Winter blues

Seasonal affective disorder (SAD) is sometimes called winter depression and can appear as the ambient light changes during the winter months. While medically different from generalized depression or major depression, SAD is a mood disorder that can still cause major disruptions in the lives of people whom it affects. Dr. Stephanie Dillon is a licensed psychologist who has been practicing for over 30 years. She sat down with us to explain what SAD can look like and how to seek help if you suspect you may be suffering from it.

What is seasonal affective disorder as you understand it? How's it different from other kinds of depression?

Seasonal affective disorder is caused by events that happen in the external world. Now, that can be said also of certain kinds of depression, where something is kicked off by an unfortunate event that goes on, like somebody has a car accident or they lose a loved one, something like that. But with seasonal affective disorder, it has to do with the actual change in the quality and quantity of the light in the external environment. Most people who are affected by SAD have those effects beginning in fall and winter, and then as the light source, meaning the sun, gets smaller in the sense that there are fewer hours of it, and so people don’t get exposed to the same amount overall of sunlight. And for some people, this triggers something called seasonal affective disorder, which is, can be, really unpleasant, like all depression.

Can they coexist? Major depression and seasonal affective disorder?

So SAD can co-occur with major depression. Certainly one would hope not. Anyone who has major depression would hope not, and anyone who is subject to SAD would hope not, either, because a co-occurrence would undoubtedly mean more intensity. So the population statistics in this country on SAD are not necessarily agreed upon, like the range is anywhere from, gosh, 500,000 or all the way to 3 million. So in other words, it’s one of those things that’s not measured very correctly, and there’s a lot of divergence about what is the occurrence in the general population of this.

What are the kind of signs or symptoms that somebody would look out for?

Pretty much the same kinds of signs and symptoms that you would have with another kind of depression. You would have a low mood. You would feel kind of helpless, hopeless. And, again, there’s a giant range … of intensity of the symptoms.

How can people distinguish between, kind of, being a little down versus potentially having a diagnosable condition?

You would feel a noticeable drop in your mood. It’s not something that would just blow by you at all. You would notice that food didn’t have that same good taste. Things that you love to smell, like a vanilla candle for example, or your favorite aftershave or perfume, that wouldn’t smell very good anymore. Your appetite might drop off a little. You might have trouble either going to sleep or staying asleep, or you might be oversleeping. So they are the common symptoms that you would actually see with depression, but they’re related to the changes in the seasons.

I've read that the biochemical causes of depression are still somewhat of a mystery. Is SAD the same?

I think there is a lot of supposition about the factors that cause SAD. For example, people will say, “Well, maybe about 15 percent of it can be ascribed to people who have relatives who have a major depression.” But the reality is it’s really difficult to target what the causal factors are. Some people say it’s a subset of major depression, but that doesn’t really give very much information. It’s not clear that the people who get this have a genetic loading for it.

What kind of treatments are available?

I think probably a visit with a psychologist would be really helpful because I think then the person who’s struggling with this could get some number of ideas about what’s going on in their life, and if the depression that they’re experiencing is absolutely related to … SAD or is it something to do with other things in their life? The recommendations about treatment are—the most frequent one—is for people to use a light box, and the light box is literally a box that you sit in front of that has the equivalent of sunlight in it. So it has the range of light rays that you see if you were looking toward the sun. You spend about half an hour in front of it in the morning because that sets up your day to be a better day. And then you would literally feel better.

It's helpful that there's such a concrete medical apparatus to treat SAD, but what can people expect from a visit with a psychologist?

A psychologist is going to be, I think, very interested in trying to get a pretty complete picture of you in the first visit, and it’s not easy to do, and it’s pretty essential because, you know, for one thing, I want to find out if somebody is suicidal. … I want to find out about their relationships, their employment, if they’re isolated, what they see as the major problems that they’re facing. Are they feeling pretty alone? Do they have a good social support system and social network? Who can they tell the truth to?

Is there anything someone who suspects they might be suffering from SAD or other mood disorders can do personally to have some control over it?

I think that there are a lot of things that you can do yourself, and sometimes you might have to push yourself a bit to do these things. But for example, exercise is something that really does make a difference because it changes your physiology. When you change your physiology, then you’re having an impact on your mood, on your optimism. So that’s one thing. Another thing is, and there’s research about this, doing a gratitude list every morning, trying that for a month. And in the gratitude list you have to name three specific things, and they can’t be, “I’m glad I’m alive.” That’s a little too tired. But, you know, something unique, something smaller, whatever that might be. The theory … is that it sets you up to feel good about things, three specific things, and it changes the tone of the conversation you’re having with yourself. It’s really effective.