Clinical Editors: Megan Dodson, PA-C and Sarah Dobro, MD
Now that we’re deep winter, the sun sets at an absurdly early hour — sometimes even before we’ve even wrapped up the workday. For some, the lack of sunshine is no big deal. For others, the cyclical change can trigger the physical and psychological symptoms of an aptly named condition: Seasonal affective disorder or SAD.
What is SAD?
“Seasonal affective disorder is depression related to seasonal changes, which occurs around the same time each year,” says One Medical provider Sarah Dobro, MD. “I see it fairly frequently in my practice. Winter depression is the most common form, but not the only form — some people get it in the spring or summer instead!”
Also known as seasonal depression, SAD may manifest in mild symptoms. People with mild SAD may get a little down as the temperatures drop and the days get shorter. This version of SAD is sometimes called “the winter blues.” But true seasonal affective disorder is a form of depression and can actually impact how you function on a daily basis, including how you think and feel.
According to the Cleveland Clinic, about 5% of adults in the United States experience full blown SAD, and about 10% to 20% of American adults experience the milder form of the winter blues.
What are the symptoms of SAD?
“Some of the most common symptoms are depressed mood (feeling sad or blue), sleeping too much or not enough, little interest or pleasure in doing things you'd normally enjoy, and hopelessness,” Dobro says. “Lesser known symptoms include difficulty concentrating, fatigue, irritability and increases or decreases in appetite/weight.”
Signs and symptoms of SAD may include:
- Feelings of sadness that last most of the day, almost every day
- Loss of interest in activities you used to enjoy
- Low energy and feeling sluggish
- Sleeping too much
- Difficulty with focus or concentration
- Carbohydrate cravings, overeating, and weight gain
- Feelings of guilt, hopelessness, or worthlessness
- Thoughts of not wanting to live or wishing you did not exist
While those who experience fall and winter SAD may be more likely to have symptoms like oversleeping, carbohydrate cravings, weight gain, and fatigue, those who are more prone to spring and summer SAD may notice insomnia, poor appetite, weight loss, irritability, and anxiety.
What causes SAD?
There’s no single cause of SAD, but a variety of factors may contribute to developing the condition. The reduced sunlight may have a big impact on the biological clock (aka circadian rhythm) which is the body’s internal clock — this disruption in typical sleep/wake patterns could play a big role in mood changes related to SAD. Additionally, reduced sunlight has been linked to lower levels of serotonin, a brain chemical that affects mood, so the seasonal shift could cause that chemical to drop. And finally, the changing of the season could also disrupt the body’s balance of the hormone melatonin, which plays a role in mood as well as sleep.
Some people are more prone to developing SAD than others. The condition is diagnosed more often in individuals assigned female at birth than individuals assigned male at birth, and it tends to occur more frequently in younger adults than older ones. Having a family history of the condition and/or living with major depression or bipolar disorder may increase the risk of SAD. People who live far from the equator are also more likely to develop SAD, potentially because of the decreased winter sunlight. Those with low levels of vitamin D — which can help boost serotonin activity — may also be more likely to develop SAD. Vitamin D is produced in the skin when it’s exposed to sunlight, so with decreased daylight hours, it may be tougher to get an adequate amount.
How can you prevent or manage SAD?
While there are a variety of potential factors at play, Dobro says understanding how seasonal changes can contribute to SAD, as well as your own risk, may help you manage or even prevent the symptoms of SAD from taking over.
“Make a calendar reminder for several weeks before your SAD usually begins and start treatment at that time every year,” Dobro says.
For those struggling with the symptoms of SAD during fall and winter, try these tips:
1. Try using a light box
Otherwise known as phototherapy, light therapy involves sitting in front of a box that emits bright light, mimicking natural outdoor light. Sitting in front of a light box every day upon waking may have a positive impact on brain chemicals linked to mood. “It's very important to use a light box that produces enough light (measured in lumens), position it correctly, and pay attention to correct timing (ideally early in the morning).” According to the American Academy of Family Physicians, you should position yourself 12 to 18 inches from a white, fluorescent light source (standard dosage is 10,000 lux) for 30 minutes per day in the early morning. In order to get the most out of light therapy, you should keep your eyes open, but you do not need to stare directly into the light.
2. Consider a dawn simulator
Dobro says that dawn simulation therapy may be helpful in addition to or instead of bright light therapy for some people suffering with SAD. This specific type of therapy involves a device commonly referred to as a sunrise alarm clock that gradually exposes you to increasingly intense light for about 30 minutes or more before you wake up (some dawn simulators also double as sunset simulators, gradually decreasing the intensity of light about 30 minutes before a set bedtime). “This uses a device to emit low levels of white light that gradually increase to room level that peaks at the time you usually wake up,” Dobro says. The idea of these simulators is to help you wake more naturally (especially during the winter months when it’s harder to get out of bed) so you feel less groggy and more energized throughout the day.
3. Explore cognitive behavioral therapy (CBT)
Some research has shown that CBT — a common form of talk therapy — may produce long-lasting benefits in the treatment of SAD. If you think you could benefit from CBT, reach out to your primary care provider. They can help connect you to a behavioral health specialist and determine a treatment plan that best fits your needs.
4. Spend time outdoors when possible
It’s not always practical to get out of the house during the winter months, but making an effort to get some sunlight when possible may help alleviate some of the symptoms of SAD. Try to squeeze in a 10 minute walk on your lunch break or enjoy your morning cup of coffee outside. If going outside is absolutely impossible, try to take advantage of any natural light in your house you can. Consider rearranging furniture or opening the curtains to allow as much daylight into your living space as possible.
5. Prioritize movement
While it may be tempting to trade in your workout gear for pajamas and a cozy blanket during the winter, regular physical activity has been proven to boost mental health and emotional well-being. Exercise can help reduce elevated cortisol or stress levels, as well as trigger the release of feel-good hormones like endorphins, boosting your overall happiness. To stave off the effects of SAD, aim to get about 150 minutes (30 minutes 5 times a week) of physical activity a week. If you can’t fit a full workout into your schedule, try to squeeze in a quick 10 minute walk or add more movement throughout the day with these tips. Any physical activity is better than none. Not sure how to maintain a regular workout schedule in winter? We break down ways to stay active in cold weather here.
6. Talk to your primary care provider about other treatments
For some people, medications like antidepressants may be necessary to combat the symptoms of SAD. If you’re experiencing symptoms of seasonal depression, talk to your primary care provider. They can help guide you toward an effective treatment that helps you feel your best at all times of the year.
7. Stick to a routine
When you’re feeling low or in a rut, it can be difficult to find the motivation to keep up with regular daily chores and tasks. Following a schedule or routine, however, can improve your mental health and reduce stress and anxiety. Building a good morning routine, for instance, can help you start your day off strong with a sense of purpose and control. This might mean waking up, taking a shower, getting dressed, and eating a nutritious breakfast. You might consider going on a morning walk or making time for a mindfulness meditation, breathing exercise, or a morning walk. Whatever your routine looks like, it’s especially important to stick to a set sleep schedule. This means going to bed and waking up at the same time every day and aiming for 7 to 8 hours of sleep each night, as irregular sleep patterns and lack of sleep can worsen your mental health.
8. Stay connected
Friendships and relationships play an important role in our physical and mental health. Social connection has long been associated with a greater sense of overall happiness and esteem, as well as lower levels of anxiety and depression. Though it’s easy to stay home where it’s cozy, prioritizing social activities this winter can help you avoid the feelings of loneliness and sadness that accompany SAD. Even just giving your loved ones a call or hopping on a video call can boost your mood.
Have more questions about SAD or your mental health? Our primary care team is here to help. At One Medical, we aim to provide exceptional care designed around you and your unique health goals. Sign up today to book a same or next day appointment — in person or over video — through our app.
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