December 8, 2016

Are the winter blues real?

Days are getting shorter and I'm almost to the point where I never see the light of day (it's dark when I leave for work and it's dark when I get home.) I know I'm not the only one, since this time of year I get a slew of patients coming to clinic with complaints of zapped energy despite appropriate duration of sleep (even oversleeping), low moods and social withdrawal.

Seasonal Affective Disorder (SAD; great acronym, right?) is the term for the type of depression that is associated with change of seasons (usually fall/winter until spring). In the Diagnostic and Statistical Manual version 5 (the bible of psychiatry), it's called Depressive Disorder with seasonal pattern (but I like SAD better, so I'll use that abbreviation throughout the post). Now, I should mention that there is some controversy as to whether or not SAD is a legit diagnosis. A study published in involving 34,294 U.S. adults showed no evidence whatsoever that people's depression symptoms tended to be higher in winter "” or at any other time of the year. Some studies show that depression with seasonal pattern is more prominent in some locations (northern latitudes) than in others, while other studies show no correlation between SAD and geographic location. In short, we don't really know for sure. However, I have many patients who do not experience depressive symptoms during most of the year and come in every winter with depressive symptoms. That's all the proof I need to believe in it.

There are many theories as to the cause of SAD, the most popular being decreased exposure to sunlight causes some changes in an individual's circadian rhythm (your internal clock that tells you when to sleep and when to wake). There may also be seasonal changes in serotonin (neurotransmitter related to moods) and melatonin levels (neurotransmitter related to sleep; although this study shows that melatonin levels do not necessarily change with the seasons).

There are several treatment options for SAD:


Get outside and get some sunlight whenever possible. Also make sure to eat a balanced diet (sometime people with SAD experience carb cravings and weight gain) and get daily exercise (hibernation is for the bears).


Technical specs: 10,000-lux of full spectrum or cool white fluorescent lights set behind an ultraviolet shield. All you have to do is sit a few feet from a special light therapy box so that you're exposed to bright light for 30 or so minutes 1-2 times daily. Light therapy is supposed to mimic natural outdoor light and possibly causes a change in brain chemicals linked to mood. There is research showing benefits, however one review showed these studies have a lot of bias (i.e. people want the lights to work, so they work). One of my patients states that it works for her because it forces her to sit still and "just breath" for 30 minutes in the morning, like meditation. Since there are few reported side effects to light therapy (just don't look straight at the light and stop if you get a headache), I say if it makes you feel better, then go for it!


Some people do require medications (antidepressants) to treat SAD. Depending on the situation, the medication may just be needed during the specific season but it may be required all year long. Remember, never stop a medication without consulting with your health care provider.

Talk therapy

In particular, cognitive-behavioral therapy has shown promise in treatment of SAD.

So there you have it: SAD may or may not be a thing, and the main treatment for it is self-care and light. If you think you or your teen may be experiencing any sort of depression (season-related or otherwise), make sure you take to a health care provider.