Fending Off Depression Symptoms in Winter

Try this winter game plan to ease symptoms of depression.

From the WebMD Archives

While some people look forward to the brisk days of fall and winter, anticipating family dinners and cozy nights by the fire, others dread the cooler temperatures and shorter days.

If history repeats, they know that the winter season will bring, like clockwork, worsening symptoms of depression.

  • Up to 3% of the population in the U.S. may suffer from winter depression, which experts term seasonal affective disorder, or SAD.
  • Some of the 6.7% Americans who suffer depression year-round find that their symptoms get worse in winter.
  • And countless others have a less severe form, dubbed the "winter blues."

As the days grow shorter, people often find their moods grow darker. Other symptoms of depression may include:

Taking action early can help you fend off these winter depression symptoms. Experts believe that SAD stems from a body clock that's out of synch and is associated with the lack of natural sunlight.

Here’s a winter game plan to keep depression at bay, or lessen its effect, this season.

If You Suffer Winter Depression, Check In With Your Doctor

Start your "game plan" as soon as you notice the first symptoms of worsening depression, suggests Norman Rosenthal, MD, the leader of the research team that first identified SAD in 1984 and author of Winter Blues.

Checking in with your doctor is a good first step, he says. That way, you and your doctor can alter your treatment if you’re already being treated, or tailor a new treatment plan based on your needs.

Know Your Treatment Options for Depression in Winter

Several treatments have been shown to improve seasonal winter depression. Among them: light therapy, antidepressant medication, talk therapy, and the hormone melatonin.

"People need to mix and match and figure out what works for them," says Rosenthal, a clinical professor of psychiatry at Georgetown University, Washington, D.C. and a psychiatrist in private practice.

See the Light to Ease Winter Depression Symptoms

Light therapy might be as simple as getting up early and walking outside on a bright winter morning, Rosenthal tells WebMD. "You can also increase light in your home," he says "Make one room a sun room."

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A technique called "dawn simulation" -- in which a light is programmed to turn on early in the morning in your bedroom -- can also help, Rosenthal says.

Light boxes are widely sold over the Internet and exposure to them can help. When buying one, get advice from your doctor and choose bigger ones -- one that is at least 1 foot by 1.5 feet, Rosenthal says. These larger boxes have more supporting research, he says.

Patients sit in front of the light boxes daily for a specified amount of time. "Using light in the morning for a half hour to an hour is very effective," says Stephen Josephson, PhD, a psychologist in New York City and associate professor at Cornell University Medical School and Columbia University College of Physicians and Surgeons, New York.

Getting bright light in the morning is best, says Al Lewy, MD, PHD, a professor of psychiatry at Oregon Health & Science University, Portland, a veteran researcher in the field.

Best time and amount? "As soon as you wake up, for at least a half hour," Lewy says. There is a subgroup of patients, however, who may do better with bright light in the evening. It's trial and error, he says.

Light therapy and dawn simulation together produce results equal to that given by antidepressants, according to a team of researchers from the University of North Carolina, who reviewed the results of 13 published studies and reported the findings in the American Journal of Psychiatry.

Consider Melatonin to Help Your Body Clock

In his research, Lewy has also found that most people with seasonal winter depression respond best not only to bright light exposure in the morning but also to a low dose of the hormone melatonin in the afternoon to reset their body clocks to normal.

The melatonin dose and timing should be calculated by a doctor familiar with the research. Lewy has found that about 29% of patients do better taking the melatonin in the morning instead of the afternoon.

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Consider a Treatment Tune-Up

If you've got a history of diagnosed Seasonal Affective Disorder (SAD), re-evaluate your depression treatment this year. "Ask your doctor if you need more medication or more talk therapy," Rosenthal says.

Sometimes, increasing your antidepressant dose in early October, through March or so, helps, says Alan Gelenberg, MD, a professor emeritus of psychiatry at the University of Arizona, Tucson, and a clinical professor of psychiatry at the University of Wisconsin Madison.

For some people with winter depression, getting more therapy during colder months can help, too, Gelenberg says. "If they do better coming in once or twice a week, fine," he says. But "for a lot of people that's not the case."

Instead, he sometimes focuses during therapy on providing a patient a set of tools to use when mood declines. The goal: Help people with depression recognize when their mood is becoming low and take action by reaching out to friends.

Another useful depression strategy: do more "homework" between your formal therapy sessions, suggests Josephson. He advises patients to keep a mood log. Journals or logs help people identify moods and their reactions to situations. This understanding, in turn, helps people with depression evaluate and replace negative thoughts.

He also advises patients to stop "ruminating" -- going over and over a perceived shortcoming in their mind. He cautions them to replace negative thoughts, such as "The party will be bad," or "People think poorly of me" with more positive ones.

Beware If You Crave Sweets and Carbs

Craving carbohydrates -- especially sweets -- is a common symptom of SAD, Rosenthal says.

But the boost in energy you get form these simple carbs is temporary, and the extra sweets can mean you'll put on weight. "I recommend a diet low in simple carbohydrates and high in complex carbohydrates [such as whole grain foods and starchy vegetables such as potatoes] and protein," he says.

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Minimize Exposure to Depressing News

Listening to the news 24-7 may depress your mood even more, says Gelenberg. It's stressful, and minimizing stress can improve your mood, he says.

Ration your viewing of potentially bad news. He did that himself, Gelenberg says, after the 9-11 terrorist attacks. "One of the things I did was not watch or listen to the news after dinner," he says. "I listened to news before dinner, I was very much keeping myself in the flow of information, but I needed a few hours in the evening to watch funny shows."

Read biographies of famous and inspiring people, suggests Alexander Obolsky, MD, a Chicago psychiatrist and assistant professor of clinical psychiatry and behavioral science at Northwestern University's Feinberg School of Medicine.

Or go see movies about people overcoming adversity, he suggests. It will put life in perspective.

Reach Out and Keep Moving

Easier said than done, acknowledges Josephson. But he encourages his patients with winter depression to try both. "Reach out to others as much as you can," he says. "Do it independently of how you feel. As the sneaker ad says, 'Just do it.'"

"Mood is highly correlated with activity level," says Josephson. "When people get depressed, they tend to withdraw and do less." He encourages those with SAD to return to their previous level of physical activity. When they do, mood improves.

Any boost in activity will help, he says, even walking around the block or getting out to a ball game.

WebMD Feature Reviewed by Brunilda Nazario, MD on October 13, 2008

Sources

SOURCES:

Alan Gelenberg, MD, chair, American Psychiatric Association's Workgroup on Treatment Guidelines for Major Depressive Disorder.
Alexander Obolsky, MD, Chicago psychiatrist and assistant professor of clinical psychiatry and behavioral science, Northwestern University Feinberg School of Medicine, Chicago.
Stephen Josephson, PhD, clinical associate professor, Cornell University Medical School and Columbia University College of Physicians and Surgeons, and psychologist, New York, N.Y.
Norman Rosenthal, MD, author, Winter Blues; psychiatrist and clinical professor of psychiatry, Georgetown University, Washington, D.C.
National Institute of Mental Health: "What are the different forms of depression?"
Westrin A. CNS Drugs, 2007: vol. 21: pp. 901-909.
Al Lewy, MD, PhD, professor of psychiatry, Oregon Health & Science University, Portland.
Lewy AJ. Proceedings of the National Academy of Sciences, May 9, 2006; vol. 103: pp. 7414-7419.
Golden R. American Journal of Psychiatry, April 2005; vol. 162: pp. 656-662.

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