Coping with Seasonal Affective Disorder

Uggggghhhhhhhhhhhhhhhhh.

That's precisely how I feel every November when the clocks go back an hour. You would think that this adjustment wouldn't feel as drastic by now as someone who has grown up in Canada for my entire life. And yet, here I am wondering why oh why I live in a place where the sun sets around 4:30pm for nearly half of the year.

In today's post, we'll discuss what Seasonal Affective Disorder is and how you can cope.

What is Seasonal Affective Disorder (SAD)?

Seasonal Affective Disorder (SAD) is not an individual diagnosis within the Diagnostic Manual of Mental Disorders (DSM-5). Rather, it is listed as a variant of major depressive disorder or bipolar disorder that has a seasonal onset and remission. This means that someone must first meet the criteria for major depressive disorder before potentially being diagnosed with SAD as well.

To recap, someone must experience five or more of the following systems during the same two-week period to be diagnosed with depression (1):

• Depressed mood most of the day, nearly every day; may be subjective (i.e. feeling sad, empty, or hopeless) or observed by others. (In children and adolescents, this can show up as irritability.)

• Markedly diminished interest in interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others.

• Significant weight loss (without dieting) or gain (change of >5% body weight in a month) or a decrease or increase in appetite nearly every day. (In children, this can show up as not gaining weight as expected.)

• Insomnia (lack of sleep) or hypersomnia (too much sleep) nearly every day.

• Psychomotor agitation (i.e. restlessness) or retardation (i.e. sluggishness) nearly every day and observable by others (not merely subjectively restless or slow).

• Fatigue or loss of energy nearly every day.

• Feeling worthless or excessive/inappropriate guilt nearly every day.

• Decreased concentration nearly every day; may be indecisiveness (subjective or observed by others).

• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with OR without a specific plan, or suicide attempt.

  • Symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Episodes not attributable to substance use or another medical condition

  • Episode not better explained by another mental health diagnosis.

  • No history of manic or hypomanic episodes.

• Some atypical features of SAD also include: increased need for sleep, carbohydrate cravings with increased appetite and weight gain, and extreme fatigue.

To add to the complexity, at least two major depressive episodes must have occurred within the seasonal period over the last two years for someone to be diagnosed with SAD. Further, the number of seasonal depressive episodes must substantially outnumber non-seasonal depressive episodes.

Why does SAD occur and who does it affect?

SAD has been linked to a biochemical imbalance in the brain prompted by a decrease in daylight hours and sunlight in the winter months (2).

According to the Canadian Mental Health Association, 2 - 3% of Canadians will experience SAD in their lifetime. However, 15% of Canadians experience milder forms of SAD that leave them mildly depressed, but still able to live their life without major disruptions (3).

Adults are more likely to experience SAD than children and teenagers, with the age of onset occurring at 18 - 30 years of age. Women are four times more likely to be diagnosed with SAD than men (4).

What can we do about it?

1. Practice radical acceptance.

Radical acceptance is a skill designed to keep pain from turning into suffering. This occurs by accepting the facts of reality rather than getting needlessly upset or denying facts. In essence, it is about taking an "it is what it is" attitude to the problems that come our way.

This is not the same as approving of something; you can absolutely detest winter in Canada and still practice radical acceptance. For example, rather than yelling at the universe every day at 4:30pm asking why the hell it demands the sun to set at such a preposterous hour, you recognize that this reality will be part of your life until March and that this isn't within your control. Rather than putting your energy toward complaining, you put it toward taking practical steps that are within your control. (Keep reading for some of these ideas!)

2. Fill your evenings with pleasurable activities.

It's all too easy to curl up on the couch once the sun sets and call it a day. Feeling more tired than usual, you might be more inclined to go to bed earlier rather than engage in activities that might bring you joy.

This is why it can be extremely helpful to schedule activities during the week that will help your mental health. This could involve booking an evening yoga class in advance, scheduling a dinner with a friend on a Wednesday evening, or committing yourself to engaging in self-care rituals after the sun sets (i.e. having a bath or partaking in a hobby you enjoy).

This could also be a good time to cook some of your favourite soups in bulk to store in the freezer or bake some yummy treats for friends and family. Or, try doing an adult paint-by-numbers or learning to knit or crochet.

3. Use light therapy.

Light therapy involves sitting by a light box that emits a very intense white light, and it's one of the standard forms of treatment for anyone experiencing SAD. In fact, some clinics in Sweden will have patients dress in all-white clothes and have them spend time in white rooms filled with bright light to help them combat the winter blues (5).

While light therapy certainly doesn't replace the sun, nor will it provide vitamin D, but I find it at least helps a bit. Personally, I have one at the office and turn it on the moment the sun sets, but you can experiment with using it first thing in the morning or during the day. Amazon has a bunch of different options, though you want to ensure that you're buying a 10,000-lux light box like this one. (Lux refers to the amount of light you receive.)

4. Take a vacation if you can.

I know that this is a luxury that not all of us can afford, but it's probably the best option for folks who can. Book a vacation at a tropical destination during the month that you find winter really starts getting to you. (For me, this is undoubtedly the months of February to March.)

Not possible right now? Consider going somewhere local for a weekend-long spa retreat or cozy getaway. (List your favourite destinations in the comments below! I love Prince Edward County, personally.)

5. Embrace the cold.

This might sound ridiculous if you hate winter (like me), but trying to create positive experiences in your present context is one of the key features of resilience. Some ideas include: building a snowman (yes, I still find this fun), going for a drive to look at Christmas lights, skating, snow-shoeing, snow tubing, or visiting an outdoor winter market.

6. Stay away from windows.

Okay, this is an odd suggestion, but I'm throwing it out there in case it helps just one person.

I used to work in a tiny little office that didn't have any windows. Most of the time, this didn't create the most pleasant experience. However, I found that I didn't mind this one bit in the winter months. Being able to control my lighting all day and not even know that the sun had set around 4:30pm actually had a strangely positive impact on my mental health. So, if now is the time to avoid working in a windowed area, see if it helps!

7. Take that vitamin D.

Being stuck inside for most of the day hurts our vitamin D levels, and low levels of this vitamin have been associated with depression (6). Food sources of vitamin D include fatty fish like tuna and salmon, eggs, and liver, though it's best to take a supplement in the winter months.

The amount of vitamin D you need depends on how deficient you are and other risk factors. A 2023 article in the National Library of Medicine recommended that folks who are deficient take 6,000 IU daily for eight weeks until optimal levels have been achieved (the serum 25-hydroxyvitamin D level exceeds 30ng/mL). They then recommend a daily maintenance dose of 1,000 - 2,000 IU. However, please consult a trusted health professional to learn what dosage is best based on the results of your own blood work. After all, Vitamin D is a fat-soluble vitamin that can build up in the body and result in hypercalcemia in extreme situations—a buildup of calcium in your blood.

Don't forget that you still can go outside even if it's cold. I personally try to bundle up every day and take a quick walk to a nearby Tim Horton's if I can so that I'm getting some natural sunlight. Use this as extra motivation to take your dog for a walk during your workday if you're working from home. Remember that exercise and movement also helps boost dopamine levels, which will probably feel extra good right now.

8. See other humans.

Dark, gloomy weather has the power to make us feel sad and lonely. Characters on TV shows or people in TikTok videos do not replace person-to-person interactions in the real world. This is the time to be super proactive and intentional about seeing friends and family members, even if you're just watching TV together. Some fun ideas to do with friends include: building a gingerbread house, baking Christmas cookies, sitting by an outdoor fire, doing a craft together, doing an at-home paint night, or having a Christmas movie marathon.

9. Don't make major life decisions in winter and remember that this, too, shall pass.

If you have SAD, you will not feel like your best self during the winter months. This isn't a sign that you are "failing." Rather, your body just might not be particularly compatible with this type of environment. The good news, however, is that the cold and dark weather is temporary. You will get through this, just like you have every other year.

10. Work with a professional.

Psychotherapy is also one of the most evidence-based forms of treatment for SAD. (If anything, it at least gets you out of the house and talking to another human being!) Additionally, you may consider speaking to your doctor about going on medications that are known to help treat depression.

To book an in-person psychotherapy session at our Markham office (or a virtual session from the comfort of your own home!) please contact hello@fresh-insight.ca.