What is a time of joy for many women was my darkest hour.
Two things I make no secret about dealing with are depression and hatred of cold winter climates, so I remember feeling an odd relief back when I learned that seasonal affective disorder was officially A Thing that had been named and could be addressed.
I must admit that that initial relief was in danger of being fully compromised upon seeing that name, and the corresponding acronym for seasonal affective disorder. I could only hear “SAD” sneered mockingly, Dr. Evil style, as if it was a punchline from an as-yet-unmade Austin Powers movie.
“Awwww, poor baby. Why are you shivering and crying? Feeling…SAD? MUAHAHAHAHA!”
Certainly a legitimate emotional/psychological disorder that negatively impacts my mood in grave ways couldn't have been named like a satirical insult from the South Park guys, who also once made the hideously regrettable acronym for the fictitious Film Actors Guild a movie plot point, right?
Well, of course not. It turns out that seasonal affective disorder was first fully recognized, studied, and named by Dr. Norman Rosenthal in 1984 while he was working at the National Institute of Mental Health. Dr. Rosenthal literally wrote the book on the subject, so let’s just bear with the ridiculously on-the-nose acronym because the SAD is bad and I, for one, am determined to face this sucker head-on this year.
The American Psychiatric Association’s Diagnostic and Statistical Manual, the DSM-5, which some of us know well, classifies SAD as a subset of major depression, and it doesn’t get more official than that. The “winter blues” get lots of folks down, but the D in SAD doesn’t stand for down, it stands for disorder. While I do support a “whatever’s clever” approach, some of us need more than a chunky sweater or copious amounts of soup to overcome.
It can feel natural to shrug off decreased energy or sleeping more once we turn the clocks back, but the U.S. reports more than 3 million cases of SAD per year, and for many of us, it requires serious attention and treatment. Women are statistically more likely to suffer from SAD, and I’ve been brainstorming ways to get the jump on this SAD jackass before it’s too late and I’m under the covers weeping in total darkness at 4:20 in the afternoon:
1. Call the evil by its name.
Do you have SAD? Just like depression that is not season-specific, symptoms may vary widely from person to person, but they can include low energy, lack of interest in things you usually dig, trouble sleeping/oversleeping, difficulty concentrating, appetite/weight changes (especially a craving for foods high in carbohydrates), irritability, low energy, loss of sex drive, hypersensitivity to rejection, heavy, "leaden" feeling in the arms or legs, and of course the more serious markers of major depression: feeling depressed most of the day, nearly every day, feeling hopeless or worthless, and suicidal ideation.
2. Talk that SAD talk.
Talk to a mental health professional about your specific seasonal challenges in addition to any emotional issues you might be going through, or please consider seeing someone if you aren’t already.
In addition to traditional talk therapy, there are cognitive behavioral therapy techniques that are tailored specifically to combat SAD. Speaking to the American Psychological Association, SAD expert Dr. Kelly Rohan describes one such course of treatment as “12 structured sessions, delivered two times per week over six weeks in the winter.” The focus is on developing skills and practicing behaviors to improve coping with the seasons and “counteract the down, lethargic mood and the tendency to give in to ‘hibernation’ urges that are so common in SAD.” Dr. Rohan encourages patients to “aggressively apply the skills they learn in CBT before symptoms start, typically early in the fall or around the end of daylight saving time.”
‘Tis the season to be proactive! The NIMH has us covered with this basic starting point for seeking treatment, and if you’re even thinking about it, I urge you to take that first step.
3. Say yes to drugs!
If a professional deems them appropriate for you and prescribes them, of course. If you’re being treated by a mental health professional and have a clinical SAD diagnosis, medications in the SSRI class such as Sertraline (Zoloft) or Fluoxetine (Prozac), or non-SSRI medications like Bupropion (Wellbutrin) or Venlafaxine (Effexor) may be diagnosed to assist in SAD management. It’s important to work with your doctor to find the right dosage for you, which may take a bit of trial and error, but your quality of life is worth it.
The exact cause of SAD hasn’t been pinpointed, but the lack of serotonin already associated with major depression may be triggered and/or increased with a change in seasons, and research indicates a connection between SAD and decreased serotonin, so these medications may be helpful.
The stigma many feel about taking psychiatric medication to begin with is something that causes irreparable harm, and the “minor” or less significant view of SAD can exacerbate that. It’s crucial for each person to do what’s best for them, and I don’t encourage overmedicating or taking medication without appropriate diagnosis or professional supervision, but I do encourage living your best life; a life that you deserve in any season. If medication can assist, there can’t be shame in that.
4. Get hormonal.
Melatonin is a naturally occurring hormone in the body and has become very popular for addressing sleep and mood issues, despite not being approved by the FDA for medicinal use.
There are many misconceptions about melatonin, but what it can do is assist in resetting your circadian rhythms when they’ve been knocked out of whack. The change in season can disrupt the balance of the body's melatonin levels, which plays a role in sleep patterns and mood. People who take melatonin to assist with travel across time zones and even falling asleep in their own bed often don’t pay close enough attention to the timing and dosage in order for it to be fully effective.
If melatonin is going to work for you, it will have a cumulative effect over time, and needs to be taken at exactly the same time every day, with the maximum efficacy timing and dosage varying per your individual needs. Though not conclusive, this test from the Center for Environmental Therapeutics may provide helpful sleep pattern parameters for you to look into with a trained professional. Bear in mind, however, that while Dr. Rosenthal and his crew recognize “the central importance of melatonin as a hormonal mediator of photoperiodic changes on seasonal rhythms” (whew — say that five times fast), melatonin alone has not been shown to fully treat SAD. It works best in conjunction with other therapies, such as…
The decrease in sunlight in the winter months is the closest thing we have to an actual villain in this story, and light therapy is the most highly advised Batman to the Bane of darkness. Which brings us to yet another fun acronym: BLT.
(I’ll give you a moment to think about sandwiches and bacon because mmmmmmm bacon.)
Bright light therapy, or BLT, involves structured exposure to a specific light source that is designed to mimic natural light. The OG homie Dr. Rosenthal has a personal “morning light routine” setup that involves using multiple 22-inch lightboxes to create a simulated Caribbean sunrise, (!) but there are loads of therapeutic lightboxes to choose from, available in a wide range of shapes, sizes, and costs.
It’s important to make sure you’re choosing a therapeutic lightbox designed specifically for that purpose and using it safely. I don’t have a lightbox yet, but I’m looking, so please let me know if you have one you love.
All due respect to the joys of technology, but let’s remember that good old-fashioned natural light can help as well. We get decreased amounts of it during the winter, but we can adjust our schedules and exposure levels to maximize what little we do get. For those of us in frigid climates that don’t love the cold, if you can bundle up and spend some time outside at a specific bright hour each day, you can soak up that natural vitamin D. Bonus points if the sun is reflecting off of snow — nice conundrum, that.
And hit up your drugstore of choice to get the “sunshine vitamin” in liquid or pill form, too. Research shows a link between decreased vitamin D and depression, and particularly SAD. I upped my own vitamin D dosage to ultra-concentrated 10,000 IU daily. And yes, of course I joke about “taking the powerful D,” because I’m just that kind of broad.
6. Negate your ions!
Negative air ionization requires purchasing a device as well, and there are even some lightboxes with a negative ion generator component built in to take advantage of this additional SAD treatment option. Air ion supply lowers in the winter, and although some air purifiers may help, a specific high-density negative ion generator is necessary for treatment use.
Columbia University psychology professor and negative air ionization treatment expert Dr. Michael Terman found that significant use could help your wintry rec room feel more like a summery field, at least in terms of air quality. If you’re hip to this, please let us know how it’s worked for you!
7. If all else fails, you could always move.
This is going to sound extreme, but maybe you just need to get closer to the equator. Seven times as many people deal with SAD in Washington State as in Florida, and if you’re staring down the barrel of a Nordic winter, may the force be with you.
Bear in mind that the good Dr. Rosenthal himself was only prompted to study and name SAD after moving from sunny South Africa to New York in winter and having a psychological response of WTF?!
Picking up and moving may be unrealistic, but maybe so is not living your best life for full seasons at a time every year. There’s no shame in doing what you gotta do to rock this life thing out, and where you live definitely affects how you live.
Whatever you do, wherever you live, and however dark it gets at whatever time of day, we’re gonna get through this winter. As God (and Powerful D) is my witness.