3 Ways to Help Manage Seasonal Affective Disorder

“I’m feeling depressed again, and it isn’t even winter,” said Alexandra, reaching for a tissue and looking down at her shoes as she began to cry. “What is going on?”

I sat quietly with her, not knowing what the future would hold. But one thing I did know, in our universe after going through the COVID-19 pandemic, was that in my clinical practice I was seeing more and more depression and anxiety. Could the diminishing light exacerbate these symptoms?

There has been a lot of press on “languishing,” the word du jour on what we are all “feeling,” affected by the COVID-19 era. But, for me, languishing evokes something out of a Victorian novel with porcelain tea cups. What we clinicians are seeing is not a tea party.

Freud once told us that, if we wanted to understand the human psyche, we should turn to artists and poets. There is a line from Sylvia Plath that spoke to what Alexandra was experiencing. Plath was writing about her experience of autumn and how hard it is to return to the stress and demands of daily life, “the best of summer gone. And the new fall not yet born. The odd uneven time.”

The French have an expression for it as well, which translates as the “re-entry blues.” I wonder if this is compounded by so many of us questioning if we want to re-enter our lives, or lives as they used to be in this altered landscape. I think these factors are underlying what we are calling “the Great Resignation” as well as the new variation, “Quiet Quitting.” Should I leave my job? Alexandra wondered. Should I move? Rather than explore what we call a geographic cure, I invited Alexandra to explore what she was experiencing.

And I wonder if the most useful question that clinicians can ask isn’t “What is it?” but “How can we help?”

With Alexandra, I tried a 3-step approach, combining increased exercise, mindfulness meditation, and cognitive-behavior therapy. The combination of these treatments gave her a new perspective on what she was experiencing. Feel free to try this intervention (or parts of it) with your patients who might be experiencing seasonal affective disorder, "post-COVID blues," “fall dread” or some combination of these.

Exercise

There is some interesting new work on what is being called “exercise snacks.” I’m finding that many patients are taking well to this idea, and it feels easier than 30 minutes of cardio. In fact, most are finding it accessible, if not appetizing. Researchers are finding that a two- to five-minute walk after lunch can help lower the risk of type 2 diabetes and decrease cholesterol and high blood pressure. Since Alexandra was worried about her high blood pressure, this was a natural intervention.

Add Some Mindfulness

Once she was outside, I added a short mindfulness meditation practice for her to try. I asked her to notice what she was seeing on her short walk. At first, she complained about how much she hated the shorter days. “OK, I get it," I responded, “but let’s look for what you like about the fall.” I paraphrased a line from the writer Camus, who wrote that autumn was a second spring where “every leaf was a flower.” This reminded her of collecting colored leaves in elementary school and then pressing them in a dictionary. She started collecting bright red and yellow leaves from her walks, which lifted her spirits.

One meditation teacher has suggested that we look for things “out of season,” noting that this can increase our sense of wonder. I mentioned this to Alexandra. This intrigued her, as she realized that she wasn’t really looking at her life but was on autopilot. “I noticed a violet on my short walk yesterday. A violet in October. That was unusual.”

Cognitive Reframes

At this point in our work, Alexandra seemed open to shifts in perspective. One of the most useful ideas came from Ruth King, who writes eloquently about race and also is a meditation teacher. King has wisely noted that when we become uncomfortable or frightened, it is good to remember that difficult emotions can be our most profound teachers.

This helped Alexandra get curious about what was frightening her. As she looked at the discomfort head-on, she was able to name it, thus becoming less reactive. Research tells us that this process of naming our experience can help us move out of the amygdala, the alarm center of the brain, and into the prefrontal cortex, where executive functioning increases. “Well, I’m worried about another lockdown,” she realized, “and I’m worried about feeling really trapped, as I did in the previous winters.” However, being able to adopt a larger perspective helped Alexandra realize that she had also grown a lot during the two COVID-19-era winters and was much more resilient and able to weather the storms and winds of life.

Cognitive Behavioral Therapy Essential Reads

Cognitive Behavior Therapy for Adolescents With Eating Disorders

Bringing CBT to Young Readers

Try these practices with your patients to see if they are a useful antidote to the winter blues.