Kyle Baird, DO is the Associate Medical Director at CU Medicine Psychiatry - Outpatient Clinic. His commitment to academia can be seen by his work as a Senior Instructor in the Department of Psychiatry and as Associate Director for the Psychiatry Residency Training Program at the University of Colorado School of Medicine.
“It’s just the winter blues” is perhaps a phrase that you have heard, or have spoken yourself, at one point or another. While it may seem like a light-hearted remark, it is important to recognize that “winter depression” can represent a serious, yet treatable, mental health condition.
Seasonal Affective Disorder (SAD) is the term that is used to refer to episodes of affective (mood) dysfunction occurring in a seasonal pattern. While this could include either elevated mood states (mania, hypomania) or depression with any seasonal pattern, the most common presentation is depression occurring in late fall and winter, which is what we will focus on here. The lifetime prevalence of SAD may be as high as 3%, and there are multiple theories regarding the cause, with suspected factors including shifts in circadian rhythm, the effects of diminished light stimulation, low levels of serotonin and genetic predisposition.
Treatment of SAD, specifically depression with a winter seasonality, has similarities to the treatment of depression generally, in that medication and psychotherapy can be effective interventions. First-line medications are generally selective serotonin reuptake inhibitors (SSRIs), which function to increase the level of serotonin activity in the brain. The selected modality of psychotherapy is tailored to the individual, after assessment of symptoms, treatment preferences, and treatment goals. In addition to the above, SAD is unique in that there is evidence to support the use of Bright Light Therapy as an effective treatment. A common regimen includes daily 30-minute exposure to a light of 10,000 lux. There are a variety of alterations that can be made to suit individual needs (I.e., lower lux light with longer exposure, dawn simulation technique). There is a wide selection of lights on the market, and not all techniques presented online may be appropriate for you or medically reviewed, so it is important to speak with your healthcare provider prior to adding Bright Light Therapy to your routine.
Symptoms to watch for:
- Depressed or low mood
- Loss of pleasure or interest in previously enjoyed activities
- Change in appetite or weight (decrease or increase)
- Change in sleep: insomnia (decreased sleep) or hypersomnia (increased sleep)
- Fatigue or loss of energy
- Decrease in ability to concentrate
- Slowing of muscle/motor movements
- Feelings of worthlessness or guilt
- Suicidal thoughts or behavior*
- A pattern of the above symptoms occurring in specific months of the year or season
Tips to stay healthy:
Good sleep hygiene
- The circadian rhythm is critical to support a variety of biological systems, including mood. By taking some simple steps, you can set yourself up for success and well-being. Some easy interventions include maintaining a regular sleep schedule, limiting light and screen-time before bed and avoiding caffeinated beverages late in the day.
Daily walks outside
- As you likely have guessed by the effectiveness of Bright Light Therapy as treatment for SAD, light can be key. By walking outside daily, you are giving your brain critical stimulation through the input of light, even on cloudy days.
Regular aerobic exercise
- Many studies have shown the benefit of regular physical activity on mental health. Please speak with your physician for guidance prior to initiating any new exercise routine, as it is important to consider any underlying conditions or limitations and adjust the routine accordingly.
How to get treatment:
Initial treatment should be sought through a primary care physician, as it is important to be evaluated for possible medical conditions that can mirror the symptoms of SAD, such as hypothyroidism or vitamin deficiency. Your primary care provider will complete a physical exam and may obtain labs. Once any medical conditions are ruled out or treated, and a diagnosis of SAD is confirmed, your primary care provider may initiate treatment themselves, or they may refer you to a psychiatric provider for specialized services.
* If you are experiencing suicidal thoughts or behaviors, please seek help immediately. Assistance can be sought at your nearest emergency room or by contacting Colorado Crisis Services by phone at 1-844-493-TALK (8255) or online at coloradocrisisservices.org.org. The National Suicide and Crisis Lifeline can be accessed by dialing 988.