Carey Roach, M.D.
Adult Internal Medicine and Pediatrics-Combined
Why Does Winter Make Me Feel Depressed?
Do you find yourself feeling depressed every year during the cold, dark winter months? Do you get tired of going to work in the dark and going home in the dark? Do you feel less energy or become more forgetful?
Since I bet some of you reading this feel worse in the Fall and Winter months, I wanted to discuss Seasonal Affective Disorder, to offer help before we get later in the season. You may be asking “Seasonal What Disorder?” Seasonal Affective Disorder is a decreased mood or depression (another name for mood is Affect) brought on by the Fall and Winter days being shorter and with less light exposure per day. A mild version is called Winter Blues.
Medicine, the military, and the government are notorious for acronyms, so, appropriately, Seasonal Affective Disorder is a.k.a. S.A.D.
Mild symptoms of S.A.D. include:
Tiredness or low energy
Oversleeping
Difficulty concentrating
Appetite changes, especially a craving for foods high in carbohydrates
Weight gain
Moderate to severe symptoms include:
Feeling depressed most of the day or every day
Losing interest in activities you once enjoyed
Severe fatigue
Problems sleeping
Feeling agitated
Feeling hopeless or worthless
Having thoughts of death or suicide
We have a tiny, semi-mysterious gland in our central brain called the pineal gland, which is responsible for our awakening and sleep cycles. It is affected by both the duration of light and the color of light, and as a result, can affect our mood. The pineal gland appears to produce less serotonin and more melatonin when exposed to less light per day. Serotonin is a neurotransmitter in the brain that affects mood, cognition, memory, and, well, everything in the body. The lack of serotonin causes depression, anxiety, and a general decline in cognition and sense of well-being.
Vitamin D also helps raise serotonin, so it makes sense that, as light exposure decreases, vitamin D levels decrease, and further affecting serotonin levels.
By the way, good food raises serotonin, which is likely part of us wanting to eat more food when depressed or bored, so weight gain is common with SAD. The holiday barrage of foods just amplifies that.
Melatonin is a hormone that regulates our sleep-awakening cycle. Increased levels of melatonin cause sleepiness.
Approximately 5-10% of the population of the United States annually has SAD, and they tend to have a decrease in their mood in late September into October, as the days get shorter. They then improve by March-April. It tends to affect people who live closer to the poles than near the equator because the angle of the light hitting our atmosphere is more dramatic toward the poles. As the Earth tilts away from the Sun during the winter seasons in the Northern Hemisphere, the days are shorter farther to the North than they are to the South. The change in the angle of light changes the color of light, also affecting the pineal gland.
The unique thing about SAD is that it can improve by increasing exposure to sunlight. Getting outside once daily for at least an hour helps, as does leave as many windows uncovered during the day. But an innovative treatment is sitting in front of a small light box for a half-hour to one hour per day during these months. The light is of the same color and intensity as that of sunlight, and you can easily get these boxes from Amazon. Here is a nice review on CNET of the different light therapies available this year: https://www.cnet.com/health/best-sad-light-therapy-lamps-for-2020/
The light box needs to produce an intensity of light of at least 10,000 Lux. Ideally, it should be 12 inches square or more and placed 18-24 inches from the user. Some lights are smaller and more compact, so need to be placed closer to the user, depending on the instructions that accompany each box. The light box should filter out as much UV light as possible, and one that is not a treatment light for psoriasis or other skin conditions, which emit more UV light. Preferably it should aim downward to decrease direct exposure to the eyes. Treatment duration ranges from 30 to 60 minutes, depending on the size of the light.
Of course, people get depressed for other reasons, and it may coincide with the darker months. Some people get depressed during the holiday months while grieving the loss of a loved one, or they feel lonely during the holidays; so I always have to be sensitive to those factors in treating my patients with depression, and not assume it is only from SAD.
Regardless of the benefits of light box therapy, if someone is moderately or severely depressed, they usually still need antidepressant medication and counseling.
So, if you recognize that you have these symptoms this time of year, consider the light box therapy, but always consult your physician or psychiatrist about whether you also need medication for treatment. You should consider checking your thyroid levels and Vitamin D levels to be sure a deficit in either is not contributing to your symptoms. Consider seeing a counselor or clinical psychologist to help.
I also recommend taking at least 2000 units daily of Vitamin D3, especially during the winter months. Taking 5000 units daily of D3 is preferred. Taking more than 5000 units daily of D3 might cause some liver irritation.
I, as a physician, and all of us should be concerned if someone is depressed enough to be suicidal, making sure that person gets help. Light box therapy in the short term will not help with that.
Christmas, and, literally, Hanukkah, are seasons of light and love and happiness; and I pray that for each of you this season, and that the winter does not get to you.
If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the Crisis Text Line (HELLO to 741741) or go to the National Suicide Prevention Lifeline website.
Carey Roach, MD is Board Certified in both Adult Internal Medicine and Pediatrics-Combined. He practices primary care medicine at the Barg Family Clinic in Little Rock, Arkansas. Currently his hobbies include swabbing for Covid 19, eating his wife's great food, and getting an education from his kids about The Mandalorian. His views are his alone, although based on research and experience, but do not necessarily reflect the views of the management or staff of the Barg Family Clinic (although he thinks they should.)
Comments