Dealing with the winter time blues

Shorter, colder days can present mental health challenges.

 By Lauren Drapeau 

Tough on wildlife, too (Photo by Will Collette)

With Seasonal Affective Disorder, SAD, ‘the symptoms tend to be more severe, more present in younger people.’

As every geographic location experiences seasons differently, New England’s transition into the colder months poses a particular threat to the mental health of residents in the area. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5, defines Seasonal Affective Disorder, more commonly referred to as seasonal depression, as a major depressive disorder with a seasonal pattern.

While the symptoms are similar to depression, they will occur most commonly in the fall and winter months, and begin to subside with the arrival of spring. Less sunlight, in other words, can allow individuals to struggle with daily functioning or become overwhelmed and distressed. 

SAD can occur during warmer months as well, but this is much less common. In these cases, individuals would experience the onset of symptoms during springtime. 

The disorder can affect individuals of any age range, but the symptoms typically begin to present themselves between the ages of 18-30, according to the DSM-5. 

“The symptoms tend to be more severe, more present in younger people,” said Michela A. Muggeo, clinical psychologist with Brown Health Medical Group Primary Care. “Then in older people, they are still present but not severe.”

Early onset symptoms may be overlooked at first, according to Muggeo, but some depressive symptoms are more common with SAD than others.

“With the seasonal [depression], sleep issues are more prevalent, and there are changes in appetite,” Muggeo said. “These are two symptoms that are a bit more severe in Seasonal Affective Disorder.”

Alongside fatigue, lower moods, and loss of interest in activities that an individual would typically enjoy, there are increased cravings for sugar and carbohydrates. As the seasonal cycle continues, these would start sometime in the fall and increase in severity through the winter, according to Muggeo. Along with the seasonal cycle, the symptomatic cycle persists. 

For younger age groups, a concern lies in the fact that these symptoms may begin to present themselves at the start of their school years.

It may be difficult to differentiate between Seasonal Affective Disorder symptoms and depressive symptoms triggered by a change in environment when moving into school and adjusting to new surroundings, according to Christopher Furey, family medicine physician with Care New England Medical Group Primary Care.

“I feel like people get caught off guard when it happens in the fall,” said Nompelelo Boucher, the founder and owner of Cumberland Counseling. “I think that it’s the lack of preparedness for people to understand that things are going to slow down in the brain.”

At Cumberland Counseling, clinicians tend to see more people attending, or returning to, therapy at the beginning of the colder seasons. Boucher credits this phenomenon to the lack of sun, the days getting shorter.

“Ironically enough, the days feel longer, things feel tougher, it feels tougher to concentrate,” said Steffen Gillom, clinical director and an associate clinician at Cumberland Counseling.

People experiencing Seasonal Affective Disorder have reduced levels of serotonin in the brain, as shorter daylight hours may prevent molecules in the brain from being able to maintain normal serotonin levels, according to the National Institute of Mental Health.

“It just leads to a lot of maladaptive thinking patterns in the brain about your own self-worth and who you are and where you’re going,” Gillom said. “It’s actually just– you’re really far away from the equator and you need sun.”

This ultimately becomes a unique issue for locations at greater distances from the equator. 

Boucher was born in South Africa, and stated that she does not remember anything about a seasonal depression phenomenon. Looking at research in Alaska, according to her, the highest rates of this situation take place there. 

“It really is something that has to do with the sunlight,” Boucher said. “It really is something that has to do with New England.”

Gillom expressed that many clients of color looking to treat symptoms are coming from places where, in their country of origins or in more southern states, they couldn’t draw a distinction between how they felt throughout the months. This has become a dialogue in their Cumberland office.

According to studies, SAD varies based on geographical latitude, age and sex. Younger people and women are at higher risk, according to psychiatry.org.

Boucher and Gillom believe these numbers represent a lack of proper research. 

“Women are already in therapy for other reasons,” Boucher said. “Men just come in with this low mood and lack of motivation, and they’re so upset because they want to go forward. That’s what we see the most.” 

Both professionals agreed that most of the individuals expressing higher levels of depressive symptoms during this time are, indeed, men. While this doesn’t necessarily mean more men experience SAD, it also suggests that women might not be the largest group affected by the changing seasons. 

From a clinical standpoint, Boucher worries that SAD has not been emphasized as pertinent enough to treat as its own condition. Due to the nature of therapy, patients are encouraged to attend regularly.

“There might be a financial component to it, too,” Boucher said. “Because it’s known to be a time-limited experience, we are almost encouraged to [focus on] things like bipolar, mood disorder, things that are going to be ongoing.”

There is no medication specifically designed to treat SAD, although individuals can be prescribed umbrella medications that are meant to treat larger disorders like depression and anxiety, such as Prozac or Zoloft. 

“It’s known to be something that is fleeting, so maybe the research has lagged in that area,” Boucher said.

Commonly prescribed methods to treat the seasonal onset of depression include light therapy, psychotherapy, antidepressants, and vitamin D. 

Many clinicians will recommend light therapy boxes, which can be purchased on Amazon, to improve mood and energy. It is important that these are made specifically for SAD when purchasing, according to Muggeo. With routine exposure, these light boxes can help mimic early sunlight exposure that one might experience during warmer months. 

If these do not work, antidepressants can temporarily be prescribed in order to help individuals through the season. Psychotherapy may be encouraged for more severe symptoms. 

“One of the day-to-day recommendations is to get out as much as possible,” Muggeo said. “If you can’t because you’re working during the day when it’s light out, sit next to a window or have lights or candles around your space.”

Clinicians recommend that if this pattern persists annually, people reach out earlier in the year for treatment options to get ahead of symptoms before they become more severe.

Gillom expressed that the first step in looking at SAD for further research would be to analyze behavior patterns and how individuals cope. Looking at specific demographics may help to understand the issue on a broader scale, as well, according to Gillom. Individuals with lighter skin have less melanin, allowing them to absorb radiation more effectively and produce more vitamin D. 

“I think that we could have these conversations across communities of color, as well,” he said. “I know for my friends who are black and brown, they are usually taking some sort of vitamin D supplement at this time of year. Our skin is darker and so therefore it’s repelling the sunlight.”

Both clinicians teach other clinicians in the field, and stated that SAD has not been added to their dialogue quite yet. 

“This is something that is in the background, but it’s something that is causing so much suffering,” Boucher said. “I don’t think we’re talking about it.”

Additionally, Boucher and Gillom state that many of the research’s numbers may not be completely accurate as many demographics are unaware they may experience SAD. After discovering a behavior pattern with seasonal depression, individuals still may need a mixture of multiple treatments in order to balance their mood, according to Muggeo. 

“At any time of the year, if you’re feeling depressed or anxious, I think reaching out, if you’re in school, to your student health services or to a medical professional is the first step for sure,” said Care New England Medical Group Primary Care’s Furey.

If any New England residents, or other individuals farther from the equator, experience depressive symptoms in the colder months, there are options available.

Anyone in immediate danger should call 911.

Other resources:

— BHLink: For confidential support and to get connected to care, call (401) 414-LINK (5465) or visit the BHLink 24-hour/7-day triage center at 975 Waterman Ave., East Providence. Website: bhlink.org

— The Samaritans of Rhode Island: (401) 272-4044 or (800) 365-4044. Website: samaritansri.org

— The National Suicide Prevention Lifeline: (800) 273-TALK, or (800) 273-8255

— The Crisis Text Line: Text HOME to 741741 “from anywhere in the USA, anytime, about any type of crisis.”

— Butler Hospital Behavioral Health Services Call Center: Available 24/7 “to guide individuals seeking advice for themselves or others regarding suicide prevention.” (844) 401-0111

— Thrive Behavioral Health’s Emergency Services: 24-hour crisis hotline (401) 738-4300.

— Prevent Suicide in Rhode Island: a Rhode Island Department of Health resource. If you are in crisis, call (800) 273-8255 or text TALK to 741741. Website: preventsuicideri.org/

Lauren Drapeau is a senior journalism major at the University of Rhode Island. She is the current editor-in-chief of the campus newspaper, the Good 5 Cent Cigar, and has been on the editorial board for 3 semesters. She is also a consultant at URI’s Digital Writing and Research Studio, and serves as a TA assistant for multiple journalism courses on campus. In her free time, she enjoys spending time outside, seeing friends, and reading.