Beating the Winter Blues: Effective Strategies for Treating SAD
Seasonal affective disorder, also known as SAD, affects an estimated 5% of the U.S. population each year in autumn and winter. During these seasons, people with SAD typically experience decreased energy, fatigue, oversleeping, overeating, craving sweets and starches, difficulty concentrating and getting things done, and withdrawal from friends and family. As you can imagine, given this cluster of symptoms SAD can cause considerable suffering and disability.
The tendency to experience seasonal changes and difficulties exist on a spectrum. People who experience these changes to a milder degree are said to suffer from the winter blues. The distinction between SAD and the winter blues is not hard and fast. A person might easily experience SAD during one winter and the winter blues during another, depending on where they live, the severity of the winter, what treatment they may be receiving, and many other factors. Fortunately, it is often unnecessary to distinguish between whether somebody has SAD or the winter blues.
The following is a summary of the most commonly used treatments for seasonal affective disorder. If you wish to learn more about each type of treatment you can find further details elsewhere on this website, as well as in my latest book Defeating SAD: A Guide to Health and Happiness Through All Seasons.
1) Light Therapy
The observation that the symptoms of SAD develop as the days get short and dark and remit in the spring and summer was a powerful clue that the symptoms of SAD might be caused by the changing length and strength of environmental light across the seasons. If that were the case, we reasoned, perhaps giving people more light during the dark days would reverse their symptoms. This turned out to be true. Through a series of experiments, our team at the National Institute of Mental Health in Bethesda, Maryland, and other groups throughout the northern hemisphere, found that light therapy, as it came to be known, was indeed an effective treatment for SAD. Important elements involved in successful light therapy included:
The brightness of the light
Environmental light is measured in lux. Indoor light levels. in the absence of direct sunlight, often fall between 300 to 500 lux. To get a therapeutic effect, we and other researchers found that much higher environmental light levels are necessary. Although light levels were initially found to be effective at 2500 lux, increasing levels further to 10,000 lux was found to be preferable.
Obtaining a light box
Practically speaking, this level of light is best achieved by obtaining a special light fixture, which commonly goes by two opposite-sounding names – a SAD lamp or happy light. In order to administer the light properly, the box needs to be placed at a certain distance from the recipient and used for a certain amount of time, preferably in the morning. More details about the best box to use and how to use it can be found elsewhere on this website.
Light from other sources
Remember, not all therapeutic light has to come from a box. Even though the months of winter are dark, you’d be surprised how much light you can get by walking outdoors on a winter day and glancing up periodically at the sky. Outdoor sports, such as skiing, will expose you to even more light.
2) Cognitive Behavior Therapy (CBT)
Often the down feelings of SAD or the winter blues can be aggravated by certain dysfunctional behaviors and distorted thought patterns that are amenable to being modified by systematically inspecting them and, where necessary, changing them. Kelly Rohan, professor of psychology at the University of Vermont, has conducted most of the research in this important area.
Therapeutic behavioral interventions include helping people to exercise, socialize, and commit to potentially enjoyable activities, which easily fall by the wayside when you have SAD. Cognitive corrections are geared towards improving the distorted thinking that commonly occurs in people when they feel depressed. The depressed person is taught to identify certain types of specific distortions which are given names such as “fortune telling.” For example, depressed people who experience a rejection may conclude that nobody will ever accept them. The term “fortune telling” highlights the unwarranted nature of this assumption. Instead, patients are encouraged to think of possible reasons for the rejection that don’t reflect poorly on their worth.
Rohan and colleagues have found that a CBT approach is not only helpful in reversing the symptoms of SAD but also in preventing them from occurring in subsequent winters.
3) Attention to foundational habits
Certain healthy habits, when practiced regularly, can boost and maintain your good spirits through the wintertime. Such habits include:
- Exercise, both aerobic and resistance training
- Making sure you get enough good sleep – but not too much
- Managing your diet. Even though people with SAD crave sweets and starches, the energy boost these foods may give you is short-lived and you are likely to be going back for more before long. Shift your food group intake towards proteins, complex carbohydrates (such as legumes, grains and green vegetables)
- Meditation, such as Transcendental Meditation and Mindfulness practices can be helpful in providing stress release helping you stay grounded.
4) Minimize stress.
Recognize that this is a season when people with SAD or the winter blues have trouble with stress and can be greatly helped by relieving stress. Often it is worth paying for prepared food or services if you can afford to do so. Sometimes people with SAD feel ashamed to ask for help and thereby compound the problem by taking on more stress.
When should you consider getting medical help?
If the above self-help methods do not seem to be having their desired effect after a week or two and you are still suffering from SAD or the milder version, the winter blues, consider consulting a mental health professional. You may benefit from antidepressant medications and other professional services and I certainly recommend you access these opportunities if you are still having trouble. There is no need to suffer when help is available.
If your functioning is severely disturbed and your symptoms are jeopardizing your personal life or your work, that should spur you on to seek medical help sooner rather than later.
If you feel as though life is not worth living and have any thoughts of harming yourself, please do not delay in seeking out professional help.
How long should treatment continue?
There is no fixed rule to measure how long to continue treatment. The best guide is to use your “internal sad meter.” What I mean by that is evaluate how you are feeling, asking yourself questions such as:
- Is my energy level lower than normal?
- Am I sleeping too much?
- Am I eating too much, especially sweets and starches?
- Am I having trouble getting things done?
- Am I having trouble socializing and is this causing me problems with friends and family?
- Have I lost all interest in sex?
Depending on how you answer these questions you will have a very good sense as to whether you are suffering from the winter blues or SAD – and how you are managing with the condition. Once you have made this assessment you can decide whether you need more treatment or not.
When should I stop treatment?
This varies from person to person. Once again I suggest that you consult your “internal sad meter.” If you are feeling well again in those aspects of your functioning that are important to you, it may be time to taper some of your treatments such as additional light. Other self-care, such as maintaining your foundational habits or checking your thought processes and behaviors will serve you well throughout the year. When spring comes and you choose to pack away your lights, or your lightbox, don’t put it too far away as spring weather is often erratic and a snap of cloudy weather may call for bringing out the lightbox for a week or two.