How to Treat Seasonal Depression

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If you feel down, less energetic, and moody in the fall and winter, you are not alone. Nor are you necessarily just experiencing the "winter blahs." Seasonal Affective Disorder (SAD) is is a type of depression that is linked to the season’s shorter days and fewer daily sunlight hours. Unfortunately, its signs and symptoms are often ignored.

Signs of Seasonal Affective Disorder (SAD)

Each autumn and winter, patients, both new and ones I haven't seen for some time, complain that they feel sluggish, lethargic, and irritable. Often they are sleeping more than usual and find it a struggle to get out of bed. Their appetite increases, and they crave carbohydrates, gain weight, and experience an afternoon slump. During our consultation, it becomes clear that they've lost their "get up and go" attitude and are often dragging themselves throughout the day. They are withdrawing socially and declining invitations from friends to get together. Alcohol and substance use often increase in frequency. What frequently prompts them to seek help is that their job and relationships are at risk.

By asking patients about their past experiences, I can detect if there is a seasonal pattern. Inquiring about family history can also be helpful. When patients tell me that they've been miserable in the winter for years but feel better in the summer, it's a pretty safe bet that they are suffering from Seasonal Affective Disorder (SAD).

There are both lifestyle and medication strategies to prevent and relieve the symptoms of SAD.

5 Lifestyle Strategies to Relieve SAD Symptoms

1 Get outdoors. Studies show that being outside in nature has a positive effect on our mood, cognition, and health. Unfortunately, most people spend less time outside in the cold weather and that is exactly the time we need to soak up sunlight because of the shorter daytime hours. Being active is also an excellent way of combating fatigue and depression. Even a brisk 10-minute morning walk can make a difference.

2. Be mind-body fitness focused. Practicing yoga, tai chi, qi gong, or meditation have an impact on both our physical and emotional selves. They can improve balance, strength, concentration, breathing capacity, and resilience. Research has shown that mindfulness-based stress reduction can be as effective at reducing anxiety (which generally accompanies depression) as medication. Of course, there are benefits to incorporating mind-body practices throughout the year, not just if and when you are experiencing SAD. Meta-analyses of these interventions have shown that they are effective at regulating mood and modulating anxiety and depression.

3. Plan social engagements. Many people have become more isolated as a result of spending months indoors during the COVID-19 pandemic and working from home or in a hybrid arrangement. The cold weather often exacerbates this tendency to isolate. While it may be tempting to sit at home and watch TV when it’s cold and gray outside, social interaction can help lift our spirits. Whether you engage in community recreational activities or invite friends to visit or dine with you at a cafe, be sure to schedule time to see loved ones.

4. Let the sunshine in. Keep your window shades open on sunny days and use light therapy lamps, which emanate bright light to compensate for a reduction in sunlight during the shorter winter months. A meta-analysis of studies assessing the effect of light therapy lamps on depression has shown that bright light treatment is effective in mimicking outdoor light and boosting mood. Some health professionals recommend that those with SAD sit in front of a light box for 30 minutes every morning.

5. Eat plenty of fresh fruit and vegetables, get exercise, and speak to your doctor about taking a vitamin D supplement.

5 Medication Modifications to Discuss with your Doctor

Wellness practices, as I’ve described above, are not always enough to prevent or spur someone out of their seasonal depression. Many times I find that for the fall and winter months, I need to increase a patient’s dose of the drug they might be taking. Or sometimes I will add a small dose of another antidepressant—one that gives an energizing boost, curbs one’s appetite, or reduces anxiety. The ability to tailor medications today to a patient’s symptoms is remarkable. By adopting a “mix and match” approach, it is possible to get the best therapeutic results with a minimum number of side effects. Many, if not all, of these modifications can be reversed once the sunny spring and summer months arrive.

Please consult your health practitioner if you find yourself sinking into a seasonal depression. Here are some of the medication modifications that might be considered and discussed to augment the effect of the psychiatric medication you are taking:

1. Increase the primary antidepressant that has already been prescribed

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2. Add another antidepressant from a different category as an augmenting agent.

3. Add a low dose of a drug which quiets negative, ruminative thinking. Abilify is one example of such a medication.

4. Add a low dose of a psychostimulant, like Ritalin or Adderall, to boost daytime energy and help with early morning sluggishness.

5. Add an anti-anxiety medication. This could be a short-acting or long-acting drug, depending on the need.

The experience of falling into a slump during the fall and winter months is very common but there's no need to settle for a depressive and hopeless mindset. Speak to your health practitioner and work together on a plan to ensure that you live your best life all your long.

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