Could the place you call home make you sick during the winter? Some people love the change of the seasons, the early arrival of darkness, and the crisp chill in the air. They mean snow—and everything it comes with, from hot cocoa and holiday festivities to cuddling in front of a fire—is on the horizon. But if you live in the northern half of the United States, the changing seasons can spell serious trouble for your mental health in the form of seasonal affective disorder. Nicknamed SAD by doctors, seasonal affective disorder tends to crop up during the winter months for an estimated 6 percent of the population. Most affected individuals live in parts of the country that are hundreds (if not thousands) of miles from the country’s southern tip. Where they live literally causes them to come down with a case of depression, which is seasonal, but is depression nonetheless. If you’ve been feeling down since the days started getting shorter and you’re already dreading the winter blues, you could be suffering from the weather-related mood disorder. But how can you tell if you’re just lowercase sad or actually suffering from uppercase SAD? Here’s what the experts say about who is most at risk of experiencing seasonal affective disorder and what to do if you’re one of the millions of people struggling with the condition.
Why so sad?
With a name like seasonal affective disorder, it stands to reason that the condition is tied to the change in seasons. Nor should it be surprising that—unlike better known mental health disorders such as major depressive and bipolar disorders—SAD typically crops up during one time of year: in the late autumn or winter. Still, SAD is a mental health condition, and it shares a lot in common with other types of depression, says Jade Daniels, a research psychologist with mental health app Woebot. “Commonly, people with SAD tend to experience lower energy, feel more lethargic, and notice fluctuations in weight gain and appetite.” Sound familiar? With such marked similarities to depression and a catchy acronym that literally describes how the disorder makes many people feel, seasonal affective disorder is not without controversy. It’s been written off as a “trendy” disease in many an internet think piece, and scientists were thrown into a kerfuffle about the condition in early 2016 with the publication of a study that claims SAD doesn’t really exist. But numerous other studies on the condition have been published in peer-reviewed journals, and they all seem to point in the other direction: SAD isn’t just real, it’s serious. Statistics back that up. The condition affects some 14 million Americans, Daniels says, and they’re all people whose symptoms worsen as the season goes on if they don’t seek and secure treatment. SAD is also listed in the most current version of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM-5, a compendium of conditions that the American Psychiatric Association (APA) uses to diagnose and treat patients. The APA dubs seasonal affective disorder a “form of depression” and notes that sufferers experience mood changes and symptoms similar to depression. The precise cause for this seasonal downshift in mood is unknown, but according to Craig Travis, PhD, director of behavioral science at OhioHealth Grant Medical Center, there are several biomarkers that relate to developing SAD. “Some researchers speculate that maybe ‘winter blues’ is partially a biologically driven natural human adaption left over from our primitive ancestors to long cold winter months, and we should all be hibernating during the winter months,” Travis tells HealthyWay. “We crave carbohydrates, gain excess fat storage, decrease activity and energy levels, [experience] increased lethargy/tiredness, tend to sleep more, etc.” That’s not definitive, however, he’s quick to point out. Scientists are well aware that humans are not bears, and we cannot burrow into a cave to take a long winter’s nap. To that end, SAD is considered clinically different from general winter “blah” feelings. Feeling down and out sometimes is normal, and it doesn’t call for a trip to your doctor’s office. You have to venture over the line into experiencing an impairment of daily functioning to be considered to suffer from seasonal affective disorder.
The Science Behind SAD
“Some research has shown people with SAD have increased serotonin transporter protein during the winter months,” Travis says. Serotonin is a chemical produced by the nerve cells, and it’s linked to our moods. In fact, many depression medications are called SSRIs, which is short for selective serotonin reuptake inhibitors, and their express purpose is to regulate serotonin transport in the brain.
“Melatonin is a natural human hormone that regulates sleep and circadian rhythms,” Travis says. “Darkness naturally triggers an increase in melatonin and engages the sleep cycle in all human beings.” The problem? People with SAD tend to produce more melatonin than others, he says.
“Vitamin D is associated [and] produced with more sunlight,” Travis says. “Less daylight during the winter months [means] less vitamin D produced.”
It’s also theorized that the risk of developing SAD comes down to our environment, at least for some people. “Descriptors (and thus experience) of winter are often in dreary harsh negative terms,” Travis explains. “That is, winter is often viewed socially and psychologically as depressing, grey, cold, barren, harsh, and death-like. That kind of mindset can set up a depressing mood, and that affects some people more than others.”
Who is affected, anyway?
Of course, winter isn’t exactly depressing, grey, and cold in every area of the country. The southern part of the United States tends to experience mild winters, if it experiences any winter at all. While it’s snowing in New York, it can be sunny and 89°F in Florida. Hence the thousands of “snowbirds,” who spend the wintry half of the year enjoying southern climes, only returning to their northern homes when the spring thaws out the ground. Considering the effect light and wintry doldrums have on the psyche, it’s hardly surprising that Southerners tend to have much lower rates of seasonal affective disorder than people in, say, New England. “Research shows about 1 percent of folks in Florida suffer with SAD, while 9 percent of New Englanders do,” says Travis. But it’s not only Americans (or Canadians) in northern climes who are affected by seasonal affective disorder. The risk of developing seasonal affective disorder is linked to the distance they live from the equator during the winter because of the way the earth tilts away from the sun, reducing the amount of light experienced during daytime hours. So when someone in South Africa is making their way through winter, their risk is akin to that of someone in Maine. SAD is also more prevalent in women, who are four times more likely than men to struggle with the condition. It also tends to be diagnosed in people over 20, although chances of experiencing it decrease as we get older. There are other risk factors to consider, too. If you have a family history of SAD or if you suffer from closely related conditions, such as depression or bipolar disorder, your chances of developing the issue in the winter months are heightened, Daniels says.
What to Look For
So, it’s cold. It’s dark. You’re feeling “off.” But do you actually have SAD? The diagnosis is one that has to be made in a healthcare provider’s office, and it can be tricky, Daniels says. “As SAD shares symptom similarities with other disorders, it can be difficult to accurately diagnose,” she says. According to the American Psychiatric Association, doctors will look for the following in order to hone in on a seasonal affective disorder diagnosis:
- Feeling of sadness or depressed mood
- Marked loss of interest or pleasure in activities once enjoyed
- Changes in appetite; usually eating more, craving carbohydrates
- Change in sleep; usually sleeping too much
- Loss of energy or increased fatigue despite increased sleep hours
- Increase in restless activity (e.g., hand-wringing or pacing) or slowed movements and speech
- Feeling worthless or guilty
- Trouble concentrating or making decisions
- Thoughts of death or suicide or attempts at suicide
You don’t need to meet every criteria in order to be diagnosed, but again, symptoms do have to be inhibiting your daily function in order for a doctor or therapist to know you’ve crossed the line between “feeling down” and needing treatment.
How to Get Through the Winter
A physician’s diagnosis is the only way to determine for sure whether you are experiencing seasonal affective disorder. But once you have a diagnosis, there is good news. There are both diagnosis-dependent treatment options and ways to self manage. And no, you don’t have to move to Florida. One of the most popular forms of treatment is cognitive behavioral therapy (CBT). This approach equips patients with both pro-active and reactive skills that can help them manage the symptoms of SAD, Daniels says. “A typical CBT session would teach the individual how to manage feelings associated with SAD, recognize and challenge negative thought patterns and behaviors, and also adopt healthy coping strategies,” she explains. “While the legacy of CBT has been grounded in one-on-one, therapist-patient interactions, new mental health tools have demonstrated clinical evidence for effective changes on mood and provide a new medium [by] which people can access and learn effective mental health techniques.” She goes on to say, “CBT can offer an opportunity to teach preventative, useable, and effective skills to people who experience SAD. While you may be thinking immediate and affordable access to mental health care has undoubtedly proven itself troublesome, a rise in a mental health technology tools intends to fill this void.” Another popular treatment for SAD is light therapy—literally exposure to bright light that mimics the sun. “Ideally that would be increased exposure to sunlight, so get out into the sun whenever you can,” Travis says. But experts acknowledge that can be difficult when you’re facing a weather forecast that’s chock full of overcast, grey, cloudy days. If that’s your reality, light box therapy is an option to explore. Light boxes can be set up at home or at work, and the therapy lamps offer a sun alternative of sorts, exposing the body to stronger lights than a traditional home or office lamp. Some studies have posited that light therapy—when done correctly—is as powerful as anti-depressant medication. There are some provisos, however. You can’t lie down with the light directed toward you and take a nap. This is not like the (not-so-healthy) tanning you did as a teenager. You need to actually be awake and cognizant of the light. You also need to spend a solid amount of time with the light shining on you in order for it to have any sort of effect on your mental health. “The key here is it needs to be 20 to 60 minute exposure to 10,000 lux of cool fluorescent light, which is more than most household lighting,” Travis explains. “You can’t just sit under a reading lamp.” Whether light therapy works for you or not, it’s not the only medicine-free option that can help fight the seasonal scourge. Exercise has been shown to help fight traditional depression, and establishing an exercise routine can fight off the seasonal stuff too. While many of us slack off on working out when the snow-blocked sidewalks make it hard to go for a run (or just walk the dog), even simple movement can make a difference, meaning you don’t have to be going wild in the snow to experience the benefits of wintertime exercise. “It can be moderate walking,” Travis says. “Exercise is a great stress, anxiety, and depression buffer.” Another option? Establish—or reestablish—a social circle. “It’s easy to isolate in the winter in the north; isolation can be lonely and depressing,” Travis says. But human beings are social creatures, and friendships have gotten more than a few thumbs up from researchers over the years, at least where mental health is concerned. “We need connection. It’s supportive and validating to us,” Travis says. One thing to avoid? Tanning beds, which do expose the body to light, but get the thumbs down from most physician groups because the UV rays they emit expose us to more harm than good, especially when it comes to our eyes and skin. Bottom line: If winter leaves you missing your energy and contentment, or feeling like you’re someone else entirely, it might be time for a chat with your doctor.