We are coming up on the longest, darkest days of the year. For many of us, long dark days, drops in temperature, and cloud covered skies create a desire to hunker down at home, sleep more, and we notice cravings for comfort foods. For some of us, these feelings are the feelings of winter. To celebrate it we might catch up on our reading, invite good friends over for a small dinner party, and practice some true self-care in the Danish tradition of hygge. For others of us, these feelings become increasingly intense and uncomfortable.
Seasonal Affective Disorder (SAD) is a form of depression that occurs at about the same time every year. Researchers estimate that six percent of the US population suffers from SAD and another 10 to 20 percent of Americans suffer from the winter blues, a less severe form of seasonal mood changes.
Women are four times more likely to be diagnosed with SAD than men with symptoms usually beginning between the age of 18 and 30. Many people with SAD report a close relative with a psychiatric disorder. Most people develop it during the winter, but some people notice symptoms such as insomnia, agitation, restlessness, and anxiety in the summer. Symptoms can vary from person to person and year to year.
People with winter related SAD often feel their overall energy levels decline. They have a hard time getting out of bed in the morning, find they are reaching for sweets, simple starches, alcohol, and coffee for energy, and often feel like hibernating or withdrawing socially. SAD causes a noticeable loss of interest in most activities and can affect productivity at work and school, strain relationships, and result in unwanted weight gain, lowered sex drive, and disrupted sleep. Symptoms usually last for four to five months until the days begin to get longer.
There are several theories about the underlying causes of SAD. One is related to changes in the amount of daylight. People who live farther from the equator tend to suffer more from SAD. Light deprivation can also be related to living and working in a dark home or windowless office. Another theory focuses on melatonin, a hormone regulating sleep. As the days get darker, melatonin production increases causing people to feel sleepier and less energetic.
Others suggest that lower serotonin levels may have a role. Seratonin is neurotransmitter responsible for regulating processes including mood, digestion, sleep, and memory. Underlying causes of depression can also include issues with gut function, nutrient deficiencies, and inflammation.
Seasonal affective disorder can be misdiagnosed as a thyroid disorder, a blood sugar disorder or a viral infection. It is important to work with a healthcare professional if you suspect that you or someone you care about is suffering from SAD. A symptom diary or mood log can be helpful tool for identifying a pattern of SAD and monitoring symptoms.
60 to 80 percent of SAD sufferers benefit from light therapy. The idea behind light therapy is to replace missing daylight with bright light from an artificial light box. Most people with SAD benefit by sitting in front of a light box first thing in the morning for 30 plus minutes, additional time can be divided up during the day. Most people respond to light therapy within 2 to 4 days. Some people can have adverse reactions to light therapy if they use it too late in the day, or have manic depressive disorders, or sensitive skin and eyes. Similarly, a dawn stimulator, which mimics a natural sunrise, can be helpful.
Diet is important because SAD patients tend to crave and binge on carbohydrates. Too little serotonin in the brain leads to carbohydrate cravings and too many simple carbohydrates leads to increases in blood glucose and insulin levels. A moderate to low carbohydrate, nutrient dense diet can help stabilize blood sugar levels, reduce cravings, and keep weight under control. Eating slowly and chewing well will stimulate digestion and absorption of nutrients. Reducing the use of caffeine and alcohol also will help stabilize both blood sugar and mood.
There are several nutrients that can help improve symptoms for those who suffer from SAD. Vitamin D can be a helpful addition to a treatment plan if levels are low. A simple blood test will detect deficiency. St. John’s Wort can improve symptoms of SAD, but is it more effective when used with light therapy. A note of caution, St. John’s Wort has many contraindications and interacts with medications.
Another effective intervention for SAD is a combination of cognitive behavioral therapy and behavioral changes, which together help identify pleasurable activities to help cope with winter. Sometimes Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants are used to treat SAD. These medications do have side effects and it can take several tries to find one that works.
Self-care is another important tool in boosting mood. Monitoring changes in mood and energy levels help identify problems sooner rather than later. Taking a walk or eating lunch outside (without sunglasses) when there is available light, making simple social plans to meet a friend for tea, and setting a daily routine can all be helpful. Cooking nourishing meals is another important part of self-care. Regular aerobic exercise (30 minutes a few times a week) helps boost mood for those with SAD. Planning a vacation to somewhere sunny during the winter months can also be helpful.
SAD is a unique kind of depression. It has many different causes and different treatment options. If you are facing the winter with a sense of dread or think that you might be suffering from SAD, talk to your health care practitioner. Choose a practitioner who is asks a lot of questions about you and helps you figure out which interventions might be the most effective for your unique situation.
Barbara Sobel, MS, CNS, LDN is an functional nutritionist. She empowers her clients to incorporate personalized nutrition and lifestyle changes that support optimal health and vitality.