Fall is the best time to prepare for winter seasonal depression

The Washington Post

By Richard Sima

October 5, 2023

A fall check-up can help you prepare for – and potentially prevent – winter seasonal affective disorder

Fall is the best time for those who suffer from winter seasonal affective disorder (SAD) to check in and prepare.

Susceptible people — an estimated 5 percent of Americans — already are feeling the effects of winter SAD, lower moods, lethargy and excessive sleep, despite the sweltering global heat records of summer and early fall.

“The good news is you’re dealing with a predictable phenomenon,” said Norman Rosenthal, a psychiatrist at Georgetown University School of Medicine who first described SAD. “The bad news is itis not always as predictable as you’d like.”

Winter SAD probably is caused by reduced daylight, which knocks our circadian rhythms out of sync and can affect brain circuits involved with mood. (Summer SAD, in contrast, is thought to be precipitated by heat, humidity and allergies.)

Since the height of summer, we have been losing daylight. D.C., for example, has already lost over three hours of daylight by this point in October, while those living in higher latitudes have lost even more.

From here on, the Northern Hemisphere will continue to experience shorter periods of daylight until the winter solstice. (By then D.C. will have lost almost 5½ hours of daylight.)

But because of the historical heat, it can be easy to miss the signs that it is already time to prepare for winter SAD, which can last up to five months and, counterintuitively, begins in the fall.

How to prepare for winter SAD

It is easier to prepare for and prevent winter SAD than to dig oneself out of depression.

“By the time you’re down, it’s already late in the day,” said Rosenthal, author of the recent book “Defeating SAD: A Guide to Health and Happiness Through All Seasons.” “If you let yourself get really down, then you’re just coping to get from day-to-day with your daily activities, let alone preparing for the future.”

Before winter arrives, make proverbial hay while the sun is still out. Here is what experts advise.

Begin light therapy

A light box for light therapy in the morning helps us recalibrate our circadian rhythms and, when used correctly, can be an effective treatment for winter SAD with minimal side effects.

Making sure you have a light box and identifying a room in the house with bright light can help you prepare as the days grow darker, Rosenthal said.

If you know you respond well to light therapy, the clinical guideline is to “initiate it upon the very first symptom each year,” said Kelly Rohan, a professor of psychological science at the University of Vermont who researches SAD and other mood disorders. “Don’t wait to be in the depths of a full depression. The very first day you wake up and say, ‘Oh my gosh, I feel more tired than I did yesterday,’ that should be your cue to resume light therapy.”

Check in with your physicians

Let them know you are entering your “season of risk” so they are on notice to help, Rosenthal said.

If you do not have an official diagnosis of winter SAD but find symptoms have gotten in the way of your daily life, ask your primary-care provider for a referral to a qualified mental health professional, Rohan said.

“I don’t know what it is about seasonal depression that people tend to try to go it alone,” Rohan said. “Depression is a serious mental health issue. We wouldn’t try to figure out and treat our own cardiovascular issue or cancer.”

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and Wellbutrin are approved by the Food and Drug Administration for SAD. Reminding your prescribing doctor or psychiatrist may make it easier to adjust medication dosage sooner rather than later.

Alerting a trusted therapist also can help that person to catch early signs of SAD symptoms and provide support. Psychotherapy, especially cognitive behavioral therapy (CBT), has been shown to help with SAD by teaching effective coping skills.

A 2016 randomized controlled trial conducted by Rohan and her colleagues found that people who received CBT therapy for SAD had lower rates of recurrence the following winter compared with those receiving light therapy.

Maintain routines that help mental health

It can be easy to go into hibernation mode when it starts becoming dark early. “It might feel good in the moment but usually serves to maintain depression, if depression is a problem,” Rohan said.

Instead, try to “be really mindful of your routines that serve to maintain your good mental health and try to keep up with those as much as possible,” she said.

Staying sociable, engaging in hobbies and exercising can improve your mood. Preparing early for these activities in the winter, such as having a warm coat to continue your walks or signing up for choir practice, can in turn make it easier to keep these mood-boosting routines.

Reevaluate your outlook on the changing seasons

People with winter SAD have learned negative associations with the signs of autumn and winter.

After preparing for winter, try to ask, “How can I find beauty in this colorful season, autumn, resplendent with the fruits of summer?” Rosenthal said. “You can start really enjoying the colored leaves because they’re not kind of a warning of bad things to come but part of the joy of the season.”