(Video) Ask a U of M Expert: Tips for coping with SAD

MINNEAPOLIS/ST. PAUL (12/22/2021) — With winter in full swing, some individuals may be experiencing the winter blues or seasonal affective disorder (SAD). 

University of Minnesota Medical School expert Sabine Schmid discusses what SAD is and provides tips on how to navigate it.  

83 seconds - What is seasonal affective disorder and how is it different from feeling down?

Dr. Schmid: It is common for people to feel a little “down” when days get shorter in the fall and winter. This is known — among other names — as the “winter blues.” Seasonal Affective Disorder (better known as SAD) goes beyond that. It's a type of depression with a recurrent seasonal pattern. By far the most common pattern is “winter SAD” when symptoms start in the late fall or early winter and subside during the spring and summer.

Symptoms include those of major depression such as feeling down most of the day, losing interest in activities, feeling hopeless and trouble concentrating. In addition, winter SAD is often associated with a decrease in energy, oversleeping, craving for carbohydrates, weight gain and social withdrawal. 

In addition to general risk factors for depression such as being female, having a family history of mental health problems, and living further north presents a risk factor for SAD due to the shorter daylight hours in winter. 

234 seconds - For those experiencing SAD, what advice would you give them? And, what misleading advice on social media would you recommend to be wary of?

Dr. Schmid: I recommend consulting sources and websites distributing information based on scientific evidence such as the National Institution for Mental Health (NIMH), the American Psychiatric Association (APA) and to consult a mental health professional. Let’s address some common misbeliefs:

1. SAD is a minor form of depression

Unlike the winter blues, SAD is a type of “major depressive disorder” and more serious than simply feeling down or more tired during shorter days. SAD is characterized by serious mood changes and often affects how people feel, think and act. Meeting full criteria for a major depressive disorder, SAD can be debilitating and often concurs with other physical and mental health problems such as substance abuse and suicide risk.

2. Bright light therapy is always an effective treatment for SAD

If used correctly, bright light therapy is an effective treatment for some people with SAD. However, in order to be effective, light exposure needs to be applied correctly with sufficient intensity (10,000 lux) and duration — recommendation is approximately  20-50min per day — as well as correct positioning of the light source. Unfortunately, even with proper usage, bright light does not alleviate SAD symptoms for everyone.

3. Overcast weather causes SAD 

SAD is related to the duration of daylight exposure, not cloud cover. As with any psychiatric disorder, many questions remain about the causes of SAD. Evidence points to the involvement of the brain chemical serotonin, which regulates mood. In SAD, the regulation of serotonin functioning — influenced by sunlight — appears impaired, resulting in abnormal serotonin levels in the winter. It has also been found that people with SAD produce too much of the hormone melatonin. Together with serotonin, melatonin helps maintain a healthy sleep-wake cycle and helps our body adjust to seasonal changes. In SAD, an excess of melatonin impairs our adjustment to changes in daylight. Many people with SAD have Vitamin D deficiency, which has also been linked to serotonin functioning. We typically consume Vitamin D with food, but also produce it when skin is exposed to sunlight. 

4. People with SAD need to change their attitude

SAD is not caused by a ‘bad’ attitude. It’s caused by neurochemical changes in the brain. People don’t cause SAD and cannot simply shake it off. If you or a loved one suffers from seasonal depression, please seek professional help. SAD is a psychiatric disorder which can cause significant distress, persist for months, and return every year.

Treatment for SAD includes: 

• Life-style changes;
• Light therapy (under professional guidance, insurance covers);
• Cognitive Behavior Therapy: a type of psychotherapy proven effective for SAD;
• Antidepressant medications; and,
• Vitamin D supplements (under professional guidance).

A positive factor in the treatment is that SAD is predictable. Those with known SAD should consult a mental health professional about when to start treatment to help minimize symptoms.

In cognitive-behavior therapy for SAD, we emphasize the following:

• Learn as much as you can about SAD, your specific timeline and symptoms.
• Prepare for triggers (turning the clock back) and early warning signs (spending more time in bed or feeling sluggish). 
• Plan concrete and specific steps for maximizing daylight exposure, maintaining physical exercise, eating nutritious food (monitor Vitamin D levels as indicated) and making social connections a priority.
• Execute the planned steps for self-care, physical, and social health. Often we can modify (as opposed to stop) an activity we enjoy during the brighter months. Reach out for social support or professional help if you get stuck.
• Look forward to symptom remission in the spring. The temporary nature of SAD is tremendously helpful because most people can still remember and imagine what they value and enjoy when doing well. 

106 seconds - What advice would you give to family, friends and significant others who want to be supportive of an individual with SAD in a sustainable way?

Dr. Schmid: SAD can negatively affect social relationships. For those who never experienced SAD or other depression, it may be difficult to understand and rather frustrating to watch.  Why don’t they just “snap out of it and do something?” Well, yes, that would be great! Here is how you can help:

1. Stay connected: The protective effect of family support and social connectedness can hardly be overstated. When already depressed, it can be powerful in disrupting an otherwise vicious cycle. 

2. Understand: Ask your loved one with SAD to educate you about the disorder, explore their experience, and validate their emotions. You don’t need to agree with the beliefs. For instance, you can acknowledge that short days allow little opportunity for outdoor activities, which is frustrating, without agreeing that they are helpless.  

3. Encourage following the strategies proven to work. A warm and supportive posture works better than criticism. 

4. Model and encourage a healthy lifestyle: Simple things such as eating nutritious food, getting enough sleep, going outside for sunlight, fresh air and maintaining physical activities can lift our spirits and be effective “antidepressants” for everyone.

Protect yourself ffrom the effects depression can have on others. For loved ones, it is crucial to stay strong and resilient by taking care of ourselves.Last of all, allow yourself to have guilt free fun.

Sabine Schmid, PhD, LP, is a clinical psychologist with the University of Minnesota Medical School and M Health Fairview. Her expertise is in cognitive psychology with a focus on mood disorders, ADHD, obsessive-compulsive disorder, and stress anxiety disorders.

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