March 2, 2015 by Heather Purdin
Curing the "Winter Blues"
The winter blues were first clinically referred to as Seasonal Affective Disorder (SAD), though the most recent revision of the Diagnostic Statistical Manual (DSM-V) refers to these seasonal blues as "Seasonal Pattern Specifier" — a descriptor applicable to major depressive disorder and bipolar disorder. Most literature continues to refer to this medical condition as SAD. It impacts nearly 11 million Americans each year.
The DSM-5 criteria for adding the seasonal pattern specifier to one's diagnosis include:
- Depressive episodes at a particular time of the year;
- Remissions or mania/hypomania at a characteristic time of year;
- These patterns must have lasted two years with no non-seasonal major depressive episodes during that same period;
- These seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime.
Geography, particularly latitude, appears to impact the SAD prevalence rate, which is as high as 9.9% in Alaska and just 1.4% in Florida. A deficiency in Vitamin D is common in patients with SAD. Additionally, Canadian researchers analyzed 14 studies including 31,424 participants, which indicated a link between vitamin D deficiency and depression.
Medication management and phototherapy (light therapy) are the most commonly prescribed interventions. Counseling is often advised. In severe cases, suicidal thoughts may require the support of inpatient hospitalization for stabilization.
Subclinical Seasonal Affective Changes
As many as 1 in 5 Americans share some subclinical features of SAD but do not meet full diagnostic criteria for a mood disorder or the associated seasonal pattern specifier. It is still advisable to speak to a medical professional if you experience SAD symptoms to ensure your condition doesn't require additional medical attention.
Seasonal Mood and Eating Disorder Recovery
If you experience seasonal affective changes, this can certainly pose challenges to the rhythm of recovery. First, remember impermanence; the season is temporary. If this is naturally a more difficult time of year for you, acknowledge that recovery may feel more challenging right now.
Work with your treatment team to determine if there is a link between your food and seasonal mood. For some, depression and anxiety impair appetite. Others may overeat. The chemical changes in the brain associated with seasonal pattern depression often cause carbohydrate cravings as the brain is seeking serotonin, which lifts mood. Unfortunately, high doses of carbohydrates, without a balance of fat and protein, actually leads to blood sugar crashes and more carbohydrate cravings. Winter can also change our movement patterns. We tend to slow down and move less, especially in colder climates. If someone enjoys exercising outside, they may experience weather related distress as a snow day or torrential downpour prevents them for carrying on with their usual workout routine.
It's widely believed SAD impacts the circadian rhythm. Many people with eating disorders also suffer from insomnia or hypersomnia. Changes in sleep routines can challenge recovery.
Light Exposure — It is our very primal nature for mammal species to slow down, hibernate, and increase energy reserves during winter. Nature guides us into this pattern by giving us fewer hours of day light, but society asks us to work in opposition and further extend ourselves. To keep up, we need light! Sunlight actually helps trigger production of serotonin, a popular neurotransmitter that helps boosts mood, regulates metabolism, and balance hormones. Try getting morning sunlight exposure to aid circadian rhythm regulation and help the body awaken and energize. Taking a morning walk, drinking your coffee or tea on the patio, eating lunch outside as weather permits, and taking frequent sun breaks (in lieu of smoke breaks) can all increase winter exposure to sunlight. On those days when it's too cold to be outdoors, open the blinds and allow sunlight to enter your home or office. Even introducing bright colors to indoor environments helps some people.
Sunlight is also our primary source of Vitamin D, which can have antidepressant effects in addition to its known role in maintaining strong, healthy bones. If you are unable to consume enough food sources and your winter climate does not allow enough sun exposure, it may be wise to consult your physician or dietitian about supplementing Vitamin D, which can be monitored through a simple blood test. Phototherapy, often prescribed by physicians who specialize in seasonal pattern co-occurring conditions, is therapeutic application of artificial full spectrum light. While a 10,000LUX light box is ideal for those needing phototherapy, less expensive full spectrum light bulbs can help in a pinch. Melatonin is a hormone made by the pineal gland, a small gland in the brain. Like serotonin, melatonin helps control your sleep and wake cycles, appetite, and mood. Just as light triggers serotonin release, melatonin synthesis requires an absence of light. Working together to control your circadian rhythm, you can think of serotonin as the "on" switch that awakens you and melatonin as the "off" switch that allows you to sleep.
Sleep Patterns — Developing good sleep hygiene goes a long way toward helping to regulate melatonin production. Allow for 7-9 hours of sleep each night to allow the body to rest, recover, and heal from each day. Light (especially from computer screens, ipads, and cell phones) prevents the shift to melatonin production, keeping the brain alert rather than relaxed. Therefore, aim for 2 hours of screen-free time before settling to bed. Late day caffeine consumption may also impair your ability to wind down at night.
Nutrition — Due to changes in seasonal availability of foods, it is common to change our diet this time of year. Crisp salads and summer smoothies are commonly replaced with warm comfort foods like soup, pot pies, and casseroles. Carbohydrate cravings are common for those with SAD because of a need for serotonin and their quick rush of energy into the bloodstream. Unfortunately, excessive carbohydrate consumption leads to blood sugar crashes and additional carbohydrate cravings. Rather than avoid comfort foods, focus on balancing all three macronutrients: proteins, carbohydrates, and fats.
Exercise — Individuals with eating disorders are advised to seek medical approval and clearance from their treatment team before beginning an exercise routine because they are at higher risk for compulsive exercise and overtraining. Additionally, their bodies may be physically compromised and unable to manage any additional energetic or caloric expenditure. Once these risks are considered and assessed, you can decide with your team if adding moderate exercise would aid your recovery. Time and time again, exercise has proven to have amazing antidepressant results almost as powerful as medication. Endorphins are released into the bloodstream, helping to energize our body and mood. Exercise can also generate body heat and improve circulation. Winter also offers a time-limited opportunity to embrace cold weather activities such as skiing, snowboarding, tubing and sledding. Enjoying these activities may help you appreciate the season a bit more, and that shift in perspective can impact your mood.
Aromatherapy — Smells can be a source of comfort by evoking positive memories and triggering emotions. A National Institute of Health (NIH) study found aromatherapy as an effective supplementary treatment for people with mild depressive symptoms. Aromatherapy experts recommend serotonin-enhancing pure therapeutic grade essential oils like Frankincense, Marjoram, Geranium, Lemongrass, Bergamot, Jasmine, Lavender, Clary Sage, Chamomile and the Citrus-derived oils. Try adding a couple of drops of these essential oils to your bath water to warm yourself up from the inside out. In general, citrus oils are invigorating and best used in the morning while calming oils, such as lavender and chamomile, would be best used at night. Essential oils can also be used in a diffuser or applied topically throughout the day. Whether you inhale the therapeutic properties through the lungs or they absorb into your bloodstream through the skin, you will enjoy the benefits.
Socialize — Reflecting rhythmic seasonal flow, the urge to hibernate is completely natural, making winter a great time to conserve energy – especially for someone who has a tinge of social anxiety. The desire to cozy up to a fireplace (or space heater in my case), with a book is understandable. However, that doesn't mean isolate and avoid social opportunities. If you tend to dread the anticipation of social engagements but feel slightly revitalized after, first focus on just showing up. Use accountability measures. Reach out to someone else who may also be experiencing cabin fever and go do something together that embraces the season, whether it be sipping peppermint mocha or taking a day ski trip following a nice powdery snow fall. Flowing with the season will help you embrace it.
Hygge — Most of these ideas are quite basic yet profound: sunlight, sleep, nutrition, exercise, aromatherapy, and socializing. When discussing this blog with a friend, she shared the Danish concept of hygge with me, which was derived from a Scandinavian word meaning "well-being" and best translates to coziness. Think atmosphere, environment, comfort, and engaging the senses and you have hygge!
Adding that splash of color to your drab office, enjoying eggnog or pumpkin flavored anything while it's in season, adding candlelight to your aromatherapy bath, and even becoming a human burrito wrapped up under plush covers watching your favorite movies with friends all counts as hygge.
Anything that improves your quality of life would get two thumbs up from the great Danes!