Winter can be a challenging season for just about everyone, thanks to temperatures below freezing, heavy cloud cover and gray slush. But for the more than 14 million people in the United States alone who suffer from seasonal affective disorder (SAD), it can be debilitating.
SAD is a depressive mood disorder that has a seasonal component. It is usually cyclical, meaning that it occurs yearly, at certain times of the year.
While many people casually refer to having SAD or joke about it, SAD is not a laughing matter. “People think it’s funny, but it is a very debilitating disorder for many,” says Dr. Michelle Riba, Professor of Psychiatry at the University of Michigan and Associate Director of the University of Michigan Comprehensive Depression Center. “It impacts quality of life and can be debilitating.”
Symptoms of a mood disorder such as SAD include crying, appetite changes, problems sleeping, decreased energy, issues with concentration and thoughts of suicide. The symptoms are persistent, occurring daily and lasting for two weeks or longer. For some sufferers, SAD can also occur outside of winter.
“SAD is serious depression with a seasonal component but it is usually not distinguishable from major depression,” says Dr. Cher Geiger, a licensed clinical psychologist in private practice at Emotional Vitality in Hinsdale.
Winter Blues or SAD?
The cold weather and grayness may make staying in bed under the covers seem more appealing during the winter than at any other time of year, but there is a difference between SAD and the winter blues.
“There is a distinct difference between the winter blues and major depression,” says Geiger. “Winter blues sometimes come from the transition of letting go of family and fun time associated with the holidays and getting back to real life. Winter blues can also come from the reality that this cold weather isn’t fun and that walking outside on a spring day is much more appealing than trudging through the snow. That can be stressful and depressing, but not a depressive disorder.”
“SAD is a depressive disorder with a seasonal component, whereas the winter blues is more about being indoors, cold and people feel cooped up and not quite right,” says Riba. “They are two different conditions. SAD is a more of a problem and needs to be treated as such.”
Severity is a distinguishing factor of SAD, with the experts noting that feeling down for a few days is different from experiencing depressive symptoms for two weeks or more. “SAD is more severe. SAD is true, major depression with a seasonal time factor,” explains Geiger.
“It can impact your functioning. If you don’t want to go to work, don’t pay your bills, and can’t care for your children, those are serious consequences,” Geiger says.
When to Seek Help for SAD
If you are unsure of whether you or someone you know is suffering from SAD, experts recommend seeking professional help. Your primary care doctor is a good start but individuals with a prior history should consult a mental health professional.
“Some of the information on the internet may not lead you to the right diagnosis or may be unhelpful,” Riba cautions, noting the importance of mentioning any concerns and struggles to your primary care doctor so it is included in your medical records. Documenting your activities and feelings by either journaling or charting can be helpful for medical professionals.
Light Therapy and Other Treatments
Treatments for SAD include light treatment, talk therapy and medication.
Light therapy is commonly associated with treatment of SAD, and they are available without a prescription. Dr. Joshua Strauss, a psychiatrist with NorthShore University HealthSystem, notes, “While some people do feel better using them, it’s a good idea to have a screening with your primary care physician to make sure everything is okay with your overall well-being before jumping in. People may or may not respond well to light alone.”
Light therapy is best used in the morning, and for only 30 minutes or less. “You can overdo it, and you don’t want to spend all day in front of the light,” cautions Strauss.
Recent research involving light therapy has been mixed. One study recently published in the American Journal of Psychiatry showed that six weeks of cognitive behavioral therapy twice a week, often known as talk therapy, was just as effective as daily bright light therapy for 30 minutes every morning. “If you’re depressed and having problems adhering to plans and crying, just sitting with a light isn’t very practical. It may not be the best treatment given lifestyle and condition,” says Riba, noting that alternative treatments work well.
Those treatments can also be used in various combinations with success.
“Light therapy has a place as an adjunct rather than a primary treatment,” says Strauss, noting a study published in Journal of the American Medical Association Psychiatry found that light combined with other treatments led significantly to improvements in those suffering from major depression.
Light therapy does not work for everyone, though, and Geiger notes that it can be effective in up to 30 percent of cases. Strauss advises getting a portable device that you can move from room to room in the morning so that sitting directly in front of it is not required and you can use it while going about typical morning activities. “That makes it much more practical,” he says.
There are some risks associated with using UV lights, including damage to the eyes that can even cause cataracts. Strauss advises those buying a light therapy device to purchase one that’s made by a reputable manufacturer and to follow the instructions included with the product.
There are other treatments beyond light therapy and what works for one SAD sufferer may not work for another. “You really want to tailor treatment to the individual, and it is not simple,” says Riba, noting that an individual’s history also comes into play.
While the weather this time of year may seem like a good reason to start thinking about a move to a warmer climate, the experts caution that relocating is not a cure.
“If you have SAD, you may still have it in Florida. You have to look at the underlying issues, and you may have other conditions, and those won’t change with a move,” Riba says.
What to Do About the Winter Blues
If you don’t have SAD but do have a case of the blues, there are steps you can take to feel more like yourself.
Some simple lifestyle changes can help improve mood, including resisting the urge to hibernate and instead getting out of the house and exercising regularly. Although gardens are covered with snow, eating lots of fruits and vegetables as part of a healthy diet can make a difference too.
Getting sufficient sleep is also important, and can be challenging with the short days leading to disruptions in circadian rhythms. Strauss recommends turning down the brightness on phones and devices and not using them later in the evening, as they can disrupt sleep. He also says that aerobic exercise early in the day can provide the body an awakening signal that counteracts shorter days.
“It is important to not be afraid of feeling down. It is an opportunity to take stock and envision the life that you want to create. Get clear on what your concerns are and take good care of yourself so that you’re in a place to address those concerns,” advises Geiger. She adds that if you aren’t able through healthy living to tackle those goals, it may be a sign that you could benefit from professional help.
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