6 Tips on How To Deal With Seasonal Affective Disorder

With Sean Zager MD

If you're feeling SAD this winter, you're not alone. Here are science-backed methods to up your serotonin production and keep your stress hormones in check until spring. 

Seasonal Affective DisorderShorter days don't have to leave you feeling SAD.

When does seasonal affective disorder occur?

As winter settles in, seasonal affective disorder (rather aptly known as SAD) has taken hold for many of us. It begins at the end of summer and the start of fall, when the number of hours of daylight begin to decrease and the sun sets earlier. It’s especially potent this year, as COVID-19 makes it harder to leave home, tend to healthy routines, and have access to the things that help keep you balanced, like enough time outside in the sunlight, no matter how short the days are.

What is seasonal affective disorder?

SAD — sometimes also called “the winter blues” — is a type of recurrent depressive disorder that occurs during the fall and winter months brought on by decreased exposure to sunlight.

How many people are affected by seasonal affective disorder?

An estimated 10 million Americans experience SAD, while another 10-20 percent experience a milder version of it. 

It’s easy to write seasonal affective disorder off as a summer lover’s condition, but even people who adore the cold-weather pleasures of winter experience SAD. It is a real mental health condition and should be taken seriously.

Seasonal affective disorder symptoms

  • You’ve experienced seasonal depression or low moods for more than two years, with the symptoms starting around the same time each year
  • You experience seasonal depression more often than other depression 
  • During fall and winter, you experience feelings of discontent, sadness, apathy, anxiety, and moodiness
  • You may feel like you’re incredibly hungry (usually for carbs as your body uses them to produce serotonin in addition to sunlight) or that you have no appetite, which is a symptom of depression
  • You might have issues concentrating, falling asleep, or oversleeping
  • You feel daily fatigue
  • You tend to socially isolate or don't feel like being around other people
  • You're experiencing an uptick in physical symptoms without a known cause, such as headaches or stomachaches
  • You're having thoughts of suicide or self-harm

Seasonal affective disorder (SAD) is associated with 

  • Family history. For many people, the likelihood of seasonal affective disorder increases if a family member was diagnosed with mental illness, such as bipolar disorder, depression, or addiction. Like all health conditions that have a genetic component, it's better to approach mental health issues proactively if possible, finding a therapist and help preventatively rather than waiting for the condition to progress before seeking treatment.
  • Gender. Seasonal affective disorder may also affect women four times more than men — and there’s evidence that SAD is associated with premenstrual disorder (PMS) and premenstrual dysphoric disorder (PMDD), which are conditions marked by irritability, sadness, depression, and/or other mental health issues before menstruating each month.

That said, many traditional indicators of depression and other mental illness such as "weepiness" and "not washing your hair or taking care of your appearance" tend to be observed more in women than men, causing many experts to question the until recently accepted conventional wisdom that any type of depression or other mental health issue actually occurs more in women. Unfortunately, research is beginning to show that more traditional male expressions of depression and other mental health issues that men tend to demonstrate, such as substance abuse, rage, or tendencies toward violence, tend to go undiagnosed and allowed to progress as a result, which doesn't help either gender.

When does seasonal affective disorder start?

SAD usually first affects people when they hit adulthood — so it often starts between adolescence and age 35, and then can last a lifetime, though there are many ways to mitigate its effects which we cover below.

What causes seasonal affective disorder?

Our minds and bodies are fully connected, which is why our hormones have a lot to do with why and how we experience SAD. According to Sean Zager MD of Paloma Health, SAD stems from how a deficit of sunlight affects our hormones as well as shifts that occur in the body’s circadian rhythms and sleep-wake cycle.

Serotonin

Commonly known as a "happy hormone," serotonin production is dependent on how much sunlight you are exposed to, so when you aren’t getting enough outdoor time due to decreased sunlight during those long, dark months, it decreases, which can cause depression and lethargy. In addition to sunlight, your body uses carbohydrates to create serotonin. If you're feeling low during winter months, eating portion-sized amounts of healthy, unrefined carbs such as oatmeal, sweet potatoes, and fruit can help boost your serotonin production when it is slipping and lift your mood without the risk of a sugar binge or crash that can sometimes be triggered in the absence of both sunlight and carbs in people dealing with SAD.

Melatonin

“These physiological shifts may include an increase in the production of the hormone melatonin which is produced by the pineal gland to support sleep." Dr. Zager says. In people with SAD, this elevated melatonin production can lead to symptoms of drowsiness and fatigue.” 

Cortisol

The stress hormone cortisol seems to play a role in SAD as well, as it is produced in the adrenal glands and does the polar opposite of what melatonin does, explains Dr. Zager. “When melatonin levels rise in the evening and night, cortisol levels fall to support sleep, and when melatonin levels drop in the morning and daytime, cortisol levels rise to support energy and stress management while we are awake.”

People with SAD experience an intense heightening of melatonin levels during the winter, while their cortisol levels begin to plummet — all leading to fatigue and low mood, a vicious cycle that feeds itself. In other words, when you’re experiencing SAD, your energy drops — and when your energy drops, it can worsen SAD.

Are people with endocrine disorders more likely to experience seasonal affective disorder?

There can be a connection between endocrine disorders (especially hypothyroidism) and SAD, as both can cause profound fatigue, oversleeping, overeating, and depression.

“The pathophysiology that links the two likely involves a dysfunction in the hormonal cascade between the brain and thyroid gland — also known as the hypothalamic-pituitary-thyroid axis,” Dr. Zager says. This axis is part of our neuroendocrine systems, which oversee everything from metabolism, to the regulation of thyroid hormones, to how you handle stress.

It’s also worth noting that doctors may actually misdiagnose seasonal affective disorder as hypothyroid-ish. According to a review in the journal, Depression Research and Treatment, “People with SAD may also have subtle decreases in thyroid function, and their hypothyroidism can mask symptoms of SAD.”

If you're feeling tired or low, or if you're experiencing any of the symptoms mentioned above — and if you believe you have a thyroid condition — schedule a medical appointment to get checked out. Ask for a full thyroid test, and describe the change in your mood and mental health.

If you’re reading this, you’ve already acknowledged that you may need some support, which is an excellent first step. As with any mental health issue, speak to your doctor about your SAD symptoms sooner rather than later so that you can get the treatment you need to feel better.

How to use light therapy to treat SAD

If you work indoors, adding light therapy is an easy first step to reduce seasonal affective disorder. Here are a few affordable ways to do it:

1. Get outdoors

If you can safely get outside, aim for a daily, socially-distanced walk in the morning before work or on your lunch break. If it’s easier to find time to go for two shorter walks during the day rather than one long one, that works too. You’ll be increasing your physical fitness and getting the vitamin D you need. Outdoor daytime exercise — think hiking or biking — is also a great option.

2. Keep your workspace by the window and remember to move

If you’re going to be working all day at a desk, try to avoid dark rooms. Move your desk next to your window and set a timer to get up every 30 minutes for stretching and light breaks.

3. Get a SAD lamp

What is the best light for seasonal affective disorder?

Here are the three types of SAD lights that medical experts recommend:

Broadband light lamps

  • According to Dr. Zager, “There is research that supports the efficacy of dawn simulation, a technique that involves the use of these natural light alarm clocks to produce a gradual ‘dawn effect’ indoors for the treatment of SAD.” 

Light therapy lamps

  • For the rest of the day, there are a multitude of affordable light therapy lamps to choose from. The standard is a 10,000-lux exposure bulb, as they have been studied and proven most effective. Try sitting in front of it for thirty minutes to an hour a day to start.

Light therapy visors

  • If you prefer not to have to sit still that long, there are light therapy visors that have the same effect. All light therapy devices are believed to help reset your circadian rhythm.

Some people should not use light therapy, such as if you have eye conditions or other health issues that make you sensitive to light, like systemic lupus erythematosus. If you are prone to migraines or headaches, light can also have a triggering effect. Certain medications, such as antibiotics and anti-inflammatories, can make you sensitive to light as well. If you have bipolar disorder, light therapy may trigger manic phases, so be sure to speak to your doctor and/or therapist first if you have any of the above contraindications.

Can you take vitamin D for seasonal affective disorder?

Beyond getting enough sunlight, supplementing with vitamin D may be helpful in alleviating SAD symptoms. The jury is still out as to whether or not vitamin D (which occurs in small amounts in some foods but is primarily produced by the body when exposed to sunlight) can be helpful when it comes to SAD. Some studies say it works, while others say it doesn’t. It’s worth noting that most Americans are deficient in vitamin D (which Dr. Zager says may be linked to an increased risk of SAD), so it can't hurt to add a supplement to your routine, particularly as it has recently been shown to decrease the risk of severe complications from COVID-19 and a lack of it is linked with obesity.

Many doctors will prescribe a vitamin D supplement to SAD patients as food alone cannot provide enough without sufficient sunlight.

How to prevent seasonal affective disorder sleep problems

Hitting the hay at the same time each night (and waking up at the same time each morning) is important — even if you feel resistant to it.

There is evidence supporting the benefits of optimizing sleep hygiene,” Dr. Zager says. Avoid bright light at night (that's right, save it for the daylight hours) such as your computer or phone up to two hours before bedtime. As the past year has been nothing short of a roller coaster ride, you’ll also want to avoid scrolling through the news late at night. Not only will it keep you up, it can increase your anxiety and lead to bad dreams.

Want to get on the right track? The Sleep Foundation recommends making gradual — versus sudden adjustments to your sleep routine, especially if you have SAD.

Try to wake up a little earlier every day, even if it is only 15 minutes. At night, make bedtime a priority and embrace a ritual around it, such as setting an alarm for when you should begin getting ready for bed, just as you do to wake up. It also might look like stretching, meditation, dimming the lights, drinking a cup of tea, turning out the lights, and setting time for turning off the TV to help you wind down.

How can seasonal affective disorder be treated?

Therapy and antidepressants are the most common treatment for people with SAD, as it can present as depression. Any psychiatric medication is always most effective when combined with therapy, and there doesn't have to be anything "wrong" with you to start, so it's a good idea to ask your PCP for a referral for a therapist at the same time as you bring up the possibility of antidepressants. Your PCP or psychiatrist may prescribe selective serotonin reuptake inhibitors (SSRIs), which include drugs like Fluoxetine (Prozac) Citalopram (Celexa), Sertraline (Zoloft) Escitalopram (Lexapro), and many others. These work by increasing the amount of serotonin your brain is able to use.

Your doctor or psychiatrist may also prescribe another class of meds called norepinephrine-dopamine reuptake inhibitors (NDRI), such as Wellbutrin XL. These drugs boost norepinephrine, another "happy hormone" like serotonin. One advantage to NDRIs over the more commonly and widely used SSRIs is that they tend to have less sexual side effects. However, because they increase adrenaline, they are contraindicated if your depression is accompanied by anxiety, which they can exacerbate.

In case you needed one more reason to try therapy...

Therapy can be helpful to everyone, in that it allows you to explore what is making you feel the way you do as well as to begin to work toward change. Having someone to talk to and get support from who does not have a personal stake in your behavior (unlike a parent, sibling, or partner) is universally helpful and can direct you toward healthy ways to tackle any mental health issue. If you don’t have a therapist or can’t access one, check for clinics and nonprofits that offer free or sliding-scale therapy in your area. They often have waiting lists, but there is likely to be a clinic or center that offers free mental health services within driving distance, so don't assume that therapy is out of your price range. This article by our sister site, Psycom has useful tips and resources to get the help you need, regardless of your budget.

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