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Winter Blues and Seasonal Affective Disorder

Our guest experts in December 2009 were psychiatrists Dr. Abby Hershler, Dr. Maithili Shetty and Dr. Nadiya Sunderji, and therapist Almuth Weigeldt from Women’s College Hospital in Toronto.

Dr. Hershler, Dr. Shetty and Dr. Sunderji all practice in the Mental Health in Medicine/General Psychiatry Program at Women's College. Dr. Hershler provides consultations to community shelters and is interested in education, advocacy and psychotherapy. Dr. Shetty provides consultations to the WISE (Wellness of Independent Seniors) team and the Urgent Followup Clinic at Women’s College, and is interested in medical psychiatry, addictions and education. Dr. Sunderji has expertise in psychotherapy, and provides shared care in the Family Practice Health Centre at Women’s College one day per week.

Almuth Weigeldt, MA, is a mental health therapist in the Women’s Mental Health Program at Women’s College. She has over 20 years experience in individual, couples, family and group therapy. In her 11 years at Women’s College, she has specialized in relational psychotherapy and issues related to medical illness, as well as interpersonal trauma.

Here are their answers on Winter Blues and Seasonal Affective Disorder.

Q: Now that winter is here I arrive at work when it is still dark and leave when it is dark again. What effect will this have on my mood?

A: The effect of darkness on mood continues to be scientifically studied and appears to depend on many biological and psychological factors that are specific to each individual. If you notice a change in your mood as the daylight hours shrink, try to adjust your schedule to allow for time outside in the sunlight (even a walk around the block) and take time for self-care. And remember: the days get longer after December 21!


Q: Is it true that people in northern countries like Canada have a higher rate of seasonal affective disorder (SAD)?

A: There is some research to suggest that SAD is associated with the shorter day length in winter. Recent studies estimate that SAD is more common in northern countries because the winter day gets shorter as you go farther north.

Studies done in Ontario indicate that 1 per cent to 3 per cent of the general population has SAD. This means that up to one million people in Canada may have difficulties in the winter due to significant clinical depression. Another 15 per cent of people have the ‘winter blues’ or ‘winter blahs’ – winter symptoms similar to SAD, but not to the point of having a clinical depression.


Q: Why does my seasonal affective disorder seem to get more intense every year? This year it has hit me like a ton of bricks. Will it ever go away or will I always have it?

A: SAD can be considered a regular depression that recurs in the fall and subsides in the early spring and may be triggered by the change in daylight. It needs to be assessed and treated appropriately like any other form of depression. Untreated depression symptoms may worsen over time.

When people have had a single episode of depression they are more vulnerable to developing a second or third episode. However, it’s important to get help, because there are many therapy/counselling and medication treatments available. It’s good to note that exercise (30 to 60 minutes, three times per week) in combination with other treatments can be a great way to boost your mood.


Q: I have been feeling quite down lately. I don’t seem to have a lot of energy for the things that I used to do in the wintertime (e.g. winter sports, preparing for the holidays) and I certainly don’t think that I’m going to be able to summon the energy to cook Christmas dinner for my family. How do I know if I have a case of seasonal affective disorder or if it is just the winter blues?

A: Many people feel ‘down’ during the winter, but some people have more severe episodes of feeling down all the time, fatigue and low energy, problems with sleep and appetite, loss of interest in activities that usually provide pleasure, and reduced concentration to the point where they have difficulty functioning at work or in the home. These people have a clinical depression. SAD describes people who have clinical depressions only during the fall and winter months and feel better during the spring and summer.

Other common symptoms of SAD include increased need for sleep, lethargy and an increased appetite for carbohydrates. With more severe episodes, people may have thoughts about death and suicide.

The Aurora Depression Self-Test may help you clarify whether your symptoms warrant a visit to the doctor’s office.


Q: I suffered from depression last winter. Am I at risk of being depressed again this winter?

A: When people have had a single episode of depression they are more vulnerable to developing a second or third episode. Of course, increased stressors (job stress, relationship stress, recent moves or losses) can make you more susceptible to another depressive episode this winter. However, it’s important to get help, because there are many therapy/counselling and medication treatments available.

Often constant negative self-talk, pessimistic thinking and being isolated is worsened during depressive episodes. Our thoughts, feelings, behaviours and physical symptoms are interrelated and by changing a pattern of negative self-talk or isolating behaviours you can improve your mood.


Q: My friend has been really moody lately and never feels like going out. How can I be supportive? Should I try to remind her that it’s just temporary or should I try to encourage her to be more active? Help.

A: Not knowing why your friend is moody, we can only suggest some general approaches. Your friend may need to be coaxed to speak to her doctor.

As a friend, letting someone who is feeling down know you are there to listen and to keep her company is really important. Distraction with enjoyable activities sometimes helps at least temporarily lift someone out of the blues. However, do not expect your friend to participate in exuberant activities. Depression is often accompanied by guilt and a sense of low self-worth, so that not being able to participate in fun stuff may make your friend feel even more like there is something wrong with her and may make her want to withdraw. Allow your friend to set the pace of activities, and do things ‘with’ rather than ‘for’ your friend.

Avoid saying things that you cannot back up, like ‘this is only temporary’ or ‘snap out of it’. Instead, remind her of things she used to enjoy with you and encourage her to try small steps to help herself in the moment.

Ask about her thoughts and if you hear she has thoughts of ending her life encourage her to see her doctor. Let her know it matters to you that she is well.


Q: Do light boxes really make a difference? If so, what are your recommendations for type and strength? 

A: Several reviews of the scientific literature have concluded that light therapy (provided by fluorescent light boxes that have greater than 2,500 lux light intensity) is effective in the treatment of 60 to 90 per cent of people with SAD. Ideally the light intensity should be at 10,000 lux, for 30 minutes per day usually in the early morning. 5,000 lux light boxes and 2,500 lux light boxes require you to sit in front of them for 45 to 60 minutes and one to two hours respectively. The light box is placed in front of you usually while you are seated. You can do other activities, but your eyes must be open for you to get the effect (no sleeping)!

You should see some change within a few days and symptoms should start to improve within a few weeks.

Make sure that your light box has a UV filter. There are also some LED light boxes available that do not require a UV filter, but there is not as much evidence to support their use.

Please note that it is important to consult with a doctor to confirm your diagnosis and discuss treatment.


Q: Is there any reason an older person with glaucoma should not use a light box?

A: Glaucoma and other eye problems could be worsened by the use of light therapy, so that in these cases other forms of treatment are safer.

People who have conditions such as diabetes, macular degeneration and retinal disease, or who are on particular medications may need to have eye examinations before they start light therapy. You should always consult with your doctor before starting treatment.


Q: Do tanning salons help to prevent seasonal affective disorder?

A: People should NOT use tanning salons to treat SAD. There is no evidence that they are helpful, and are generally considered risky in that they promote the development of skin cancer and can damage your eyes. There are safer ways to address the issue, for example by using therapeutic light boxes.

Light therapy works because it enters through the eyes, not through skin exposure to light. UV rays found in tanning beds can damage your eyes, whereas fluorescent light boxes have filters to block harmful UV rays and LED light boxes do not have any UV rays at all.


Q: How effective are exercise and diet for the prevention of winter blues and seasonal affective disorder?

A: Spending time outdoors, daily exercise and yoga are all helpful in reducing winter blues and there is some evidence that these activities may even help in the treatment of SAD. See the question below for your answer about diet and SAD.

Take a lunchtime brisk walk or spend some time outdoors during daylight hours! Exercise (30 to 60 minutes, three times per week) in combination with other treatments can be a great way to boost your mood.


Q: Does vitamin D help in the prevention of winter blues and seasonal affective disorder? If so, how much should I take?

A: There is some evidence to suggest that Vitamin D deficiency may predispose people to developing SAD, and it has been theorized that high-dose Vitamin D supplementation can help combat some symptoms of SAD. There have been a few small studies, but at this time, the evidence is still inconclusive. If you are suffering from the winter blues or SAD, then light therapy is the only treatment that has a large amount of supporting evidence.


Q: Can diet help combat my winter blues? I often feel like warm, starchy comfort foods at this time of year. Should I make more effort to eat fruits and veggies? Not sure if it will make any difference.

A: It is very normal to have cravings for carbohydrates during this time of year. However, if you are experiencing significant weight gain and abnormally strong cravings for carbohydrate and fat-rich foods and are experiencing symptoms of depression (see above) then it would be important to let your doctor know.

Studies about the effects of diet on mood have been contradictory and inconclusive. Some studies show that it is unlikely that carbohydrates have an impact on non-depressed individuals. Some studies have investigated the possibility that the increased intake of carbohydrates and decreased intake of protein in depressed individuals may make things worse. All of the studies require more research to draw any certain conclusions.

A balanced diet with seven to eight servings of fruits and vegetables and including foods rich in omega-3 fatty acids (such as salmon, mackerel and flaxseed), folate and B12 can help promote health.

Alcohol can be a depressant and may worsen anxiety symptoms. Be aware of how alcohol can affect your mood, and perhaps adjust the amount of alcohol you have especially during the holiday season.

The bottom line is that a balanced diet like Canada’s Food Guide is beneficial for overall health and well-being.


Q: Are there any herbal medications that one can take for seasonal affective disorder?

A: In mild to moderate SAD, studies have shown that the use of extracts from the St. John's wort plant (hypericum perforatum) may be effective. Additionally, crocus sativus (saffron) has been studied with mixed results and it is recommended for use after the failure of other treatments.

Please note that herbal remedies are regulated by Health Canada under the Natural Health Products Regulations. Products must undergo an approval process before they can be licensed. Licensed products are assigned a natural product number and only products with such a number are recommended for use.

There is an increasing number of randomized controlled trials (RCTs) for herbal remedies (and other complementary medicines). However, there is still much controversy about the quality of these trials (including issues such as small sample sizes, variability of diagnostic criteria etc.). There are also variations and lack of standardization in dosage, potency and concentration, all of which make it difficult for clinicians and patients to be confident that they are using the same doses as described in clinical studies. This makes recommendations difficult.

If you are interested in more information about herbal remedies, consider a visit to a naturopathic physician.


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