Winter Blues: Seasonal Affective Disorder (SAD)

Winter Blues: Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD)

Depression can occur at any time of year. However, for many, winter represents the most vulnerable time. Changes in sunlight, temperature, changes in the brain and body’s internal chemistry, and the stress of the Holidays can all play a role. In some ways, Winter Depression is built into our biology – just think of bears that hibernate during the winter. Indeed, symptoms of winter depression can mimic hibernation, with lack of energy, sleepiness with difficulty getting out of bed, and an increased appetite with carb-cravings. Difficulty with concentration and focus can also be a symptom. Because of the physical symptoms, some describe seasonal affective disorder (SAD) as “vegging out.”

Some individuals only experience depression during the winter while others may experience it any time of year but more so during the winter.

Some specific findings associated with winter depression include:

1) Lower available levels of the brain chemical messenger serotonin. There is evidence that serotonin remains less available to stimulate neurons for people with SAD. This is because after serotonin is released from a neuron, thereby making it available to attach to and activate docking stations (known as receptors) on surrounding neurons, it is sucked back in by the releasing neuron too quickly in people with Seasonal Affective Disorder (SAD).

2) People with SAD may make too much melatonin, a hormone that promotes sleepiness. Excess melatonin levels can cause daytime fatigue. This can also throw off a person’s day-night cycle (circadian rhythm).

3) Insufficient Vitamin D levels may play a role in SAD. Vitamin D may be involved in the action of serotonin.

4) Activity of a structure deep in the brain called the hypothalamus may be uniquely sensitive to sunlight in people with SAD. The Hypothalamus controls sleep and appetite, and also may play a role in mood.

Treatment for Seasonal Affective Disorder (SAD):

First, it is important to rule out other possible causes, such as low thyroid or anemia as examples. I have had a number of patients where these were uncovered as causes of fatigue.

Very effective treatment for SAD is available. Bright Light therapy, Cognitive-Behavioral Therapy (CBT), and antidepressants are the most evidence-based. These and others that are often helpful are listed below.

Bright Light therapy

There are lots of different styles and price points of bright light lamps or boxes. Specific levels of luminosity (often 10,000 lux is recommended) and timing of bright light are important components. The timing of bright light may depend on the type of depression. For pure SAD or winter worsening of depression, the morning is usually best. Morning bright light resets circadian rhythm, activates the hypothalamus, and suppresses melatonin secretion. Melatonin release is regulated by light. Melatonin is always primed to be released in the brain but held back or suppressed by bright light. This is why melatonin is released at night (and also why you shouldn’t bring your phone or laptop into bed at night!).
(Note that although using bright light later in the day can make SAD worse by messing up circadian rhythm, there are always exceptions. I occasionally find that bright light later in the day whether exclusively or in addition to morning light paradoxically is more beneficial. Also, mid-day bright light is better for Bipolar depression).


Many antidepressants are used for winter depression but one is specifically FDA approved for it. However, your doctor needs to make sure this is the right antidepressant for you (for example, it’s not as good for some symptoms of depression or anxiety).

Cognitive-Behavioral therapy (CBT)

This can help change unhelpful behaviors and negative thinking, help change perspectives on the winter, and teach stress-reduction techniques.

Exercise. For those who are not inclined towards exercise, thinking of this recommendation simply as “getting the blood flowing” can be helpful, as even 10 minutes of physical activity a day can be beneficial. Outdoor activities can be especially helpful.

Vitamin D. Consult your doctor for Vitamin D dosing for SAD.

This article was originally published on Dr. Neal Ranen, Baltimore Psychiatric Services

Stress Can Have a Direct Impact on Your Mental Health and Overall Well-Being

Stress Can Have a Direct Impact on Your Mental Health and Overall Well-Being

Effects of Stress on Your Mental Health – Baltimore Psychiatry

Many people make daily comments about being completely stressed out or under so much stress. Even though there are common themes when it comes to stressors, these can really vary from person to person. In other words, what stresses one person may not stress another.

It is known that stress can result in severe physical and mental health consequences.  Physically, the onset of stress can be observed as a result of getting too little sleep or rest, poor eating habits, or too many things to do in very little time. Internally, stress can negatively affect the nervous, cardiovascular, immune and endocrine (hormone) systems, amongst other biological effects.  Mentally, the onset of stress comes with constantly worrying about finances, children, your health or the health of other family, retirement, or the occurrence of a traumatic event.

A great deal of stress occurs as a result of everyday tasks and responsibilities. There is often a collective set of issues that could possibly lead to the onset of stress. These issues typically stem from tasks and responsibilities being piled on an individual.

Internally, our bodies often react to these everyday constant stressors of modern society similar to if they were immediate dangers or catastrophic events because physically we have limited hardwired ways of responding to stress.

Consistent bouts with stress without making the necessary changes to eliminate the effects can eventually cause your mental health to suffer. It is important to understand that external events can result in stress. This results in a feeling of not being in control.

How to Get Your Stress Levels Under Control

The good news is there are tools to combat stress. The process is not a lengthy one, but change will not occur overnight. There are cases of chronic stress, which may require major lifestyle changes or psychiatric attention. Individuals can attempt to find their level of tolerance for stress and make honest attempts to remain within those limitations. It is advisable to avoid stressful situations whenever possible, and minimize the effects of stress when not possible.

Here are a few tips to help control stress:

  • Maintain a Realistic Attitude. Setting expectations are critical. Don’t be afraid to simply say NO to activities or situations that stress you out (and are not absolutely necessary –although expectations sometimes come into play in determining what is absolutely necessary). Any situations or events that make you anxious or overly nervous, or cause you to be overextended, could eventually cause stress to build-up. Take a realistic approach to responsibilities and shy away from those that seem to be overwhelming. Make changes and see if you can reassign responsibilities to others if executing them will cause you to stress out.
  • Execute tasks at a comfortable pace. There are no perfect people and you should know that no one expects you to be perfect. The pressure of perfectionism can backfire, as stated well by the aphorism: “The perfect is the enemy of the good.” If certain tasks or activities seem to be too overwhelming, spread them out or get help with completing them. You don’t have to do everything on your own. Some things can be put off to a later date or treated as a group task. The key is to decrease the amount of stress associated with completing the task.
  • Reevaluate your workload to make necessary changes. If stress has occurred as a result of work, reassess your job duties. If possible, you may need to decrease the number of hours you work or completely change the industry in which you work. Although the latter option sounds extreme, think about how much time you spend at work. There have been numerous cases where employees have become so stressed with work that it becomes the main factor contributing to poor mental and physical health.
  • Engage in stress-reducing behaviors like exercise and meditation. Exercise can chew up excess adrenaline that would otherwise be manifest as anxiety. meditation helps to build up the relaxation pathways of the nervous system, which prevents the alarm system pathways from being constantly active.
  • Talk to a Professional such as a Psychiatrist. If your stress is a result of something that you can’t change in life, or the symptoms of stress are distressing, speak with a mental health specialist. As a psychiatrist, because I am a physician, I can evaluate both the emotional and physical symptoms of stress. For example, I focus on cognitive-behavior therapy and problem-solving therapies for stress, but can also offer medication, prescribed gently for targeted symptom relief. I conduct an evaluation of your situation to provide helpful information on how to alleviate stress in your life, either by modifying the stress or changing the response to it. Professional help can be invaluable because I know that some of the above suggestions are easier said than done, especially when you’re in the midst of the stress!

The onset of stress can easily manipulate the behavior of an individual. They become irritable, difficult to work or associate with, and may find that just getting through the day has become effortful. Stress-related disorders are more common than most people know. Failure to treat stress-related symptoms could lead to severe depression, panic attacks, or aggravate bipolar disorder. The good news is there are helpful proven approaches that provide relief, which is why it is so important to reach out for help and not blame yourself when your own efforts don’t seem to be helping.

Dr. Neal Ranen can assist you with stress and anxiety treatment in Baltimore.  Contact us today to set up an appointment!

This article was originally published on Dr. Neal Ranen, Baltimore Psychiatric Services