Feeling SAD? Understanding and Combating Seasonal Affective Disorder

Written by Natasha Bidadi, PharmD, BCGP (clinical pharmacist), Zainab Haque, MS, RDN (registered dietitian), and Chelsea Myer, CHES, CPT (certified health coach)

We have all heard of the “winter blues”. We snuggle up in our comfy blankets and warm homes to combat the bitter cold and long dark nights and anxiously await the spring—with the renewal, growth, and rebirth it offers. For some, the fall and winter seasons can be accompanied by much more intense feelings than “the winter blues”. For those that suffer with seasonal affective disorder (SAD), mood changes may develop like depression. This blog contains information regarding seasonal affective disorder and ways to help keep the winter blues away.

What is Seasonal Affective Disorder?

Seasonal Affective Disorder (SAD) is linked to a biochemical shift in the brain that is created by shorter daylight hours and less sunlight.  It’s typically at its highest in January and February and is more common in women. SAD is estimated to affect 5-20% of adults and its symptoms can last up to 40% of the year.(1) Common symptoms of SAD include depressed mood, increased sleep, loss of energy (despite increased sleep), increased appetite, an increase in carb cravings, weight gain, loss of interest in activities once enjoyed, feeling worthless or guilty, difficulty concentrating, and thoughts of suicide.(2) If you’re experiencing any of the symptoms above, it is important to seek evaluation from a primary care provider or mental health professional. Many treatment options exist for SAD. While symptoms tend to go into remission with the onset of the spring, treatment can improve symptoms more quickly.

How do you treat Seasonal Affective Disorder?

After formal diagnosis of SAD, the primary treatment of choice is antidepressants and light therapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressants and most used agents to help treat SAD. Common SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram) and Lexapro (escitalopram). Although benefit may be felt in two weeks, it can often take four-six weeks for SSRIs to start working for SAD. Side effects can include nausea, headache, dry mouth, dizziness, and sexual dysfunction depending on the dose that is taken. It’s important to remember that these side effects should improve over time, and often are worse within weeks one to two of starting SSRIs.(3)

Our exposure to lights and darkness has a large impact on our sleep-wake cycle. In the winter, when daylight hours are shorter, this interruption in our normal sleep-wake cycle can cause or worsen seasonal affective disorder. Another treatment for SAD is light therapy. Light therapy includes sitting in front of a therapy box which emits light 20 mins or more per day, usually first thing in the morning. We can help improve our sleep-wake cycle by being exposed to light therapy in the morning and limiting exposure to blue lights and bright electronic devices in the evening (such as televisions, tablets, and cell phones).(2)

If you have difficulty absorbing medication and supplements through your gastrointestinal (GI) track you may be a candidate for an intravenous (IV) infusion at ivira. For patients who have been referred by their provider with an order for IV vitamins and nutrients, ivira offers a Myer’s Cocktail IV including: saline fluid, vitamin B12, high dose vitamin C, and magnesium to help boost mood and energy levels. The team at ivira ensures that you are cared for in comfort each drip of the way at our five-star infusion suite. Click here to find out more about ivira infusions.

Diet and Nutrition to help with Seasonal Affective Disorder

Many studies have observed the relationship between dietary patterns and mental health and have found that the food we put into our bodies does have an impact on our mood, energy levels, and cognition.(4,5) Serotonin, a key neurotransmitter involved in modulating mood, can decrease when experiencing depression. While serotonin is commonly known as a brain neurotransmitter, about 95% of serotonin is actually manufactured in the digestive system. It’s no surprise that the food we consume and process within our gut influences our mood and emotional wellbeing.

Traditional American diets are typically high in processed foods, refined sugars, and saturated fats and when consumed daily can lead to inflammation, oxidative stress, and nutrient deficiencies. Recent evidence points to the ‘Mediterranean diet’ benefitting a reduced risk of depression.6 The Mediterranean dietary model consists of fresh fruits, vegetables, whole grains, healthy fats, nuts, seeds, fish and seafood, whilst eating moderate amounts of lean meats and dairy. There are key nutrients that may help to lower the risk of depressive symptoms. Try adding these nutrients into your diet:

• Omega 3s: Omega-3s are associated with improving brain function. Sources include fish, nuts and seeds, flaxseed oil, soybean oil, fortified foods. Eating two servings of fish per week is an excellent way to get more omega-3s in your diet.
• Vitamin D: Vitamin D contributes to brain health by preventing the depletion of dopamine and serotonin. Sources of vitamin D include fatty fish such as salmon and tuna, egg yolk, fortified milk, cheese, and sunlight. Getting that much-needed sunlight in the winter months can be a challenge. Try eating a consistent breakfast to get your vitamin D.
• Folic acid/vitamin B12: More research is needed regarding the effect of B vitamins on depression; however growing evidence suggests these vitamins are lower in people with depression compared to people without depression.7 Sources include beef, liver, chicken, fish, fortified breakfast cereal, and eggs.
• Antioxidants: Antioxidants are substances that protect your cells from free radicals and can prevent inflammation associated with depression. Many different foods include antioxidants such as berries, broccoli, carrots, dark chocolate, sweet potatoes, artichoke, beets, peanuts, and kale. Tip: look for foods with bright, vibrant colors! Try adding some blueberries into your yogurt. Cooking with more nutrient-dense foods can also increase your antioxidant intake.

We can’t forget to mention seasonal foods! With winter comes an abundance of produce such as winter squash, sweet potatoes, blood oranges, beets, pomegranates, and parsnips. A wide range of flavors gives the opportunity to create new, interesting dishes. Try making butternut squash soup or making your very own pomegranate juice to incorporate these seasonal foods into your diet.

It’s important to remember that SAD can be multifactorial, and every human body is unique. Food is just one of many elements and it alone may not be the cause or treatment. However, the growing body of evidence shows that consuming a wide variety of fruits, vegetables, whole grains, lean proteins, and less processed foods and refined sugars can have a positive effect and contribute to a healthier lifestyle.

These nutrients are best acquired from foods. Talk to your doctor, pharmacist, or registered dietitian before you begin taking any supplements. ‍

Exercise and Seasonal Affective Disorder

When dealing with Seasonal Affective Disorder, it is easy to want to stay inside and keep to yourself. However, it is important to try your best to still engage in hobbies and activities that bring you joy. You can try engaging in hobbies that are conducive to staying inside, such as reading, crafts, or home-workouts. While we recommend getting fresh air, if you decide to stay in your home, sunlight and greenery are still beneficial, according to the National Institute of Mental Health.8 Something as simple as just opening your blinds to allow sunlight into your home and adding some houseplants can help boost your mood. It is common to fall into the habit of staying indoors and in the comfort of your bed during these cold winter months… we understand. However, we want to emphasize the importance of social interaction during this time, as well as the importance of avoiding sedentary behavior.

A great option if you are looking to stay active from the comfort of your home includes at-home workouts. Try this quick, bodyweight workout: 

• Circuit 1:

1. Squats
2. Jumping jacks
3. Step ups (on a stair or stool, complete 10-15 reps on each leg)

• Circuit 2:

1. Push-ups (can be assisted on a wall/elevated surface, or complete from knees)
2. Calf raises
3. Lunges (10-15 each leg)

• Do 10-15 repetitions of each exercise and complete each circuit 2-3x through.

Alternatively, fitness is a great way to engage with likeminded individuals. In an effort to avoid self-isolation, socializing with others is an extremely effective way to help with the negative effects of SAD. Group exercise classes are an excellent way to connect with others and boost your mood.

While exercise is important, we know it can be difficult to schedule at least 30 minutes every day, especially those battling SAD. Even small steps to reduce sedentary behavior throughout the day can be extremely beneficial for our physical and mental health. Try some of these movement tips:

• While waiting for the water to heat up for your shower, complete 10 squats.
• Every time you have to take the stairs, take them twice!
• When watching TV, stretch it out. Some simple stretches include pike, butterfly, cobra, and figure-4 stretches.

Remember to be gentle to yourself. Take it one day at a time and set small goals and work on prioritization. Don’t forget that winter-onset SAD is temporary and the sun and warm weather will come out soon! It is okay to ask for help and lean on friends and family during this time.

Please call the Care Coordination team at ivira if you have any questions regarding antidepressants or SAD in general at 302-274-0020. We are available M-F 9am-5pm.

If you are struggling with depression, please know you are NOT alone! Here are some resources you can utilize:

• SAMHSA’s National Helpline, call 1-800-662-HELP (4357), or text: 1-800-487-4889, a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

• If you or someone you know is in immediate distress or is thinking about harming themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

References:

1. Torres F. Seasonal affective disorder (SAD). American Psychiatry Association. https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder. Published October 2020. Accessed February 11, 2022.
2. Avery, D. Seasonal affective disorder: Epidemiology, clinical features, assessment, and diagnosis. In: Post TW, ed. UpToDate. UpToDate; 2022. https://www.uptodate.com/contents/seasonal-affective-disorder-epidemiology-clinical-features-assessment-and-diagnosis. Accessed February 11, 2022.
3. Selective serotonin reuptake inhibitors (SSRIs). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825. Accessed February 11, 2022.
4. Huang Q, Liu H, Suzuki K, Ma S, Liu C. Linking what we eat to our mood: A review of diet, dietary antioxidants, and Depression. Antioxidants. 2019;8(9):376. doi:10.3390/antiox8090376
5. Wang J, Zhou Y, Chen K, et al. Dietary inflammatory index and depression: A meta-analysis. Public Health Nutrition. 2018;22(4):654-660. doi:10.1017/s1368980018002628
6. Yin W, Löf M, Chen R, Hultman CM, Fang F, Sandin S. Mediterranean diet and depression: A population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity. 2021;18(1). doi:10.1186/s12966-021-01227-3
7. Coppen A, Bolander-Gouaille C. Treatment of depression: Time to consider folic acid and vitamin B12. Journal of Psychopharmacology. 2005;19(1):59-65. doi:10.1177/0269881105048899
8. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (Updated 2021). NIMH Seasonal Affective Disorder (NIH Publication No. 20-MH-8138). Retrieved from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder.