Overcoming seasonal depression

With less sunshine and natural light and colder temperatures, you might be feeling some “winter blues” and changes in mood. About 5% of the population has seasonal affective disorder, or SAD, a type of depression that is characterized by its recurrent seasonal pattern, with symptoms lasting about four to five months per year. The predictable onset of SAD–in the fall or early winter–typically resolves, even untreated, by spring.

Boulder Community Health (BCH) psychiatrist Daniel Fisher, MD, specializes in treatment-resistant mood disorders–says there is a distinct triad of SAD symptoms, leading to a lower quality of life.

“Many people will at least experience some degree of tiredness/daytime fatigue, overeating (with carbohydrate cravings), or sleeping too much,” says Dr. Fisher. “There is a small subset who develops a full clinical depressive episode, which impairs a person’s functioning and can even involve hopelessness and suicidality. Seasonal depression is not a reaction to situational stress, like the holidays.”

Low energy and sad mood are two additional symptoms. The Centers for Disease Control (CDC) says those most at risk for SAD are female, younger, live far from the equator, and have family histories of depression, bipolar disorder or SAD.

It’s unknown why some people get seasonal depression and others do not. There does appear to be a biological and genetic component related to someone's difficulty regulating serotonin, the neurotransmitter believed to be responsible for balancing mood, and the overproduction of melatonin - a hormone released in response to darkness. The combination of decreased serotonin and increased melatonin impacts circadian rhythms.

Board-certified psychiatrist Dan Fisher, MD talks to Denver Channel 7 about seasonal affective disorder and some treatment options.

Tips to Feel Better

Dr. Fisher says you might improve your mood just by exercising outside on a sunny day or using light therapy. His suggestions include:

• Outdoor exposure to AM doses of light.
• Daily outdoor walks–cloudy or not.
• Bright Light Therapy through the means of a 10,000-lux light device or lamp, also known as a happy lamp. Dr. Fisher says to only use these under the supervision of your doctor, as some adverse effects can ensue from inappropriate use.
  • Use the light device or lamp for 30-45 minutes each morning; the earlier the better. Sit with the light 12-18 inches away from you. Don’t stare directly at the light. Instead, read or do computer work.
• Dawn Simulator: a technique that involves timing lights in your bedroom. Set the device to turn on 90 minutes (about 1 and a half hours) before your desired awakening. You’ll wake to slowly brightening light by your bedside.
• Aerobic exercise, especially early in the day. But any time is better than none.
• Practice good sleep hygiene and behavior that regulates the sleep-wake cycle:
  • Strive for the same wake-up time each morning.
  • Skip caffeine or strenuous exercise late in the day.
  • In the hours before bedtime, reduce screen time or blue light exposure from TVs, tablets or cell phones.
  • If you cannot sleep, get out of bed, go to a quiet place, wait until you are tired, and then go back to your bedroom.
  • Avoid napping during the day.
• Antidepressants–usually serotonin reuptake inhibitors (SSRIs)–if a patient meets the criterion for a depression diagnosis.
  • Dr. Fisher says seasonal depression is quite common in patients with bipolar disorder. He advises caution with SSRI’s–as they are not always the most effective treatment for people with bipolar disorder.
• Cognitive Behavioral Therapy (CBT) can be effective in reducing the recurrence and remissions of SAD
• Vitamin D.

Nutrition

If you have seasonal depression, Dr. Fisher and Boulder Heart cardiologist Nelson Trujillo, MD recommend avoiding simple carbohydrates. Fiber and starch are complex carbs, while sugar is a simple carb.

“Many of us try to cheer ourselves up by eating traditional ‘comfort foods,’ which tend to be high in saturated fats, salt and/or simple carbohydrates like refined flour and sugar,” says Dr. Trujillo, who urges preventative care with his heart patients. “Unfortunately, that approach tends to backfire since those foods tend to cause chronic inflammation, which negatively affects mood and overall health.”

These foods also tend to be low in brain-supportive nutrients like antioxidants and omega-3 fatty acids.

Dr. Trujillo urges you to choose “Greens Over Blues” - meaning eat as many nutritious and colorful fruits and vegetables as possible to boost mood and energy. His other tip – walk 10 minutes out, 10 minutes back, every day.

Feelings of Hopelessness

Those who have SAD should especially seek medical attention when experiencing feelings of hopelessness and suicidality. Community members who don’t feel safe or are in crisis can visit Foothills Hospital's Emergency Department (ED) for a voluntary psychiatric evaluation - available 24/7. Licensed professionals will complete a comprehensive psychiatric evaluation and ensure all people are referred to the appropriate level of care.

If a person is having an acute crisis due to a mental illness - and in imminent danger to self or others or appears to be gravely disabled - the licensed professional will consult the psychiatrist and ED provider to determine whether a mental health hold is needed. A mental health hold is an involuntary hold that ensures a person in crisis is kept safe for up to 72 hours (about 3 days) of treatment and evaluation.

988 Suicide & Crisis Lifeline

Everyone can help prevent suicide. The 988 Suicide & Crisis Lifeline is a network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States.

If you or someone you know is feeling suicidal or in need of emotional support, text or call 9-8-8. Callers can follow prompts with separate lines for veterans, Spanish language speakers and LGBTQI+ persons.