Beyond the “Winter Blues”

Dr. Kenneth Etefia MD is a double-board certified adult and Child psychiatrist as well as owner-operator of Renaissance Behavioral Medicine a private psychiatry practice in Beverly Hills and San Mateo, California


The holiday season has arrived and for many this means a return to cherished traditions involving faith, reconnection with family, and, of course, copious amounts of food and football (Go Chiefs!). However the high spirits, good will, rest, and relaxation that we commonly associate with the waning days of the year are not universal. In fact, it has been reported that 92% of adults notice seasonal changes in mood, 27% have problematic seasonal changes in mood, and 0.5 to 3% experience changes in mood with season extreme enough to reflect the presence of a clinical illness, Seasonal Affective Disorder (SAD). Such variations in mood have been linked to lower fall-winter vitamin D3 production, living in northern latitudes, negative personality traits, and reduced physical exercise in colder months.


Blues v. SAD Individuals that have a predictable, mild downturn in mood for a few days or weeks during the fall-winter months have the “blues”, a common form of depression that does not require intervention by a medical doctor. On the other end of the spectrum are individuals with SAD. This condition is a subtype of Major Depressive Disorder (MDD)-its most common manifestation- and Bipolar Disorder, indicating that depressive states or extreme elevations in mood that are termed mania only emerge with changes in season. MDD is diagnosed when someone has an episode with at least 2-weeks of low mood, disinterest, or difficulty deriving pleasure from daily experience in association with at least 4 other symptoms of depression including but not limited to changes to appetite or sleep, reduced energy, impaired concentration, diminished self-worth, and, in extreme cases, suicidal thinking or behavior. These symptoms provoke distress and impair functioning in relationships and occupational roles. Depression is designated SAD when MDD episodes emerge only during the same seasons for at least 2 years and most MDD episodes in a person’s lifetime have been linked to particular seasons. In a typical case of SAD symptoms of depression emerge in the fall-winter or spring-summer (southern hemisphere) and will often resolve even without intervention 3-6 months later. In SAD increased sleep, carbohydrate craving, and weight gain are more common than in a typical case of MDD.


Treatment of SAD As SAD may persist for months and yield severe depressive symptoms it should be treated by a psychiatrist, a medical doctor specializing in the care of individuals suffering from mood disorders. SAD is treated with a combination of antidepressants, phototherapy, and talk therapy. Antidepressants are medications that block the degradation of brain messaging chemicals called neurotransmitters and are thought to help with depression by normalizing the level of nerve cell activity in brain regions implicated in emotion regulation. Examples you may be familiar with include serotonin reuptake inhibitors, fluoxetine (Prozac) and sertraline (Zoloft). Phototherapy uses a bright artificial light to correct for diminished exposure to solar radiation in the fall-winter months. This treatment involves use of a light box, an apparatus that emits light roughly 20x more intense than typical household lighting, for 20-60 minutes each morning. The most common form of talk therapy utilized for SAD is CBT (Cognitive Behavioral Therapy), an approach that involves evaluating and correcting negative thought patterns and developing healthier behaviors for stress management.