Seasonal Depression

Seasonal affective disorder, or a depression that comes around year after year in certain seasons, remains a somewhat controversial diagnosis. The depression epidemiologists feel enough confidence to say that there are people who become depressed regularly, usually in winter, and recover in the spring, and that this is not related to lack of exercise or opportunity to socialize or to stimulus deprivation, but appears to be related to absence of sunlight. In the depressive phase, patients feel lethargic, sleep too long, gain weight, and crave carbohydrates. They become sad, anxious, irritable, and socially withdrawn. Four times as many women as men are affected; over half the women complain of premenstrual mood problems as well. Symptoms often improve if the patient moves nearer to the equator during winter. Light therapy, using a powerful fluorescent light regularly, was initially thought to be helpful, though later studies can’t show it adds any benefit.  But sitting quietly in a good light, reading a book or practicing mindfulness, will do anyone some good.

I was always skeptical about this condition, simply believing that every depressive just feels worse in the winter, until I met Noah, who has a distinct pattern of seasonal bipolar disorder.  In August, he begins to be anxious about his upcoming classes (he’s a teacher at an upscale prep school in New York), and by October is in a state of major depression.  He believes he’s doing a lousy job at work and that everyone sees.  He can’t sleep, loses interest in food, and gets into an obsessive negative thinking cycle.  He looks tense and uncomfortable and feels that he can barely express himself, despite the fact that his students give him positive feedback.  Then, about January 12—we have tracked this for several years—he starts to feel better.  By March he is in a definite hypomanic state, energetic, confident, outgoing and full of ideas.  Students flock to his classes to be entertained, but they actually rate his teaching lower than they do in the fall.  In his hypomanic state, he has real trouble focusing, and sometimes makes decisions he regrets very much later on.  Early summer is the best time of year for him.  The seasonal nature of his work probably contributes to this condition, but I am at a loss for a full explanation.

It is true that fall and winter often make depression worse.  The shorter days, the more closed-in feeling, the lack of opportunity to exercise and socialize, and the fact that life is just generally more of a hassle in the winter, all make it more likely we’ll just roll over and stay in bed.  This is precisely the wrong thing to do.   We know that regular exercise is one of the best treatments for depression; if you have longer evenings with less to do in the winter, it’s time to step up your exercise level.  Put on warm clothes and go for a walk outside; within five minutes you’re accustomed to the cold and you won’t feel like such a prisoner.  Make social commitments and keep to them.  Plan a vacation getaway.  Above all else, be mindful of your thinking and mood.  Remember that you can develop more power to stop your gloomy train of thoughts, and that there are many things you can do to shake yourself out of a mood.