How to cope with Winter Blues

Meaning of Winter Blues

The "winter blues" is a depressive disorder that begins in fall and lasts throughout the winter.

It is recurrent, meaning that it happens every year as the days become shorter and sunlight decreases. It is seasonal (hence its name).

Its scientific name is Seasonal Affective Disorder, with its very descriptive accronym "SAD".

Let's look into its symptoms and who are affected by it:

Winter Blues Symptoms and Prevalence

Prevalence of SAD

SAD can affect from 1 to 2.4% of the general population, but several studies have reported that 10 to 20% of those living in northern or southern countries (far from the balmy Equator) reported milder forms of Winter Blues (1).

SAD is a major depressive disorder, and its symptoms have a serious impact on mood. People feel sad and depressed, and lacking energy.

It is more prevalent among women and younger people. Those with a family history of bipolar disorder, or depression (including SAD) are at risk too.

SAD appears to run in families so it may have a genetic component (2).

Symptoms

Winter Blues symptoms include (3):

• Feeling sad.
• Lack of energy. Feeling tired and lethargic.
• Sleeping more than normal.
• Feeling Irritable.
• Crying frequently.
• Craving for carbs adnd sugars.
• Weight gain due to overeating.
• Social withdrawal, isolation.
• Difficulty concentrating.

Some, or all of these symptoms may appear in those afflicted by SAD. Some symptoms may be more severe than others. There is a mild form of SAD (called "subsyndromal SAD") and severe SAD which may even include thoughts of suicide.

Geographic Location and Winter Blues

The further away you live from the Equator, the higher the chance of suffering from SAD.

Although all parts of the World get the same quantity of daylight during a year, this daylight is not spread out equally.

On the Equator, day and night hours are identical: 12 hours daily, throughout the year. At the other end, on the South or North Pole, you have 6 months of darkness and 6 months of daylight. Both, poles and Equator get the same 50% of sunlight and 50% of darkness, but in the poles winter sets in for a dreary 6 months of darkness.

As you move away from the Equator, days become longer during summer, but nights become longer during winter.

So a person living in New York City has shorter winter days and longer winter nights than one living in Miami.

Someone living in Juneau, Alaska, has even longer winter nights and shorter winter days.

Why does it hit you in Winter?

Lower levels of Mood boosting Serotonin

Some studies (3) have found that people affected by SAD have difficulty in regulating a neurotransmitter called serotonin.

Serotonin is a chemical produced by your nerve cells and it plays an important role in regulating mood (as well as other bodily funcions such as appetite & digestion, sleep, sexual desire, memory, and social behaviour).

Serotonin is transported by a protein called SERT, that moves it from the synaptic gap (where two neurons link-up to transmit nerve impulses) into the main body of the nerve cell, where it is recycled.

People suffering Seasonal Affective Disorder have 5% more SERT during winter than during summer. So having too much SERT will lead to lower serotonin levels in the synaptic gap, reducing its activity.

During summer, sunlight helps keep SERT levels low, but shorter days during fall and winter boost SERT and therefore lower serotonin levels.

The outcome of less serotonin is depression.

Young (2007) (4) revealed that the levels of serotonin in human brains are higher during summer.

Higher production of Melatonin

It is also possible that people afflicted with SAD have an altered production of melatonin (3).

Melatonin is a hormone produced by the brain's pineal gland. It is what makes you sleepy when it gets dark.

The darker winter days stimulate melatonin production causing people with SAD to feel more lethargic and sleepy.

Melatonin by itself does not cause Winter Blues, but coupled with lower serotonin levels it has a negative impact on the body's circadian rythm.

Disrupted Circadian Rythm

The circadian rhythm is your body's internal clock. It runs on a cycle that is about 24-hours long.

It is generated internally but is modulated by external clues (temperature and sunlight) and therefore is affected by seasonal changes of daylight (or sudden changes caused by a flight across several time zones, which disrupt the clock provoking jet lag).

People with SAD have a circadian rythm with a different timing to that of other people. This mistmatch between circadian rythms and sleep⁄wake cycles makes it hard for their bodies to adjust to the seasonal changes of light and darkness.

Treatments therefore focus on enhancing serotonin levels and adjusting the body's internal clock, as we will see below.

How to cure the winter blues

Treatment for SAD

What good is the warmth of summer, without the cold of winter to give it sweetness John Steinbeck, Travels with Charley

Scientific research has found five different approaches FOR treating Winter Depression:

1. Vitamin D.
2. Light Therapy.
3. Melatonin.
4. Antidepressant medication.
5. Counselling.

Let's look into each of these therapies:

The key is to improve serotonin levels and also reset the body clock, which is done either with Melatonin or Light Therapy, or both (2).

Vitamin D

The mechanism by which Vitamin D interacts with depression is yet unknown, but a study (5) reported that it may enhance serotonin production and therefore improve mood.

According to Melrose, (2015) and Young Sup Woo (2019) (3, 6), low levels of Vitamin D are linked with depression and people suffering from SAD have deficient levels of this vitamin.

Low levels of Vitamin D are usually caused by unbalanced diets (eating food that lacks this vitamin) or lack of outdoor activity: sunlight is necessary for your body to make Vitamin D from cholesterol.

It is the sun's UVB rays that provide the energy to synthesize Vitamin D.

Sunlight and Vitamin D

Exposing 50% of your skin area (without sunscreen) for 12 minutes at midday, in mid latitude USA produces an amount of Vitamin D equivalent to supplementing 3,000 UI per day (7).

But the cold winter conditions keep you indoors, and covered up. This makes it hard to expose skin surface to the sun, so it halts its natural production.

This means that during winter, Vitamin D must be supplemented. The current recommendations for Vitamin D intake are 200 - 600 IU per day. However, these are considered too low by many researchers, who suggest that people not getting enough sunlight exposure may require 800 - 1,000 IU per day to attain optimal blood levels of Vitamin D (30-40 ng/mL) (7).

Bear in mind that Vitamin D is soluble in fat. Your body stores it in its fatty tissue. Overdosing can cause intoxication, and adverse reactions could occur with doses of 50,000 IU or more per day.

Dietary sources of Vitamin D

Good quality oily fish such as sardines, mackerel, trout, tuna, swordfish, and salmon are a great source of Vitamin D. So are eggs, milk, and mushrooms.

Below are some high-Vitamin D food sources according to the US government's dietary guidelines.

Light Therapy

Since less daylight is one of SAD's triggers, this therapy focuses on using bright artificial light as a treatment to reset the circadian rythm that is mismatched in SAD subjects.

Light Therapy is also known as phototherapy and Bright Light Treatment.

The equipment consists of a "light box", a source of light that emits a spectrum similar to sunlight with an illumination level of 10,000 lux (roughly 20 times stronger than regular indoor lighting).

Timing the exposure is important, and Lewy (2) provided the following Treatment Guidelines:

Bright light causes phase shifts of the circadian rythm. Light exposure in the morning causes phase advances, and in the evening it causes phase delays.

• For patients that don't have early morning awakening: 1-2 hours of 2,500 -10,000 lux exposure immediately after waking up.
• Note that getting up earlier to fit the schedule into your daily life may retard the response for a few days.
• Allow 2 to 4 days for the initial response.
• Avoid bright light in the evening and don't go to sleep earlier.
• Those who don't respond to treatment may need longer morning exposure time.
• If patients begin waking up early or feel very tired in the evening, this means too much morning light exposure: So reduce it and add some late evening light exposure.
• Once response has been achieved (it usually takes 2 weeks) reduce the frequency of light exposure.
• If there is still no response, avoid bright morning light and start a trial of evening bright light (7-9 pm).

Light Box Tips

Before buying any light box, check out the following tips (8):

• Output of 10,000 lux at a comfortable sitting distance.
• Lamp should filter out ultraviolet rays that can harm skin and eyes.
• White light is better than colored light, full spectrum or blue lamps offer no therapeutic advantages.
• Don't shine light directly into your eyes, it should shine downwards with an angle that minimizes glare.
• Your eyes must always be within range of the light (it is an ocular - visual therapy, not a skin illuminating one).
• Avoid eye discomfort or injury by using safe light sources.

Risks and side effects are rare, and include mild visual complaints such as tired eyes, headaches, nausea, dizziness, agitation, and even sleep distrubances (9).

Melatonin

This hormone is linked to the mismatch between the sleep - wake cycle and the body's clock.

Resetting the phase to eliminate the mismatch is done via light exposure (see above) and also by using low doses of melatonin.

It should be taken at the correct time because it can shift the rythm too much causing a phase mismatch in the opposite direction (2).

Melatonin causes phase shifts opposite to those caused by bright light.

So afternoon - evening melatonin is used in patients with "phase delay" and morning melatonin for subjects who are "phase advanced".

There are side effects associated to melatonin supplementation such as headache, nausea, dizziness, drowsiness, reduced alertness (don't drive or use machinery within 5 hours of taking the supplement). It can interact with diabetes medication, anticoagulants, immunosuppressants, etc.

You should check with your doctor before taking Melatonin or any other medication.

Antidepressant Medication

Selective serotonin reuptake inhibitors (SSRIs) are the drug of choice for treating SAD (10); they increase the levels of serotonin in your brain.

Some antidepressants have side effects such as feeling anxious, shaky, agitated, and they can also cause altered digestive issues. Follow your physician's advice, take it as prescribed and stop it as indicated.

Counselling

An alternative to medication is counselling and psychotherapy.

Counselling involves talking about your worries and problems to a trained counsellor, who will help you find ways to understand them and work through them.

Discussing how you feel about yourself and how your past experiences affect how you feel today, can help you solve these issues and improve your mood.

Changing how you feel and think about certain situations or circumstances can help you feel better.

Other treatments for Winter Blues

There are other treatments that may or may not be successful in treating SAD.

Herbal therapies

Herbal therapies such with St. John's Wort (Hypericum perforatum) are effective (11), and Ginko biloba has an effect that is similar to the use of placebo.

Tryptophan

There is weak evidence that tryptophan has some benefits. Tryptophan is an amino acid that your body uses to build protein. It can't be synthesized by your body so it must be obtained from your diet.

This amino acid "increases brain serotonin in humans as in experimental animals, is an effective antidepressant in mild-to-moderate depression;" (4)

The body also transforms tryptophan into melatonin which may improve the symptoms of SAD.

Some tryptophan-rich foods are: cheese, soybeans, cod, salmon, sesame, sunflower seeds, pumpkin seeds, chicken, turkey, pork, beef, and oats.

Exercise

Physical excercise boosts serotonin levels too! (4, 12) ; exercise alone or combined with light therapy has a mood improving effect on SAD patients.

Prevention: being proactive in Fall

But why wait until winter, when SAD becomes full blown? Why not take some preventive action during fall?

SAD is a recurrent disease, meaning it happens each winter. That is why a preventive treatment during the months that precede it could reduce or even eliminate its symptoms.

Light treatment taken at the first signs of depression can postpone future episodes (9).

Combining medication and counselling with light treatment during the months preceding winter could help prevent SAD.

Other Fun ways to beat the winter blues

Winter may be dull and dreary, but the good news is that it is followed by spring. Having an optimist mindset is a great way to face winter: as Victor Hugo said "Winter is on my head, but eternal spring is in my heart."

Being optimistic will let you handle stressful situations better and view events in a more favorable and positive light.

Despite the cold and the long dark nights, winter is a beautiful season, its contrast with summer sets a background for our lives.

Winter's long months end in the awakening of life, the rebirth of spring: blooming flowers, warm sunny days and the promise of summer.

So here are some more tips that you can try to help improve your mood and make you feel that life is good, even in winter (10):

• Get as much natural sunlight as possible. Get outside when the sun shines. Use your lunch break to be in the sun.
• Take a walk in the sun, it will be good exercise and expose you to sunlight.
• Sit near a window when you are indoors.
• Exercise more, at the gym, or at home doing light chores. But if you can exercise outdoors in daylight it will be better.
• Eat a healthy and balanced diet
• Avoid stressful situations.

COVID-19 Pandemic and SAD

An article published by Mental Health America (2020) (13) expressed the organization's concerns that COVID-19 would add more stress to those who suffer from SAD. The pandemic has already caused a surge in depression cases (job loss, fear of becoming ill, work from home stress, just to mention some).

A second wave of the pandemic could reinforce isolation, and people would rather stay indoors, which would tend to promote SAD.

The article lists some of the tips we have given in this article (getting outdoors and light therapy) and adds two important ones: Connect with others and Get help if symptoms are interfering with your life.

Summing up

Winter Blues is a real depressive condition that affects up to 2.4% of the general population. Mild forms of it can afflict up to 20% of the people in northern countries during winter.

References and Further Reading

(1) Rastad C, Wetterberg L, and Martin C., (2017). Patients' Experience of Winter Depression and Light Room Treatment. Psychiatry J. 2017;2017:6867957. doi:10.1155/2017/6867957

(2) Alfred J. Lewy, et al., (2009). Winter Depression: Integrating mood, circadian rhythms, and the sleep/wake and light/dark cycles into a bio-psycho-social-environmental model. Sleep Med Clin. 2009 Jun 1; 4(2): 285-299.doi: 10.1016/j.jsmc.2009.02.003

(3) Melrose S., (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564. doi:10.1155/2015/178564

(4) Simon N. Young, (2007). How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci. 2007 Nov; 32(6): 394-399.

(5) Lansdowne AT, Provost SC, (1998). Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl). 1998 Feb;135(4):319-23

(6) Young Sup Woo, et al. (2019). Vitamin D Deficiency/Insufficiency among Inpatients with Depressive Symptoms. Clin Psychopharmacol Neurosci. 2019 Feb; 17(1): 121-124. Published online 2019 Feb 28. doi: 10.9758/cpn.2019.17.1.121

(7) Elizabeth R. Bertone-Johnson, ScD, (2010). Vitamin D and the Occurrence of Depression: Causal Association or Circumstantial Evidence?. Nutr Rev. 2009 Aug; 67(8): 481-492. doi: 10.1111/j.1753-4887.2009.00220.x

(8) Center for Environmental Therapeutics, Light Box Selection Criteria. Accessed: 12.Dec.2020.

(9) Meesters Y, Gordijn MC, (2016). Seasonal affective disorder, winter type: current insights and treatment options. Psychol Res Behav Manag. 2016;9:317-327. Published 2016 Nov 30. doi:10.2147/PRBM.S114906

(10) National Health Service, NHS, UK. Seasonal affective disorder (SAD). Accessed: 12.Dec.2020.

(11) Sarris J, Kavanagh DJ, (2009). Kava and St. John's Wort: current evidence for use in mood and anxiety disorders. Altern Complement Med. 2009 Aug;15(8):827-36. doi: 10.1089/acm.2009.0066

(12) Valim, V et al. (2013). Effects of physical exercise on serum levels of serotonin and its metabolite in fibromyalgia: a randomized pilot study. Revista Brasileira de Reumatologia, 53(6), 538-541. https://dx.doi.org/10.1016/j.rbr.2013.02.001

(13) Mental Health America (2020) Seasonal Depression/SAD And COVID-19 Complications. Accessed: 12.Dec.2020.

About this Article

How to beat Winter Blues (Seasonal Affective Disorder), A. Whittall

©2018 Fit-and-Well.com, 06.Sept.2019. Updated. 13.Dec.2020. https://www.fit-and-well.com/wellness/winter-blues-SAD.html

Tags: winter blues, SAD, Seasonal Affective Disorder, Vitamin D, light box, serotonin, sunlight, darkness, melatonin, depression, COVID-19.

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