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After we “fall back” from daylight saving time, afternoons get darker as temperatures continue to drop—and for some people, these shifts can negatively affect mental health.
On Tuesday, November 15, 2022, SciLine interviewed: Dr. Kelly Rohan, a professor of psychology at the University of Vermont and discussed topics including: how seasonal changes can affect mental health; how the COVID-19 pandemic has worsened seasonal mental health problems; who should consider seeking treatment for seasonal depression; and research-backed strategies to boost your mood during the winter.
KELLY ROHAN: Kelly Rohan, Ph.D., professor of psychological science, University of Vermont. I study adult mood disorders with specialization in seasonal affective disorder.
Interview with SciLine
How does the transition from summer into winter in North America affect people with seasonal affective disorder (SAD)?
KELLY ROHAN: For people with seasonal affective disorder (SAD) the transition into the fall and the winter is very difficult and involves a lot of symptoms of depression, feeling tired, sleeping more, having low energy, and the symptoms in a kind of domino effect can develop into a full-blown clinical depression for people with SAD.
What kinds of symptoms might people see with SAD?
KELLY ROHAN: Seasonal affective disorder (SAD) is clinical depression, and, therefore, the symptoms are the same as those in non-seasonal depression. They include feeling sad, feeling really down, losing interest in things that the person would usually enjoy, like their hobbies, their social activities, extreme fatigue, difficulty concentrating, making decisions, eating a lot more or a lot less than usual, sleeping a lot more or a lot less than usual, feeling guilty or worthless about oneself, and in extreme cases, thoughts of death or suicide.
How has the pandemic affected people with SAD?
KELLY ROHAN: Nationwide, we’re seeing more cases of anxiety and depression in response to the COVID-19 pandemic. We’re not seeing more cases of seasonal depression specifically because it looks like more of a stress-related phenomenon that we’re seeing. However, for people with seasonal depression, the pandemic certainly made things worse in terms of more symptoms of depression, for people with seasonal depression episodes starting earlier than they otherwise would have and lasting longer—even year-round in the summer when people with seasonal depression are usually feeling great, back to their normal selves—just the pandemic-related stress lingering and some of those symptoms not fully resolving the way that they used to pre-pandemic.
What treatments or practices may mitigate SAD?
KELLY ROHAN: There are three treatments that are backed by research for seasonal affective disorder or SAD. They include antidepressant medications, the same ones that are effective for depression. Drugs like the selective serotonergic reuptake inhibitors, the SSRIs. To my knowledge, there’s only one medication that’s FDA approved for seasonal affective disorder, and that’s bupropion extended-release, which is approved specifically for the prevention of SAD when taken ahead of the symptoms. Another treatment is bright light therapy, and that’s a very effective treatment with clinical trials around the world supporting it as a really robust improver of SAD symptoms. And the third treatment is a kind of talk therapy that’s called cognitive behavioral therapy.
How does light therapy work?
KELLY ROHAN: We don’t know exactly how light therapy works to improve the symptoms of seasonal depression. The leading theory is that when we deliver this bright light first thing in the morning, we’re simulating an early dawn, which should be jump-starting circadian rhythms—the biological clock in a body—back into a better phase of position, more like the clock would run in the summer because light therapy is designed to simulate an early dawn.
How do light therapy and cognitive behavioral therapy (CBT) compare, according to your research?
KELLY ROHAN: So for more than 20 years, I’ve been doing these clinical trials to compare light therapy, which is the leading treatment for seasonal depression, to a brand of talk therapy called cognitive behavioral therapy. And so far three studies into this line of work, we have found that both treatments improved SAD symptoms a lot. If it were a horse race, it would be a dead heat and it would end in a tie that both treatments work really well. Where things get interesting is in following our participants into future winters after treatment has ended, where we see longer-lasting benefits of cognitive behavioral therapy, specifically fewer relapses of the depression and less severe symptoms following cognitive behavioral therapy relative to light therapy.
When should individuals seek treatment for SAD?
KELLY ROHAN: Most people with seasonal depression suffer for many years before they tend to come forward for treatment. So, I would say if you feel like you struggle with symptoms of depression in the fall and the winter, there’s no reason to suffer. There are at least three effective treatments that are available. For you in terms of when to ask for a referral to a mental health provider, I would say it’s when the symptoms are getting in the way of your ability to function in important roles like at work or at school, or in relationships, or they’re keeping you from doing things that are really important to you to live a valued kind of life that you would want to live, like your ability to participate in your social activities and your hobbies and then your interests.
For people who don’t have SAD, are there any research-supported strategies for improving your mood during the winter?
KELLY ROHAN: So, these symptoms happen on a continuum. People with seasonal affective disorder are at the extreme—people with clinical depression in the fall and the winter months. Most people at a high latitude are going to have a few symptoms, maybe sleep a bit more, have a bit less energy, mood might dip a little bit, but not to the level of clinical depression. So, for folks that experience some symptoms but don’t have full-blown clinical depression, there are a few things that you can do that would be helpful. First of all, work really hard to stay in your routines. Fight through the fatigue—the first Monday that we come out of work after the time change and it’s dark. Instead of going home to get under a blanket on the couch or passively watch Netflix, keep doing the things that you were doing the Friday before. If that was going to the gym, go to the gym. If it was seeing people, see people. It’s really important to fight through the fatigue. Not go into hibernation mode—and stay active. Keep doing things that are fun and enjoyable. Find things to celebrate in the wintertime, things that you like to do. Maybe things that are specifically available in the wintertime and are not available in the summer. Skiing, ice skating, snowboarding, get out there and engage with winter, find something to love and enjoy about the season. Third, go for a walk first thing in the morning after sunrise. There’s plenty of good light to be had in the wintertime, even though the dawns are happening later. This has two benefits: It gets more light to the retina and helps to entrain our body’s biological clock to the light-dark cycle, which helps us sleep better, which helps us feel more alert. And also there’s antidepressant effects associated with moderate physical activity. So, two birds, one stone: a walk and all the physical activity benefits associated with that, and more light to the retina first thing in the morning, which is helpful for the biological clock.
Can people diagnose and treat SAD by themselves?
KELLY ROHAN: I caution against self-diagnosis and self-treatment of seasonal depression. Depression is a serious mental health problem, so it’s best to leave that to the qualified professionals. And in terms of treatment, even though light boxes are commercially available without prescription—it’s an industry not FDA-regulated. I do recommend if you wish to pursue light therapy doing it under the watchful eye of a trained mental health provider who can help you get the dose just right. There’s no one-size-fits-all to light therapy. Individuals differ and how many minutes a day do they need in order to benefit, and at what time or times of day does an individual need to use it to benefit? In addition, there are side effects: usually mild—eye strain, feeling a bit wired, maybe a little bit of a minor sunburn because some people are very fair, despite the UV shield that’s in place. But rare-but-serious side effects include elevated mood states like mania, hypomania, and the possibility of increased suicidal thoughts and actions. So, for all of these reasons, it’s best to do it under the watchful eye of a trained professional who can help get the dose just right while minimizing any side effects.
[Posted November 15, 2022 | Download video]