Patrick Wester, PMHNP
The weather is getting colder, the days are getting shorter and many people are nervously anticipating for the dip in their mood that they know is coming, based on experience from so many years before. Like so many different mental health conditions, seasonal affective disorder has a number of contributing factors that play a role in what you are experiencing. Luckily, there are a number of strategies that can be implemented to address and treat seasonal affective disorder .
Seasonal Affective Disorder (SAD) is a subtype of major depressive disorder (MDD), with the differentiating factor being that SAD is seasonal in nature. SAD is highlighted by experiencing recurring episodes of depression that appear at a specific time of year, which for most people is the fall and winter months, and symptoms later alleviating during the spring and summer months. More than just the “Winter Blues,” SAD affects nearly 5% of the population, with women and people living in more northern latitudes being disproportionately affected. As a subtype of MDD, SAD has similar symptoms and can range from mild to severe. These symptoms include:
While the exact cause of SAD is not known, there are a number of factors that are thought to be contributing to this condition. The most commonly believed cause of SAD is the reduced exposure to sunlight in the winter months. This is because sunlight helps regulate the body’s circadian rhythm, our internal clock. Our circadian rhythm governs sleep patterns and mood and inadequate light exposure can disrupt this rhythm, leading to feelings of depression. Additionally, the lack of sunlight also affects the production of serotonin, the principal neurotransmitter involved in mood regulation. During the winter months, lower serotonin levels can contribute to these depressive symptoms. On a related note, during the winter months, our bodies often produce increased melatonin. Melatonin is a hormone that helps regulate sleep and wake cycles, and when produced in excess, this can lead to increased sleepiness and feelings of fatigue, exacerbating the symptoms of depression in those susceptible to SAD. Another important biological component in SAD is the “sunshine vitamin,” Vitamin D. While the exact relationship between Vitamin D and depression is unknown, low Vitamin D levels can cause symptoms similar to depression and Vitamin D receptors are found in areas of the brain that regulate emotion and behavior. In the winter months, people tend to get less sun exposure, which can result in lower vitamin D levels, which can exacerbate depressive symptoms. Finally, there is some research that suggests that there is a genetic component to SAD, with those with a family history of depression or other mood disorders may be more susceptible. Additionally, abnormalities in the brain’s structure or chemistry may make certain individuals more vulnerable to seasonal mood changes and at a higher risk of experiencing SAD. While not a biological component, it is also important to consider that in colder weather, we are less likely to socialize and interact with others, leading to isolation and loneliness, which can make SAD more pronounced.
Like so many other mental health concerns, the best approach to successfully treating SAD often involves a combination of strategies, tailored to your needs. Cognitive Behavioral Therapy (CBT) is a well-established form of psychotherapy that is often used to treat depression and anxiety, including SAD. The goal of CBT is to help individuals identify and change negative thought patterns that contribute to feelings of hopelessness, sadness and other symptoms of depression. For people with SAD, CBT can also help address the specific seasonal symptoms they are experiencing, such as reduced social interaction, excessive sleeping or the impact of less daylight. Another non-pharmacological treatment intervention is phototherapy, or light therapy. Phototherapy involves exposure to a bright light for about 20 to 30 minutes each morning, which mimics natural sunlight and helps regulate the circadian rhythm, reduce melatonin levels, and boost serotonin production. It is most effective when used in the morning, as this aligns with the body’s natural wake cycle. When used consistently, phototherapy has been shown to improve mood and energy levels in those with SAD, with its effects typically noticeable within a few days to a couple of weeks. It is important to note here that even though this is a non-pharmacological method, it is important to consult with your Principium provider before initiating phototherapy, especially if you have any eye-related conditions, as it may cause strain or discomfort. For individuals with moderate to severe SAD, antidepressant medications may be necessary. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and research shows that they can be particularly effective for treating SAD, as these medications increase serotonin levels. Additionally, Aplenzin is a medication that is FDA-approved for SAD. Similar to Wellbutrin, Aplenzin (bupropion hydrobromide) has a unique indication for the prevention and treatment of SAD. Finally, another biological agent that can be used in treatment of SAD is Vitamin D supplements. As noted previously, Vitamin D is essential for brain function and mood regulation, and there is evidence that low levels of this vitamin are linked to depressive symptoms. A Vitamin D supplement, especially in the winter months, may help boost mood and improve overall well-being. However, even though this is available over the counter, it is important to discuss this with your Principium provider as we can advise on the appropriate dosage and monitor for potential interactions with other medications you may be taking.
Finally, there are lifestyle adjustments that can be helpful in addressing symptoms of SAD. It is important to exercise and get regular physical activity, especially outdoors in natural light. Boosting endorphins and increasing exposure to natural light are great methods to improve mood and energy and help alleviate depressive symptoms. Maintaining social connections is extremely important in addressing SAD symptoms. Engaging in activities that you enjoy and socializing with others, when it feels difficult, can combat the isolation and loneliness that often accompanies SAD. Finally, maintaining a consistent sleep schedule, combined with proper sleep hygiene creating a restful sleep environment, can help regulate your mood and energy levels. Proper sleep hygiene includes habits such as limiting screen time before bed, avoiding stimulants later in the day, not taking day-time naps and creating a sleep-schedule routine.
More than simply the Winter Blues, SAD is a clinical condition with a combination of factors playing a role in those who are impacted by this. As such, there is a combination of treatment options, both pharmacological and non-pharmacological, available to you at Principium. You are encouraged to discuss any concerns or treatment options with your provider at Principium!
Principium Psychiatry has offices located in:
Grand Central/Midtown Manhattan, New York City
Wall Street/Downtown Manhattan, New York City
Greenwich, Connecticut
Santa Monica, Los Angeles, California
Principium Psychiatry utilizes cutting edge mental health care including: psychotherapy, medication management, ketamine, TMS, ECT, Botox, and other modalities. We welcome new patients for consultations and to start treatment towards a better you!
