By Dr. Anthony Levitt
More than half the population living in places where there are 4 seasons report noticeable difficulties with mood and energy in the winter months. Typically, the difficulties start to appear around November, are worse in January and February and then improve later in March and into April.
About 50% of the population report changes in their mood and energy that interfere with their daily life during these times each year. In about 2-3% of the population, these difficulties are very severe and are part of an episode of depression. This recurrent annual depression is sometimes called Seasonal Affective Disorder or SAD. Women are more often affected than men, it often begins in high school, and it usually is not recognized until the late 20s or early 30s.
There are several recommendations to help prevent and manage the symptoms of SAD. Many of these recommendations are also useful for people who have seasonal difficulties, but who may not have the full symptoms of depression.
1. Diet: As people become depressed in the winter they turn to comfort foods. In addition, there are fewer fruits and vegetables available in the winter months. We often recommend that people prepare healthy food options and freeze them during the summer months and then consume them in the winter when they feel less like cooking. This maintains good levels of nutrients year round and helps to improve health and to maintain body weight.
2. Activity: Although exercise is generally helpful for everyone, planned activity throughout the winter is particularly helpful for people with seasonal mood difficulties. Indeed, activity and exposure to light together seem to have an additive effect in alleviating winter mood issues. 30-60 minutes of walking three times a week may be a central part of a regime to prevent the low mood associated with winter time.
3. Exposure to environmental light: Spending time outside is not always easy in the winter, but it can be effective in fighting low mood. Exposure earlier in the day tends to be more helpful – usually before 10 am.
4. Sleep hygiene: Maintaining regular sleep habits may also act to prevent winter difficulties. In fact, the most common time for onset of symptoms of SAD is around the time the clocks change in October. Taking care to manage your sleep at these times is critical.
5. Psychological preparation: Letting friends, family, spouse, even colleagues know about the difficulties you have with the winter and planning with them to help you with the above steps can be very useful. Although people close to you cannot “treat” the symptoms of SAD, they can help prepare foods, encourage outdoor activity, provide emotional support, etc. Importantly, they can also provide guidance regarding when you might need to seek professional help.
6. Light therapy: Light therapy is probably the most effective and well tolerated treatment for SAD (and it can help with low mood in the winter too). The best light units to use are those that have been clinically tested by reputable scientists. The typical treatment involves 30 minutes of exposure early in the morning. Tanning beds are NOT light therapy and have other serious health risks. Desk lights and dawn simulators appear to be equally effective – check out which one fits your needs and lifestyle before commencing treatment.
7. Medications: Although only a few medications have been tested in SAD, most scientists agree that all antidepressants are probably effective in treating this subtype of depression. Speak with your physician about what options are available. Medications work quickly, are very effective but are not without their side effects.
8. Other treatments: Negative ion generators are probably the most common non-light treatment recommended for people with SAD. Melatonin is sometimes recommended, but there is little scientific evidence to support its use and it does have side effects.
9. Psychotherapy: Cognitive behavioural therapy has been shown to be effective in preventing and treating SAD. Other forms of psychotherapy are probably also effective, but have not been tested as yet.
There are many management options available for people with SAD or seasonal mood difficulties and most people will find the best combination for themselves, to allow them to find relief from the “winter blues”.
Dr. Levitt is Research Director in the Department of Psychiatry at Sunnybrook Health Sciences Centre, and Professor of Psychiatry at the University of Toronto. He specializes in the management of treatment resistant depression and bipolar disorder, and is a strong advocate for enhancing patient and family access to, and navigation of, the mental health system.