Why seasonal depression is about more than the bleakness of winter

"This season is my nemesis," a friend groused to me recently. "I'm just hanging on till spring." The good news, I guess, is that at least now the days are getting longer again. But for those of us who don't live in especially warm, bright parts of the world, winter can be a real mood killer. The American Psychiatric Association estimates that about 5 percent of American adults suffer from seasonal affective disorder (SAD), a condition marked by "mood changes and symptoms similar to depression" and typically (but not exclusively) tied to the winter months.

The notion that a particular time of year can exacerbate mental health issues just seems to make sense. I mean, look outside. Bleak, right? But the concept of seasonal depression is a relatively modern one. The term is attributed to author and psychiatrist Norman Rosenthal and his colleagues at the National Institute of Mental Health, who identified the condition back in 1984. It entered the DSM just a few years later. It's still one of the more enigmatic mental health conditions.

"There is little known about the exact origins of SAD," says Sarah Rollins, a licensed clinical social worker and practitioner with Embodied Wellness in Michigan. "Researchers have indicated a few possible causes including your biological clock, vitamin D deficiency and melatonin."

As with any mental health disorder, a SAD diagnosis requires a professional, but Rollins notes that "Common symptoms of winter depression include oversleeping, changes in appetite such as craving foods high in carbohydrates, weight gain, low energy or fatigue and negative thoughts."

As with other real and misunderstood disorders like OCD and ADHD, SAD can at times be a casual shorthand for a self-diagnosed range of emotions and responses. It's definitely not a tidy cause and effect that the colder weather equals misery. A 29 year survey of suicide rates in the U.S. found the highest occurrence in April, May and June. Not exactly months known for being chilly. And as a feature in Johns Hopkins Medicine noted in 2019, "Those numbers can be two to three times higher than in December, when suicide rates are the lowest." Similarly, a U.K. 2018 review of psychiatric referrals found that "There were fewer referrals to psychiatric liaison services in winter months compared with other seasons."

Conversely, while a recent WalletHub study did list Hawaii among the happiest U.S. states, it also placed the decidedly untropical Utah, Maryland, Minnesota and New Jersey at the top. And when the World Happiness Report annually lists its happiest nations, the top spots inevitably go to countries with some of the longest, darkest winters on earth — Finland, Denmark, Switzerland, Iceland, the Netherlands, Norway and Sweden. Maybe winter itself isn't always the problem here.

"When we think about Norway and Iceland, they also have some socialized medicine, they have social determinants of health that make life a little bit more 'difficult' in our country," says family physician Dr. LaTasha Perkins. "If you know you can go to the doctor at any time you need, if you know that your basic needs are going to be met, that helps your baseline sense of well-being be a little bit higher."

Perkins says we need to "Think about the socialization and sociology of those places that you're talking about." Looking at the more ostensibly happy regions of the U.S. and the world, it seems clear that if you're in a culture that prioritizes stability and strong social connections, the dark days might not be so grim. They may not even be that dark.  

"You don't have to go lay out on a Hawaiian beach to get the benefits of sunlight," Perkins says. "Sunlight helps with vitamin D. Also, there are serotonin receptors in your brain that are tripped by how much time you spent in the sun." She says that "Although it's winter, there's sun and there's snow reflecting that sunlight," she says. "It's definitely worth it to get up and open those shades and get that winter sunlight in your house. Having 20 minutes of indirect sunlight is great for your mood."

While seasonal affective disorder is a complex diagnosis, it still affects millions of us. Millions more experience periods where the cold and lack of daylight negatively affect our mood and our ability to do the things that give us pleasure. But there are positive actions to help get through the rough weeks. Emily Pagone, the founder and clinical director of Authentic Growth Wellness Group in Illinois, says that because this time of year is often "a little more sedentary" for a lot of us, she recommends to "Push through and lean into the cold to get those dopamine levels up. Being in nature, working on mindfulness and other mental wellness strategies, are so important to do. Venture out, even if it's cold, to keep that going on."

Pagone says winter is a good time of year to check in with your physician and mental health provider to see if there are any shifts that could make a difference. "See what their recommendations would be in terms of labs, supplements to integrate, making sure that the greens are going in, the whole constellation of things that can change because of winter." 

And on days when the season's fury is leaving you housebound, Dr. LaTasha Perkins says, "During wintertime, I often tell my patients to dance. Turn some music on and move your body. Sweat it out, even if it's some old school jams that really get your body moving, because music releases endorphins in your body if it's connected to a happy memory." Perkins also recommends, "Call someone you haven't talked to in a while. You can spend hours flipping through TikTok, or in an hour you could call someone you haven't called in a long time. Connecting with people is way to get through the quote unquote dark times."

Sarah Rollins, meanwhile, suggests giving a happy lamp a spin. "These lamps are specially designed to mimic natural light," she says. "They are relatively inexpensive and available at major retail stores. It's recommended to sit in front of a lamp 30 minutes a day. It's easy to brush your teeth, get ready for work or even watch TV in front of a happy lamp."

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When the trees are bare and the sky is thick and dark and seeing your loved ones means, ugh, putting on a coat, it can be very tempting to just stay inside until spring. But if you're feeling blue this season, it's worth examining the circumstances of what's going on. Are you less active? Are you lonely? These are things that can be helped. And whether it's to mitigate seasonal depression or just have a more pleasant time until the next equinox, Pagone says it's worth it to put that coat on anyway.

"If someone's feeling the feels, that's legitimate, especially if it takes a turn when those clocks change and it gets dark around 4:15. But, she adds, "If we're boiling it down to something to keep in mind that encapsulates all of this, it would be behavioral activation, moving your body before your mind gets in the middle and prevents you from doing the thing you've been thinking about for a while, which could simply be going for a walk in the cold. Use the energy that you're able to, even no matter what kind of body that you have, or what your body is able to do or not do. Move towards the thing that you want to work towards," she says, "and see what happens."