Resisting SADness

A friend of mine claims that February is actually the longest month of the year, having, she says, at least 126 days in it. It’s a joke to take the sting out of the month. In New England where we both live, February is cold and gray and unrelenting. The holidays feel long over. Spring seems far away.

For about five percent of Americans, the long, dark winter days bring some level of seasonal affective disorder (SAD). Women are four times as likely as men to show distress. It is not usually found in children and teens. The onset usually occurs after age 20. For reasons not yet understood, it decreases in frequency as people age.

In the American Psychological Association’s DSM-5 (Diagnostic and Statistical Manual), SAD is not listed as a separate diagnosis but as a specifier for a recurrent major depressive disorder. Symptoms include loss of energy, irritability, anxiety, hypersomnia (trouble staying awake during the day), overeating and a craving for carbohydrates (and therefore weight gain). It’s as if the body and mind go into a kind of winter hibernation, consuming and conserving calories and sending us off for a nap.

In order to be diagnosed with SAD, the beginning and the end of a major depression has to be in sync with a time of year and must occur for at least two years with no symptoms of depression at another season. Although most people with SAD experience it in the winter months, there are some individuals who suffer from SAD in the summer. This article looks at interventions that are helpful for those suffering wintertime SAD.

If the darker days put you into a darker mood, there are several interrelated things you can do to help yourself:

• Bundle up and go outside.
  Yes, go outside where it may be cold and windy. There are a number of studies that show that an hour a day of exposure to the sun’s rays do much to reduce the symptoms of SAD. Why? Because exposure to sunlight helps your body regulate the production of melatonin, the hormone that helps people sleep. More melatonin is produced when there is less sun, making you sleepy. More sun can result in more energy during the day.
• Take that walk in nature.
  A recent study by university professors Drs. William C. Sullivan and Rachel Kaplan found that people who took a 90-minute walk in nature reported fewer negative thoughts than those who took a 90-minute walk in a town setting. Those nature walkers also showed reduced neural activity in the subgenual prefrontal cortex, the area of the brain that is linked to risk for mental illness. If you live in a populated area, take a walk in a park.
• Get some exercise.
  Regardless of the cause of a depressive episode, it’s always true that exercise elevates mood. Find a seasonal sport you can enjoy. Go to the gym. Establish a home exercise routine. Even 30 minutes of moderate exertion at least three to five times a week has been shown to be helpful for any depression. To treat SAD, it is even more effective if you can do some of that exercise outside (see above).
• Kick the stress.
  Stress makes any depression more depressing. Do what you can to get unnecessary stress out of your life. Stay away from toxic people. Take breaks at work. Make sure to make time for some fun in your life, even if you don’t feel like it at the time. Consider taking a class in Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) or yoga or learn to meditate.
• Eat right.
  One of the symptoms of SAD is a craving for carbs. Resist the temptation as best you can. Get junk food out of the house and stock up on healthy snacks like fruit, nuts or greens instead. Reduce or eliminate caffeine and alcohol.
• Maintain good sleep habits.
  Sleeping (or staying in bed) extra hours won’t counteract the weariness that comes with SAD. Excess “rest” may only further disrupt your sleep cycle. Aim for only a solid seven to eight hours a night. Set a regular bedtime and waking time. Don’t give in to the temptation to nap. It will be even harder to go to sleep at bedtime.
• Reduce use of screens.
  Time on screens before bedtime is likely to keep you awake, contributing to the disruption of your sleep cycle. Mariana Figueiro and her team at the Lighting Research Center at Rensselaer Polytechnic Institute found that using a tablet at maximum brightness for only two hours is enough to suppress people’s normal nighttime release of melatonin, the hormone that signals your body that it’s time to sleep. Turn off all screens at least an hour before bedtime.
• Consider phototherapy.
  According to information on the American Psychological Association’s website, phototherapy relieves symptoms in about half of the people who experience SAD. Dr. Michael Terman at the Columbia University Medical Center found that the success rate is closer to 80 percent when the light therapy is specific to an individual’s sleep-wake cycle.

  Phototherapy involves sitting in front of a special light box that imitates natural sunlight for 30 minutes or more a day. It works by stimulating cells in the retina of the eye that connect to the hypothalamus, a part of the brain that helps control circadian rhythms. Not everyone responds to the same light level and there are some known side effects you’ll want to consider. Further, there is evidence that using a light box can trigger hypomania or mania in some patients with bipolar disorder. Confer with a specialist in phototherapy before giving it a try.

• Take a vacation.
  If you can afford it, escape the winter dark. A mini-vacation of even a few days sitting on a hot rock and basking in the sunshine can do you a world of good. If the symptoms of SAD are yearly and severe, decide if it’s possible to move to a sunnier part of the world.
• See a mental health counselor.
  Do consider seeing a mental health professional for an evaluation and suggestions. Cognitive-behavioral therapy has been found to be effective in helping people combat the negative thinking and brooding that are common in any depression, including SAD. There are medications that may be helpful.

If you have a history of being diagnosed with SAD in the winter months, you can take some comfort in knowing that it is naturally time-limited. Your season of discontent will end naturally as the days get longer. But you are not necessarily doomed to a yearly bout of depression. If you know that you are likely to be plagued by SAD again next year, take steps to reduce its impact. Establish good health habits like those listed above and get treatment for your tendency to depression. Gaining sound physical and mental health is the best strategy for resisting SAD-ness.

Winter day photo available from Shutterstock