The Winter Blues
Many people are familiar with the heavy sensations that come along with colder temperatures and darker days – the same kind of sensations that make many crave an extra cup of coffee or the unthinkable jelly donut for the hopeful – yet short-lived – jolt of energy to follow. These sensations are sometimes subtle, sometimes severe; they can be feelings of moodiness and fatigue, with both mental and physical manifestations. The most severe version of the winter blues is known as seasonal affective disorder, which comes with the apropos acronym, SAD. SAD is a subtype of depression that occurs at the same time each year, usually starting in fall, worsening in winter, and ending in spring. It can, at times, feel a bit heavier than “winter blues” – although there is variance in severity of symptoms. With nearly 50% of people in the northeast feeling their worst in winter, symptoms can cause a significant disruption in life. Learning more may help you identify symptoms and treatment options.
What are the SAD Symptoms?
The most commonly reported symptoms of seasonal affective disorder are varying degrees of sadness, anxiety, or irritability, along with increased fatigue. Individuals often report a loss of interest in usually enjoyable activities or a withdrawal from social events. There can be an increased need for sleep, though more often people note more sleep difficulties. In addition to these feelings, many report cravings for starches and carbohydrates, and the accompanying weight gain that may come with that. Inversely, few people experience a reduced appetite with associated weight loss. Additionally, there may be an overall worsening of concentration or cognition. This may present as a mild brain fog or be more debilitating. A recent study showed that nearly 60% of a university hospital medication errors occurred during the first three months of the year, suggesting a pervasive seasonal component. It is important to remember that milder versions of any combination of these symptoms are also possible, and likely even more common.
A Biological Context
While many of us are familiar with some or many of these feelings, it is important to put them all into context. It’s easy to forget that despite our hectic work schedules, savvy smart phones, fascinating social media networks, and the availability of nearly anything anytime at the click of a button, we are still mammals on the planet earth. And most all mammals in regions with variable seasons have some practice of modifying their life practices in the winter months. Hibernation is the obvious and most extreme example, but in most cases there is a natural tendency to slow down, sleep a little more, eat a little more, and add a bit of extra winter weight. This is a normal and reasonable response to the change of seasons. We’ve secured ourselves in temperature- controlled environments and made all foods available year-round, but there is an inherent biological element written into our cellular structure that will always exist.
So What is Actually Happening?
At higher latitudes of the northern hemisphere during the winter months the sun is up for less of the day and does not get as high in the sky. This leads to a significant total decreased exposure to sunlight. As an extreme example, the folks in Anchorage, Alaska get only 5 1/2 hours of total daylight on the winter solstice, the shortest day of the year. As a result of this reduced light exposure, our internal biological clock that regulates mood, sleep hormones and neurotransmitters is shifted. This is called circadian phase shifting, and includes alterations in the normal fluctuations of thyroid and adrenal hormones, as well as body temperature. The pineal gland within the brain also varies production of melatonin, the hormone that causes drowsiness. Longer periods of dark mean increased melatonin synthesis during winter months, leading to higher levels of daytime melatonin. Lower levels of serotonin (the happy neurotransmitter) are also measured, which may be related to melatonin changes as well. Low levels of Vitamin D, which we absorb from sunlight, has shown to not be causative but likely an aggravating factor. Interestingly, there seems to be a genetic component – SAD tends to run in families. And the fact that 75% of sufferers are women suggests a hormonal component. While there is still a lot we do not understand about this condition, we know enough to be able to make helpful recommendations to improve symptoms throughout the winter season.
It’s All About the Light
Fortunately, there are steps you can take beyond a trip to a tropical beach, though if given the option, that’s a great therapeutic intervention. Given that the major cause of these seasonal disturbances is the lack of daylight, it perhaps will come as no surprise that one of the best evidence-based treatments is adding more light. Indeed, some studies show up to 80% improvement with regular phototherapy. The theory behind its effectiveness is that full spectrum light helps to normalize the phase shift delay in melatonin production and suppresses melatonin during the day when you don’t need it. There are many “lightboxes” on the market, but make sure to find one with a power of 10,000 lux (by way of comparison, the light on a sunny summer day measures at 50,000 lux). It’s best to start treatment in the fall, before symptoms begin. And, of course, duration is everything. Use your light box for 20-30 minutes in the morning, as treatment too late in the day may produce insomnia. Individuals often report improvement in just a few days, although full benefit is usually felt in approximately two weeks. The symptoms of SAD return quickly when light therapy is stopped, so light treatment should be continued throughout the season of low sunlight.
Preventative Measures & Other Natural Therapies
When it comes to prevention, it’s always back to the basics. The pillars of wellness – diet, sleep, activity, and stress management – can have a huge impact, especially during the winter months. Eat a well-balanced whole food diet with adequate protein and quality fats at each meal. Avoid overdoing the sugars and simple carbs even if you crave them the most! It’s also vitally important to stay active. Sitting is the new smoking. We are physical creatures who have developed a nonsensical way of living sedentary lives, and it affects many aspects of our health. Aim for at least 30 minutes a day, at least three times a week, though that is only a bare minimum recommendation. Even small steps matter – take the stairs at work, or consider a “walking” meeting. Spending time outdoors every day exposed to natural sunlight is very therapeutic, so any kind of walk outside will do – just layer up!
To ensure quality sleep, create a quiet dark environment in the bedroom. Avoid bright lights at night that suppress melatonin production. The most common culprits are our many screens – turn them off at least 30 minutes before bedtime. If that is unlikely, there are programs available for all devices that dim the screen during night time hours and eliminate the stimulating blue light. Regularize your sleep/wake cycle by going to bed and getting up at the same time each day; circadian rhythms, like our prehistoric ancestors, never heard of a “weekend.” And, of the utmost importance, be sure to manage stress during the winter months. Stay connected to your social circle and engage in regular activities that make you feel good. Or, take time to reflect and write in a journal if introspection is needed. Choose an approach that is suitable to your needs and personality during winter months. If you are overworked or exhausted, those feelings can get especially magnified during this time – all the more reason to take extra good care of yourself.
There are additional therapies that can be employed to fight off the winter doldrums. Specific amino acids, herbs, and vitamins can be incredibly effective. It’s vital to optimize vitamin D levels based on testing. Individualized care is always preferred, and it is important to discuss your symptoms with your physician before initiating any treatment.