One recent afternoon, Kelly Rohan, a professor at the University of Vermont, looked out her office window and spotted a tree half full of brilliant orange-colored leaves. To Rohan, the tree was lovely, but she knew some people might see it differently — as a harbinger of “gloom and doom.”
Rohan, a psychologist, treats and studies people with seasonal affective disorder, or SAD, a form of depression that returns year after year at the same time. The most common type peaks in winter, but it often starts in the fall as days get noticeably darker and shorter. People who are full of energy and high spirits during the summer start to feel sleepy and sluggish. Many crave sweets and starches. They gain weight. Some become deeply sad and withdrawn and don’t recover until spring.
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But right now — before the symptoms of SAD and milder forms of “winter blues” reach their peak — is the best time for susceptible people to take steps to head off a more serious slump, experts say.
“As the days get shorter, and all you want to do is to pull the covers over your head, don’t,” says Norman Rosenthal, M.D., a clinical professor of psychiatry at Georgetown University School of Medicine. He speaks from experience: Rosenthal suffers from winter blues himself.
Staying engaged in the world, even when it means putting on snow boots, can help ward off winter sadness, Rosenthal, Rohan and other experts agree. Treatment also can include medication, talk therapy and the very thing in decline right now — bright light.
Left untreated, SAD can be as serious as any other form of depression, Rosenthal says: “People can feel suicidal, people can lose jobs, and they can lose relationships.”
Morgana Rae, a life and business coach who lives in Los Angeles, says she does not have the most severe form of SAD, but has a milder version: “I get droopy as the light goes down. During winter, my thinking is not as sharp as it is in the summer. I don’t have as much energy.” And when clouds cover the California sun for too many days, she says, “I literally feel sad.”
While Rae, 54, says she’s never sought medical help for her symptoms, she is looking for answers.
So are many others. Overall rates of SAD in the United States range from about 1 to 5 percent, depending on study methods, Rohan says. But, she notes, the problem is not evenly distributed: Residents in northern areas like Alaska and New England, where winter days are particularly short, appear more likely to report symptoms of SAD (Fairbanks, Alaska, sees just three hours and 42 minutes of daylight on the winter solstice.) Women, especially those in reproductive years, are most likely to experience SAD, but anyone can be affected, says Dan Oren, M.D., an associate professor of psychiatry at Yale University. It’s possible, he says, that fewer older adults report SAD symptoms because the most vulnerable have learned to cope — sometimes by moving to sunnier locales during winter or year-round.
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A lack of light exposure is the biggest risk factor, Rohan says. A leading theory is that on darker mornings, some people’s brains don’t get the signal that day has begun, which throws their biological clocks out of sync. These people wake up groggy and stay that way, partly because their bodies are still producing the sleep hormone melatonin, Rohan says. Weak daytime sunlight and early sunsets just make things worse. Lethargy and, eventually, depression, can deepen as the dark days persist.
SAD may partly result from a mismatch between our natural tendency to slow down in winter — just like other animals — and the modern expectation that we stay productive year-round, Oren says. Both biological and psychological factors are clearly at work, he adds.
Rosenthal, who grew up closer to the equator, in South Africa, says he first experienced winter gloom when he moved to New York in the mid-1970s. Now 71, he says he's used what he's learned since then to keep his symptoms in check. For him, that includes plenty of exercise and light — indoors and outdoors — and to stay as engaged in the world as possible. He also meditates to relieve stress.
Treatments for SAD can include:
- Light therapy. Rosenthal led a team of researchers who first identified SAD in the 1980s. One early discovery was that the out-of-sync body clocks could be reset by daily exposure to bright, artificial light. Light therapy remains a mainstay of treatment today.
Patients with SAD typically are asked to sit in front of a light-emitting box for at least 30 minutes first thing in the morning. Some people also benefit from a session around sunset, Rohan says. There’s no “one-size-fits-all” regimen, she says.
- Medication. SAD also can be treated with antidepressant medications. In some studies, they work better than placebos to combat symptoms. Some people work with their doctors to taper on and off the pills, rather than take them year-round, Rohan says.
- Talk therapy. Rohan is studying a different approach, a form of talk therapy called cognitive behavioral therapy, or CBT, that addresses unproductive thoughts and behaviors. Rohan has compared light therapy and CBT, and she found that each treatment works in about half of sufferers — but that CBT seems better at preventing relapses from year to year.
In CBT sessions, patients talk about winter “in very bleak terms,” Rohan says. Therapists urge patients to question those views and to stay social and active during the season. “Usually, these folks will admit that they disengage and stop answering the phone,” she adds.
Rae, the California woman with seasonal blues, says she bought a light box last year but hasn’t tried it yet. She says she does plan to get out more this winter for early-morning walks in the sun and for evening swing dancing classes with her husband. If pandemic restrictions ease, she may take a trip to Uruguay, where it will be summer.
Rosenthal says sunny travel can be a great mood booster. “People can come back from the sunny spot feeling exuberant,” he says. But that boost may not last. Once you put away your swimsuit, he says, “you really have to get back to your regimen and do everything that you do to keep well.”
What to Know About Light Therapy and SAD
Doctors say it’s best to get medical advice before self-treatment with light therapy, especially if you have severe symptoms such as suicidal thoughts. And no one with past or current eye disease or a history of mania should use light devices without medical supervision. While prices of boxes sold online can range from less than $50 to more than $1,000, those that meet the standards used in studies can be found for "about $200 or less," says Yale SAD researcher Dan Oren. Oren is an unpaid board member at the nonprofit Center for Environmental Therapeutics, which sells and recommends some light boxes. Here are some guidelines when considering a purchase:
- Use a device that provides 10,000 lux of light at a comfortable sitting distance. Some boxes sold as 10,000 lux deliver that much illumination only if your face is within a few inches of the screen.
- The device should filter out ultraviolet rays. You don’t want a tanning lamp.
- Don’t stare directly at the light. A light that can be positioned downward will minimize glare.
The Center for Environmental Therapeutics offers more information at www.cet.org.
Kim Painter is a contributing writer who specializes in health and psychology. She frequently writes for AARP's Staying Sharp and previously worked as a health reporter and columnist at USA Today.