By MARGARITA TARTAKOVSKY, M.S.
Seasonal affective disorder (SAD) goes beyond the winter blues. It goes beyond feeling tired or sad or disliking winter. SAD is a form of clinical depression that occurs in the winter, according to Kelly Rohan, Ph.D, associate professor of psychology at the University of Vermont, whose research focuses on SAD. It starts around fall or winter, as the days get shorter and darker, and typically remits in the spring or summer.
SAD affects approximately 14 million Americans, according to author and SAD specialist Norman E. Rosenthal, M.D., in his book Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. (About 14 percent of American adults struggle with the winter blues.)
People with SAD experience a variety of physical, emotional and cognitive symptoms that impairs their daily functioning. They’re usually unable to perform at school or work and have difficulty interacting with others. Tasks that once seemed simple, such as household chores or paying the bills, suddenly become overwhelming.
The ability to think clearly also becomes impaired. In fact, according to SAD expert Dr. John Docherty, the disorder causes many problems for people at work. Dr. Rosenthal cites Docherty in his book. He lists these at-work problems by how often they occur: “decreased concentration, productivity, interest, and creativity; inability to complete tasks; increased interpersonal difficulties in the workplace; increased absences from work; and simply stopping work.”
According to Rosenthal, the physical symptoms can be especially prominent and debilitating. They include sleeping problems, fatigue, a revved-up appetite, loss of interest in enjoyable activities and diminished sex drive. And while mood changes are salient, individuals may feel the physical signs first. In the book, a middle-aged woman describes her physical symptoms:
I don’t really feel depressed. I just feel like all my systems have been turned off for the winter. I feel leaden and heavy and just want to lie about all the time. It’s only when I am expected to do something out of the ordinary, and I realize that I cannot do it, that I feel my mood being pulled down.
Light therapy, cognitive-behavioral therapy and antidepressants are effective in treating SAD. In 2006 the Food and Drug Administration approved the antidepressant Wellbutrin XL for preventing episodes of SAD.
Extensive research has shown that light boxes work well in boosting mood and energy. Light boxes emit artificial light that mimics the sun’s rays. They emit anywhere from 2,500 lux to 10,000 lux. (Lux is a measure of intensity.) Light therapy requires a daily commitment. It’s best to use light boxes in the early morning for 30 minutes or more during the winter months. (The 2,500-lux light boxes might even require two hours.) However, you can read or talk on the phone as you’re receiving light therapy. According to Rosenthal, you can do anything during your sessions, as long as your eyes are open, you’re facing the light box and there’s a proper distance between you and the box.
Early research has shown that CBT for seasonal affective disorder may be even more effective than light therapy (and doesn’t require the extensive time commitment as light boxes do). In this 2009 study, Rohan and colleagues compared SAD-tailored CBT to light therapy (along with a combination of both treatments and a wait-list condition). They found that CBT, light therapy and both CBT and light therapy were all effective in treating SAD.
However, at the one-year followup, participants treated with CBT were doing much better than individuals in the light therapy condition. In secondary analyses, Rohan also controlled for ongoing treatment, and the CBT participants still fared better.
Rohan is currently conducting a five-year randomized trial with 160 participants to further test CBT’s effectiveness.
CBT for Seasonal Affective Disorder
So what is SAD-tailored CBT? Specifically, it helps clients identify and incorporate enjoyable activities into their lives and to identify, challenge and change negative thoughts, according to Rohan. It’s classic CBT with a focus on coping more effectively with the wintertime.
For instance, people with SAD tend to view winter very negatively. They commonly say that they hate the cold and can’t do anything during the winter months. Rohan helps clients gain a more realistic perspective. She begins by challenging the strong word “hate.” Remember that you can hate poverty or prejudice, but you probably dislike the winter or simply prefer the warmer months. This slight shift in perspective is a big help. She also asks clients to come up with the evidence that they can’t do anything during the winter and to think of the times they have done fun things. Together, they also devise a plan that includes enjoyable activities.
As Rohan noted, this sounds a lot easier than it really is. Depression zaps your energy and desire to do anything, so engaging in activities may be incredibly difficult. That’s why Rohan starts small. Clients commit to doing 10 minutes of a specific activity. They also discuss potential barriers to engaging in the activity and problem solve to overcome them.
Seeking Treatment for SAD
If you think you might have SAD, it’s vital to see a therapist for a proper evaluation. “It can be dangerous to try to engage in self-diagnosis and self-treatment,” Rohan said.
In his book, Rosenthal outlines the signs to seek medical help:
Your functioning is significantly impaired. You have difficulty completing tasks that were easier before; you’re falling behind with bills and chores; you make mistakes more often or take longer to finish projects; you tend to withdraw from loved ones.
You feel considerably depressed. You feel sad more often than not; you feel guilty or hopeless about the future; you have negative thoughts about yourself that you don’t have at other times of the year.
Your physical functions are greatly disrupted. During the wintertime, you sleep more or have a hard time getting up in the morning; you’d rather stay in bed all day; your eating habits have changed.
If you’re struggling with a mild case of the winter blues, the principles of CBT can be helpful, according to Rohan. Identify fun activities that you can do in the cold months, and avoid spending a lot of time in bed and isolating yourself. Also, be mindful of your negative attitudes and thoughts about winter, and try to challenge them.
And remember that SAD is highly treatable, and there’s always hope!