Rebekah Dodson was 12 years old when she started noticing how much her mood was affected by the seasons. The daughter of a military officer, Rebekah lived on the Mildenhall Air Force Base in Littleport, England. On the cusp of puberty then, she realized that the darker it got outside the more irritable, grumpy, and tired she felt. Rebekah told her parents, and her pastor, that she was plagued by anxiety and dark thoughts. Assuming their daughter’s feelings were the normal mood swings of adolescence, her parents—fundamentalist Baptists who homeschooled Rebekah and her younger brother—didn’t take her seriously. Her pastor told her if she prayed more God would take care of her. So Rebekah, who is now a 31-year-old mother of two living in Klamath Falls, Oregon, did not realize that she had a diagnosable—and treatable—mental illness for another 14 years.
Rebekah was suffering from SAD, a convenient acronym for seasonal affective disorder. SAD is a mood and behavior disorder that affects an estimated five percent of the U.S. population. Over 14 million Americans, more than the entire population of Portugal, are thought to be suffering from SAD.
Even if you don’t have full-blown SAD, you may find yourself physically and emotionally affected by the onset of winter.
“Another 14% of the adult U.S. population is estimated to suffer from a lesser form of SAD, known as the winter blues,” Norman E. Rosenthal, M.D., one of the doctors and researchers whose team first identified the illness in the early 1980s, explains in the introduction to the fourth edition of his book, Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. “Though these people are not usually affected severely enough to seek medical attention, they nevertheless feel less cheerful, creative, and productive during the dark winter days than at other times of the year,” Rosenthal continues.
Less cheerful? Less creative? Less productive? Sound familiar? Rain batters the windows day and night, the sun seems to have disappeared, and simple tasks start to feel overwhelming. The small daily challenges that don’t really annoy you in the summertime—the dirty bowl left by your 15-year-old in the sink, the shattered vase courtesy of a basketball thrown by your 11-year-old, the mid-sentence interruption by your 4-year-old—become so annoying that you fantasize about moving permanently to the Bahamas and wonder if you’ll have to pay child support.
My friends who glory in winter activities like snowshoeing and skiing tell me they look forward to the onset of winter. But I think SAD—or its subclinical sister known as the winter blues- is even more common than Rosenthal, who is now Clinical Professor of Psychiatry at Georgetown University Medical School, has calculated. As much as I enjoy the crimson and golden leaves on the trees, snuggling under a comforter with the kids, and the smell of hot cocoa simmering on the stove, there’s something, well, depressing, about the earth going dormant.
One of the differences between SAD and classical clinical depression (though many people have both) is that SAD is temporary—strangle-holding its victims at the onset of winter and lightening its hold when the weather warms up and the days lengthen.
When she was a teenager Rebekah Dodson’s mood disorder manifested itself as panic attacks that happened more frequently towards the end of the fall. “I would have to put the lights on,” she remembers of her adolescence in England. “The sun would start to set and I would get anxious and sad. I’d feel a crushing weight of depression … A lot of people think it just means you get sad. But it’s not just getting sad, it’s a combination of symptoms. For me it was depression, anxiety, and panic.”
Unlike Rebekah, Judy Dolmatch did not start experiencing noticeable mood swings in the winter until she was in her mid-forties and was living in the Pacific Northwest for about ten years. Growing up in suburban New York, Judy was not aware of having seasonally affected mood swings as a teen or young adult. For Judy, 62-year-old licensed clinical social worker, the symptoms, which first started when she was in her 40s, always seem to come in November. “I would start feeling this sense that the world was closing in on me,” she explains when we talk on the phone. “With the really short days when it was dark in the morning and foggy and you wouldn’t see the sun all day; I would get this hollow, crestfallen feeling. It was also accompanied by agitation. I felt claustrophobic.”
Looking back on it now, Judy thinks several things contributed to her mood disorder: changing hormones due to peri-menopause, loneliness over a long-term relationship breaking up, and a lack of social engagement. She noticed that the more she had to do and the more she spent time with friends, the less heavy and depressed she would feel in the winter. “I think there is a social element to it, and a physiological element,” Judy tells me. “As long as I was busy and active I was a lot better. When I was alone or had nothing much to do it would impact me more.”
My friend Adam Marx, 53, an Ashland-based corporate trainer, experiences it differently. “The shift to winter definitely affects my mood,” Adam admits. “I’ve got winter low energy—it’s harder to get myself to exercise, I have this desire to just hang out—but I don’t feel more depressed.”
What Causes SAD? Spoiler: Doctors Still Don’t Really Know
Despite over thirty years of abundant research on seasonal affective disorder, scientists still do not understand exactly what causes it. According to the Mayo Clinic, there are three key components that all may be factors in triggering SAD:
1. Disruption of your biological clock: With the shorter days in the winter, your circadian rhythms get disrupted, which may lead to feelings of depression and despair.
2. Disruption of serotonin levels: Serotonin is a hormone secreted by the pineal gland that is known to affect your mood. Drops in sunlight seem to lead to lowered secretions of serotonin that have been found to trigger depression.
3. Disruption of melatonin levels: Melatonin is another hormone secreted by the pineal gland that helps tell the body when to be tired and when to wakeful. More melatonin is secreted during the winter than during the summer. The change in levels of melatonin during the winter may contribute to seasonal feelings of depression and despair.
There may be an evolutionary advantage to having less energy and sex drive during the winter months. Mammals that thrive in extremely difficult conditions, like in Svalbard, a Norwegian archipelago in the Arctic Ocean where there are two months during the winter with no light, do so by remaining stationary and using vastly less energy than in the summer months. You can practically pet a reindeer in Svalbard in the middle of winter—it will not run away. Why? Because, according to Rosenthal, the brutal winter is more dangerous to its survival than any predator. This “artic resignation” is probably a life-saving energy-conserving survival strategy.
What Fixes SAD?
The correct diagnosis for her mood disorders only came when Rebekah Dodson went to specialist. “I went to a family doc years ago in high school. And the doctor gave me Wellbutrin [bupropion, thought to work by influencing dopamine and norepinephrine], which made me suicidal. It’s an anti-depressant they used to throw at teenagers. It has a high suicide rate. I went to a psychiatrist finally and was diagnosed with bipolar and SAD. I have seen so many lives ruined by family doctors,” Rebekah says. “They may not know what’s going on. Like any illness, it’s horrible if you’re misdiagnosed. You wouldn’t go see a gynecologist if you had a foot injury.”
These days Rebekah Dodson keeps a light box under her desk that shines on the backs of her knees as she works in her office. She keeps it on as much as possible, especially when it starts to get darker earlier. The light was recommended to her by a therapist who said it would help stimulate blood flow and better circulation and also help alleviate her symptoms of anxiety. Rebekah also takes Klonopin (clonazepam), a prescription anti-anxiety medication, to treat her anxiety, SAD, and bipolar disorder.
She recommends that people who might be suffering from SAD see a knowledgeable practitioner: “Go to a psychologist or a psychiatrist,” Rebekah urges. “I don’t feel like a general doctor is equipped with the tools they need to accurately diagnose someone and help them.
Rosenthal, who has found in his research that Wellbutrin can successfully help with symptoms of SAD when it is given at the onset of winter, and who himself also suffers from seasonal affective disorder, tells me that SAD often goes untreated and undiagnosed, mostly because of how rushed American doctors are.
“In the modern medical community time is a problem. It takes time to say, ‘How do you feel when Thanksgiving comes?’ ‘Are you a bear in the wintertime?’” Rosenthal is a bespectacled man with a bald pate, tufts of gray hair on the sides, a mustache, and a grin as wide as the Mississippi. When we talk via Skype he enthusiastically turns his computer so I can see the dawn simulator he uses in his bedroom and the light boxes flanking the computer in his office. I in turn lift my laptop to show off my walking desk. “You can’t circle this on a sheet and get reimbursed,” Rosenthal continues. “It’s diagnosed by asking a person about their past. It’s easy to diagnose Lyme disease or hypothyroidism. But you have to look over time to see what happens to identify SAD.”
But Judy Dolmatch says she did not need to go to a specialist to confirm she had SAD. Partly because she is herself a social worker and because her symptoms were so classic, she found it easy to diagnose herself. She bought herself a lamp, starting taking a natural anti-depressant dietary supplement called Sam-e, and made an effort to learn outdoor winter sports in order to spend time in the sunshine above the cloud cover in Ashland, Oregon as often as she could.
While all of this helped alleviate some of her feelings of agitation and depression, it was not enough. For ten years the only way Judy could function in the winter was to leave Oregon and go to a warmer climate, so she joined an intentional community on the Big Island in Hawaii and arranged to spend three months out of the year there. I look out my window at the gray rain while she talks about doing permaculture in rural Hawaii and wish I could book myself a ticket.
“You can get away to someplace, even just to the top of Mount Ashland,” Judy Dolmatch says when I tell her Hawaii is not in our family’s budget. “Let the reflection of the sun on the snow enter your eyes. Even just that can help.”
8 Facts About Sad
1. SAD is not only an adult disorder. Some two million American children are estimated to suffer from it, though it often goes undiagnosed and untreated in children.
2. There seems to be a genetic component. Most SAD sufferers usually have at least one close relative with depression.
3. SAD affects women more than men.
4. A change in latitude—moving to a place where there is less light—might trigger SAD; population surveys have shown that people living farther from the equator are more likely to develop it.
5. One survey showed that people in Sarasota, Florida are nearly nine times less likely to experience SAD than those living in Fairbanks, Alaska.
6. SAD may have been first described in medieval Icelandic epics, which identified a disorder called skamdegistunglindi or “short-days depression.”
7. Thought to be partially caused by the lack of winter light, no studies have ever been done on the rates of SAD among the visually impaired.
8. Many people who have symptoms of SAD often have other psychiatric conditions (known as “comorbidities”), including chronic depression, premenstrual syndrome, bipolar and eating disorders.
7 Tips From The Experts
On How To Feel Better When You’ve Got The Winter Blues
We can’t make the rain or the cold go away and many of us can’t afford to leave the country during the winter but there are ways we can trick our bodies and our minds into being happier during the long winter months. The first step is awareness of the problem. If your depression is so severe that you are having trouble functioning in your daily life, you should consult a professional immediately. In the meantime, here are seven tried and true tips that will help you feel better if you are suffering from seasonal blues.
1. Let there be light: Install more indoor lighting in your home and office. This quick and easy change can make a big difference. If the additional lighting is not enough, you may want to research and purchase a suitable light box and be sure to expose yourself to it from 20 to 90 minutes a day. The standard therapeutic output is 10,000 lux (a unit of brightness.)
2. Learn to meditate: Meditation has been found in more than a dozen scientific studies to have tangible physical benefits, which include lowering blood pressure, reducing stress hormones, improving heart health, increasing circulation, and even relieving symptoms of chronic pain. It’s a learned skill, especially for those of us with Type A personalities who don’t like sitting still. But if you put the time into it and make a habit of meditating for 20 minutes once or even twice daily, you may experience a marked drop in your feelings of anxiety and depression. Or you can follow my late mother’s unproven untested meditation technique: sit in a comfortable position with your eyes half closed and recite Emily Dickinson poems to yourself.
3. Embrace exercise: Between the holidays, inclement weather, and mood swings it’s easy to put on weight in the winter, which makes most of us feel that much worse. The importance of daily exercise cannot be overestimated. Exercise oxygenates your blood, raises the levels of endorphins in your body, strengthens your muscles, and helps you feel better about yourself—and the world. The key to effective exercise is to realize that you can get tremendous benefits from doing less than ten minutes a day. I know it’s hard to get started. But you can do anything for ten minutes, right?
4. Eat food for your mood: You may be craving sugar and carbohydrates but foods high on the glycemic index dump sugar into your bloodstream, provoke a dramatic insulin release, and end in a sharp drop in blood sugar (and well-being), putting stress on your pancreas and predisposing you to diabetes. Instead of eating empty calories, opt for fresh vegetables and fruits, healthy fats like olive oil and coconut oil, nuts, seeds, meat, fish, and sprouted whole grains. Always choose real foods over processed edible substances posing as food. And remember that just because a company boasts its food is “organic” or “gluten-free” that doesn’t mean it’s good for you. Packaged food, no matter how cleverly marketed, is often laden with unhealthy sweeteners and full of empty calories. Get in the habit of reading ingredient lists.
5. Decide on vitamin D3. Americans are notoriously low in vitamin D and a vitamin D (or other vitamin) deficiency may be contributing to your feeling down in the dumps. It’s easy to get your vitamin D levels tested at your health practitioner’s office. Ideally you should get the vitamin D you need by spending at least 20 minutes in direct sunshine daily (longer for people with darker skin), so make sure you go outside every day in the winter. But since the sun is often absent from the Pacific Northwest during the winter months, a vitamin D3 supplement can also be helpful. Rosenthal recommends 5,000 units/day but cautions that the amount needed is highly variable, depending on the person.
6. Seek out support: If you are working through a loss of some kind or recovering from addiction or illness, winter can be that much harder. Ask your local hospital or health care provider to recommend a support group. Misery loves company. Spending time with people who empathize with what you’re going through can really help.
7. Try talk therapy: Sometimes all the lifestyle changes in the world won’t help. If you find a sympatico professional, especially someone with experience treating people with SAD, he or she can talk to you about your experiences—a big help in itself—and you can decide together if you need prescription medication.
Jennifer Margulis, Ph.D., is a regular contributor to the Jefferson Monthly. Learn more about her books and articles at www.JenniferMargulis.net.
