Winter depression: Strategies for prevention and treatment
Winter is coming! Some of us face the season with positive anticipation--looking forward to the holidays, time spent with family and friends, cozy evenings at home, maybe playing in the snow. For others of us, the change of season is more anxiously anticipated. Based on our past experience, we expect to struggle with feeling our energy drop, feeling it is difficult to enjoy anything, feeling sad and withdrawn. Maybe we’ve never noticed the pattern, or maybe we’ve been through it enough times that we have given it a name: Winter depression.
What is it?
Winter depression is a form of seasonal affective disorder, where changes in mood occur in a seasonal pattern. In this case, as fall and winter come, our mood becomes sad or down, and along with that we see other symptoms begin to arise: changes in our sleep pattern (sleeping too little or too much,) changes in our appetite (overeating or lack of appetite,) a lack of ability to enjoy things, a loss of a sense of positive anticipation. The energy level drops--where in the summertime you felt as if you had a whole other day after work to play, and looked forward to that time, now all you want to do is put on your pajamas as soon as you get home and lay on the couch. Some people begin to feel excessively guilty or down on themselves, or find their thoughts going to dark places--”what’s the point of anything?” In the darkest hours of depression, people often begin to have morbid thoughts about death and dying, questioning if life is worth living.
What can you do?
If you are aware of a pattern of winter depression in yourself, or are realizing that you are becoming depressed as the season changes, there are a number of proven strategies you can use to combat this.
Increase Your Light Exposure
Perhaps the most well researched and proven strategy for treating winter depression is to increase exposure to bright light. Given that the problem is more prevalent in Northern latitudes, where the winter days are darkest, the need for additional light makes sense. Our bodies depend on regular exposure to bright, outdoor light to regulate a number of our biologic processes. When we are stuck inside, in dimly lit spaces for a long period of time, it can take a toll.
It may be helpful to look at the lighting in your home and where you work, and increase the brightness by adding lamps, brighter bulbs, and removing window coverings. However, even a very well lit office is surprisingly dim, compared to the outside. Whereas in the office you may receive 500 lux (a measure of light intensity,) a bright but cloudy day might produce 5,000 lux. In comparison, bright summer sunshine would be somewhere around 50,000 to 100,000 lux.
One well studied method to get a more adequate daily dose of light is to use a bright light therapy device. These devices can be purchased at many pharmacies, or on the internet. However, to ensure that such a device will be helpful, you should follow a few guidelines:
Type of light: The device must produce full spectrum light--as you would get from sunlight. Standard incandescent and fluorescent bulbs do not generally produce the full spectrum light needed to help winter depression.
Intensity of light: The device must produce at least 10,000 lux light intensity.
Method of use: The device should be placed in such a way that it shines upon your face, close enough that you are getting the full intensity of the device (the device manual will often say something to the effect of “produces 10,000 lux at 24 inches.”) You should NOT stare directly at the light--this is not required for it to work. It can be set to the side while you have your coffee, read your paper, or whatever you would like to do.
Timing: Shortly after awakening, every morning, for 30 minutes.
Duration: If you are using a light therapy device to treat current depressive symptoms, it will often take somewhere between one and four weeks of consistent use before you begin to see improvement. For this reason, many people start using their light therapy device before they begin feeling depressive symptoms, in order to prevent the winter depression altogether.
Possible side effects: For the most part, light therapy is very safe. However, some people can experience discomfort in the form of eye strain or headache. If used too late in the day, you might have more trouble sleeping in the evening. Rarely, people can feel overstimulated by light exposure, more anxious, more irritable. If these side effects occur, you should hold off on using the device and discuss with your care provider.
Stay Active
It can be difficult during depression to feel like doing anything. However, overcoming the urge to withdraw, and doing things anyway, can be an effective antidepressant. One of the more well established antidepressant activities is exercise. And you don’t have to become a gym rat to see a benefit--even vigorous walking for 20 minutes, most days per week can help. Additionally, walking outside, even on cloudy days, will provide significantly more helpful light exposure than inside activities.
Another area of activity that often drops off for people during the winter months is social activity, and making an effort to maintain relationships can help fight depression. With this in mind, you might consider how to ensure that you continue to see the people you love and care about on a regular basis, even when your motivation to do things drops. Consider scheduling regular meet-ups: a weekly dinner night with friends or family, coffee dates, joining in on groups that meet regularly for activities of interest to you, etc. The key is committing to these things before winter is in full-force, before it feels like too much to do anything.
You can also take an inventory of the activities that bring you happiness or create meaning for you, and consciously commit to pursuing these whole-heartedly through the winter. Are you a fan of music? Plan to attend live music events or regularly listen to music you enjoy at home. Always wanted to explore your artistic side? Sign up for a winter drawing course at your local community college continuing education program.
Normalize Your Sleep
The change in timing of sunrise and sunset, and the overall lower exposure to light during the day, often creates changes in sleep patterns, and some researchers believe that these changes in sleep patterns are closely linked to the eventual development of depression. With this in mind, it is recommended to do what you can to ensure your sleep cycle stays regular.
Since the sleep cycle is closely linked to light cycles, one intervention that can help is the addition of a dawn simulator. These devices can be found at drug stores or on the internet. They gradually turn on a light--either a built in lamp, or a lamp of yours that is plugged into the device--at a set time every morning. Usually, the dawn simulator would be placed near the bedside or in the bedroom, and support your body achieving wakefulness in a gradual, non-jarring manner, as sunrise begins to shift later in the morning.
In the evening, excessive exposure to bright light can produce insomnia. To ensure that your body is ready for sleep at bedtime, it is important to avoid bright lights in the evening. It is especially important to avoid blue wavelengths. It turns out that the screens of our devices--TVs, tablets, cell phones--emit light skewed toward the blue end of the spectrum. Use of screens in the late evening may thus make it harder for you to fall asleep, and you might limit use within a few hours of your intended bedtime, and kick the devices out of your bedroom altogether.
If you are having consistent trouble falling asleep at night, there are some medication options that can help. One safe, over the counter option to consider is melatonin. Melatonin is a hormone that is naturally produced in your brain, and increases in the evening in response to the ambient light level falling. It is an important player in telling your body that it is time to sleep. You can supplement your own body’s melatonin production safely by taking anywhere from 1-6mg of melatonin (different brands come in different strengths,) usually several hours before your normal bedtime. For example, if your normal bedtime is 10 p.m., you would take the melatonin around 8 p.m.
If you are still having trouble falling asleep despite these interventions, there are other sleep aids, generally requiring a prescription, that you could talk to your doctor about.
Consider antidepressant medication
For those with moderate or severe depression, or who have a history of recurrent depression that they would like to prevent, antidepressant medication can help. Common medications for depression may take several weeks to have an effect, so it is helpful to talk to your doctor or care provider sooner rather than later if you would like to explore options for treatment or prevention.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.