Hypersomnia
• Suicidal thoughts

If someone you know is experiencing SAD, you may notice they are gaining weight, retreating to their rooms or homes, or expressing suicidal or negative ideas that are atypical for them. If you or someone you know cannot shake these symptoms or if they are expressing thoughts of suicide, it’s important to immediately seek the help of a trained mental health professional, as these are warning signs of major depressive episodes.

How Does SAD Affect Sleep?

Because of the increased melatonin and decreased serotonin levels, seasonal affective disorder disrupts the human body’s circadian rhythm. Circadian rhythms are roughly 24-hour biological clocks that tell the human brain and body when to sleep and when to wake. This fluctuation in the body’s normal functions typically causes a person to want to sleep longer or have difficulty waking up. Sleep abnormalities contribute to the other symptoms and vice versa, perpetuating an unhealthy cycle that might require the help of a medical professional. Treatment has been proven to help people break this vicious cycle and return their bodies to normal functioning.  

How to Regulate Sleep Patterns

In order to be proactive, you can see a sleep specialist or try home remedies. If your problem is that you sleep too much, you might start by setting a regular schedule for waking and sleeping, giving yourself maximum time awake during daylight hours. In order to regulate sleep patterns and keep your body functioning properly, professionals recommend several things.

First, it’s important to find the sleep schedule that works for you. It is recommended that you have a regular sleeping and waking schedule. If you have a fairly consistent and typical work schedule you can implement a routine and develop habits for when you go to bed and wake up in the morning. If you’re struggling with sleep, try to keep your routines consistent on weekends and holidays. Work schedule variability creates more fluctuation in your sleep and wake routines. However, you can still rely on habits that help you to fall asleep faster and stay asleep longer. For starters, ban your smartphone from your bedroom and limit blue or bright light exposure beginning at least two hours before bedtime.

Also, it is suggested that you practice stress reduction techniques before bed. Try not to go to bed with stressful thoughts running through your mind. Find a routine that helps you unwind before your head hits the pillow. You might find yoga or meditation beneficial right before bed. Or you might simply need to sit alone quietly for a few moments. Other people find it helpful to take a hot bath and diffuse lavender or eucalyptus by their bedsides.

Also, avoid anything that will interfere with your sleep, such as caffeine, alcohol, cigarettes, or other mind-altering substances. Try to stop the use of such stimulants at least a couple of hours before bed.

Avoid stimulating your mind in other ways too before you go to bed. Watching TV, reading, playing games, or even surfing the web can keep your mind and body awake. Think about how stressed you get when reading a news story that upsets you. That is a good example of how reading something can interfere with your sleep. Stop these activities at least a half-hour before bed, maybe choosing to take a shower or meditate instead.

Create a blissfully comfortable sleeping environment. You can accomplish this by keeping your bedroom or sleeping area free of clutter, investing in soft bedding, and regulating the temperature in your bedroom. In general, cooler bedrooms are more conducive to better sleep.

Avoid other things that can affect sleep such as eating too much or not enough during the day. Going to bed with heartburn or an empty stomach can make it difficult to stay asleep. Also, avoid napping during the day if possible. Turn off all the lights in your room, including the glare from your alarm clock and your cell phone.

Who Is at Risk for SAD?

While few studies have compared differences in patients with SAD and those with other major depressive disorders, there is some evidence that people with SAD tend to be more responsive to light. Furthermore, if a person already experiences depression, her or his symptoms could worsen during the winter months and warrant an additional diagnosis of SAD.

Just as with any other form of depression, women seem to be affected more than men. In fact, SAD has been found to affect four times more women than men. SAD typically emerges around the ages of 18-30. It’s also important to note that a person’s chances of developing SAD may increase the further they are from the equator. In other words, the less amount of sunlight they receive during the winter months, the greater their chances for depression.

How is SAD Diagnosed?

The presence of the symptoms we have detailed here are not enough to self-diagnose a particular mental disorder. A physician, psychologist, therapist or another mental health professional should be immediately involved if you notice more than one of these symptoms at a given time. At that point, your practitioner will assess whether or not you are experiencing SAD. A physician will usually start with a physical examination, lab tests, and a series of questions. Many times, mental health issues are indicative of medical problems, such as hormonal imbalances, thyroid disorders, or other diseases.

If your physician determines that there is no physical reason for your symptoms, he or she may still prescribe you a medication to alleviate some of them and ask to see you again in a short period. They will likely also refer you to a mental health professional for further diagnosis and treatment.

A mental health professional may start with a psychological evaluation to determine the severity of your symptoms and to clarify your diagnosis. If you are diagnosed with a psychological disorder, your therapist will likely suggest treatment and work with you to determine goals and appropriate therapeutic interventions.

How Is SAD Treated?

The treatments for SAD may follow the same protocols as those for other forms of depression. Since decreased serotonin levels contribute to the presentation of SAD, diagnosed patients may be prescribed antidepressants, most frequently Selective Serotonin Reuptake Inhibitors (SSRI) like Prozac.

Another effective form of treatment is light therapy. Sixty to eighty percent of patients suffering from SAD benefit from this type of therapy. The reduced exposure to sun and the vitamin D it provides is a primary contributor to SAD symptoms, so introducing light into a patient’s regular routine seems to help. For this form of treatment, a practitioner will prescribe a lightbox for 20-60 minutes of use every morning. These lightboxes emit UV rays that replenish a person’s body with vitamin D to aid in natural hormone production.

Vitamin D supplements have also been found to be helpful in treating SAD, as low levels of it prevent proper nutrient absorption and hinder hormone balance. Treating patients with an oral dose of the vitamin on a daily basis may help prevent and treat the disorder.

Finally and importantly in our view, SAD patients may be treated with counseling or therapy. One type of treatment that has been highly effective is Cognitive Behavioral Therapy (CBT), which is often a shorter, yet highly focused form of talk therapy used for treating many mental disorders and life struggles, including major depressive disorder and SAD. You can read more about CBT here: Cognitive Behavioral Therapy: An In-depth View

Most patients who have been diagnosed with SAD will receive more than one type of treatment until they find a combination that works. For example, they may be prescribed both medication and light therapy for a few weeks before attending therapy sessions to determine the effectiveness of the treatment. Alternatively, they may only participate in therapy in the beginning, and they might be prescribed a medication later on. Each person is unique, and each therapist has his or her method of helping patients achieve their mental health goals.

How Can CBT Help With SAD?

CBT, or cognitive behavioral therapy, is “a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness.” CBT was developed by Dr. Aaron Beck in the 1960s after conducting many experiments on the treatment of depression. The method is based on the principles that psychological problems are derived from destructive thought patterns and behaviors, and that people suffering from these disorders can acquire the tools to cope with and diminish symptoms.

During CBT, therapists strive to help their patients change negative thought patterns in a variety of different ways. They may immerse their patients in their perceived fears to desensitize them. They may give them problem-solving tools to help them deal with situations they find difficult. They may use techniques to teach their patients to relax their bodies and minds. Or they may help them gain better insight into the patterns and behaviors of those around them. Basically, CBT is meant to be a collaborative effort that gives the patient the necessary skills to treat him or herself. It should help them change their thinking and better control their emotions and behaviors. Instead of focusing on the past and what led to the patient’s behaviors, CBT is a hands-on approach that treats the patient in the present and deals with what is happening at that given time.

CBT has been widely studied for all types of depressive disorders, but only a few studies have focused solely on its effects on SAD. One fairly recent study did delve into this topic and addressed the efficacy of CBT on SAD. In the study, a group of 61 people were followed through therapy. They were initially screened and the researchers only studied those who met the diagnosis for SAD without any other major psychological diagnoses. That made it a highly focused study. They were also required not to be undergoing treatment for the disorder elsewhere during the course of the study. One group was treated strictly with light therapy for six weeks, another group solely with CBT, and the other was given light therapy along with CBT. They were assessed and questioned thoroughly during the study, and follow-ups were performed six months and one year later. The results showed, not surprisingly, that the patients who underwent the combination CBT and light therapy had the most significant improvement in their symptoms. This is a result found in many studies: holistically addressing symptoms usually results in the best outcomes for the widest number of people.

How Can SAD Be Prevented

If you’ve experienced milder winter blues or SAD in the past, it’s crucial to be proactive about symptom prevention as winter approaches. One way you can help combat symptoms is by introducing more light into your home and office environments. Keep your curtains open and add lamps if needed to get as much light as you can. Be sure to keep the lamps or extra lights on in your house later than usual.

See your physician or mental health provider well ahead of winter and consider asking for a prescription for a lightbox. As the days getting shorter, you will need to mimic the lost sunlight. If the weather and your schedule permit, it is recommended that you spend more time outdoors every day for as long as possible. You can bundle up and walk around outside your office during your breaks and lunch hour. Or, simply sit on the sidewalk bench for a few moments and soak up some extra rays.

Exercise effectively reduces symptoms of depression and SAD. Some researchers even say it is just as effective as medication. Studies regarding the link between physical activity and depression posit different hypotheses for the helpful link.

One of the most popular links involves the increased endorphin release following exercise that has been found to lead not only to instantly enhanced moods but also to more long-term effects as well. Other researchers hypothesize that the rise in core body temperature during exercise helps reduce symptoms of depression. They believe that this higher body temperature also affects the brain stem, leading to a more relaxed state. Ultimately, studies show a significant decrease in the symptoms of depression in adults who participate in consistent exercise regimens.

Implement an exercise routine if you don’t already have one, or amp up the one you have with a few more minutes of intensity. Earlier studies indicated the benefits of aerobic exercise for patients suffering from depression and prescribed fitness routines including walking or running. However, more recent studies have shown that even resistance training can alleviate these symptoms. The key is to be consistent. And if you know ahead of time that the winter blues may affect you, it’s a good idea to add some time or intensity to your routine before the winter months hit.

Regulating your sleep patterns could also go a long way toward the prevention of the symptoms of SAD. Hypersomnia is a problem for around 40% of young adults battling depression, and this number may be even greater for those dealing with SAD. Sleep pattern disruptions are problematic because a lack of sleep or too much sleep can exacerbate depressive symptoms. At the same time, depression contributes to sleep issues. Since the correlation is strong in both directions, it can be a difficult factor to treat.

Conclusion

Beating the winter blues can be as simple as recognizing your symptoms and taking steps to combat them. However, for many people, it is a serious condition that requires ongoing treatment, sometimes including therapy as well as medication. Any time there are symptoms of depression present, it’s important to seek treatment options immediately. Moreover, if you recognize them in someone you know, do what you can to help and encourage them to seek treatment from a mental health professional