The Winter Blues

We all know what the blues are. I doubt anyone can truly say without a complete dissociative disorder that you haven’t experienced the blues at some point in your life.

It might be the loss of grandparent or worse someone closer. It might be the loss of a favorite pet. Perhaps it’s the end of an amazing vacation or kissing off a loved one you haven’t seen in years. Whatever your sad moments are, most are self-limited and fortunately are rare.

sad girl in winter

When it comes to the winter blues, we can expect them every year. The chances that you have experienced this phenomenon or know of someone who has, depend a lot on where you live geographically. About 5% of the U.S. population experiences seasonal depression, but can vary by as much as 0-10% of the population depending on where you live. 4 out of 5 people who have seasonal depression are women. The main age of onset is between 20s and 30s.[1] Typically, the further away from the equator someone lives, the higher the chances you might experience this phenomenon.

Symptoms include:

  1. Hyperphagia
  2. Carb craving
  3. Hypersomnia
  4. Weight gain
  5. Psychomotor slowing
  6. Low mood
  7. Loss of interest
  8. Anhedonia
  9. Anxiety
  10. Low libido
  11. Low motivation
  12. Social self-isolation

The basic idea is that light plays a major role in this process. Similar to how certain animals den up in the winter, there may be some biologic basis for some of it. We all have “internal clocks” determine by our brains and hormones, particularly the hormone melatonin, which is responsible for our sleep patterns and circadian rhythm. There has been considerable interest in this area of the brain, as researchers seek to determine the exact cause of SAD or seasonal Affective Disorder.

The disorder is highly criticized and many even say that it doesn’t exist at all and is just a way to re-classify dysthymia or clinical depression. The overlap between the symptoms I mentioned previously and depression are considerable.

I first personally observed this phenomenon in my mother, when I was a child. My father, also a physician, purchased a light box for her. I remember her sitting in front of it. It was bright light, which appeared like the sun. It looked warm and cozy just watching her do it. To be honest, I tried it a couple of times myself, just to see if I felt different after using it. I remember feel warm and cozy all over.

Growing up in South Eastern Wisconsin, right along the Lake Michigan coastline, I guess I never realized how cloudy it was. We often had what they called, “Lake effect.” Seemed to me that this was a bit of a catchall term, but it made sense. The Western winds pushed against the Lake, causing a updraft of precipitation and a constant cloud cover.

When my wife, Amber, moved out to Wisconsin, when I was in medical school, I first really “noticed” that I lived in a constant cloud cover. I remember it being, sort of a Groundhog Day like phenomenon. It was the day before iPods and smart phones. We had a clock radio in the bedroom, which we set to wake up. She moved there in January, which we had no control over, but was not great for someone who grew up in sunny Colorado.  Every morning, just like for Bill Murray in Groundhog Day, the clock radio went off and sounded the same. “Good Morning Milwaukee, it’s another overcast, cold day. Highs in the 30s and lows in the teens. There’s a dense cloud cover with a chance of snow.” Ugh! I remember her cute face turning to me and saying, “Honey, when do you think the sun will come out.” I smiled and empathized over something that I hadn’t every noticed in the 2 dozen years I spent growing up in Wisconsin. “April or May, maybe…” I would reply, only to see her face fall into sadness. There was no remedy either. My parents lived about 45 minutes away and I asked if they still had that light box. I drove up to get it and give it a try with Amber. Not sure it helped much.

So, that’s been my experience with seasonal affective disorder. I can tell you that when the sun comes out, my wife is more energized. I can tell you that my mother-in-law “notices” when the sun is covered for a few days in Colorado. In fact, as an ER physician, I feel like I see less gloom during those early Spring sunny days. This, of course, is just my impression.

In my humble opinion, seasonal affective disorder happens to all of us to an extent. Pair your emotions on a cold, overcast day to your emotions on an early Spring warm, sunny day. There’s anticipation, outdoor enjoyment, excitement. On those cold, cloudy days, there’s not. I think that we all can learn to accept this. There may be some advantage to slowing down, knowing we are confined to a smaller indoor space. When we are indoors a lot, especially over the holidays, we will tend to eat more, cook more, and gain more weight. If we are confined to the house because of the weather and inability to go outdoors, we might even be unable to socialize with others, contributing to social isolation. It would be natural with short daylight to sleep more too.

One of the keys at Doctor of Living that you will hear regularly is to accept these things without judging them. It may be completely natural to have all of the above symptoms. Now, if you are having more than just these symptoms, such as severe disinterest in things you enjoy, suicidal thoughts, then it’s time to see a professional.

Short of these symptoms, though, seasonal affective disorder is probably grossly under recognized and most of us can attest to having a bit of what we know better as the winter blues. So, now that we have identified it, what can we do…Here are 14 ideas that can help curb your winter blues:

  1. You can certainly buy a light therapy lamp and give it a try. It may just work for you. Dedicate as much time as you can, perhaps starting with a reasonable 20-30 minutes. Maybe pair it with listening to a great PODCAST, like Doctor of Living’s PODCAST. Or a favorite album. Maybe, you could listen to some music that reminds you of sunny days on the beach.
  2. Try to get outside every single day in the winter. I know. I know. It’s cold outside, but getting outside, helps your brain to regulate your circadian rhythm. You should try and do it. That light, even if overcast does matter and helps your brain to regulate your day/night cycle. Not to mention there’s benefit to the fresh air you get in doing it.
  3. Try to plan a winter excursion, maybe a 1 week trip to the beach. Most of us save our vacation time for the summer, but hanging onto a week of vacation time for winter blues, might just be just what the doctor ordered.
  4. Try to visit family and friends in the winter to avoid social isolation. No excuses. We have heated cars and heated homes, we should make extra effort to see family and friends, because the casual and unplanned summer socials are unlikely to happen in the winter months, so catch up with those relatives you haven’t seen in a while.
  5. Don’t be too hard on yourself in terms of getting things done. If you are tire, get some extra sleep. Don’t push yourself to do too much. It’s natural to feel a bit slower.
  6. Don’t be too hard on yourself about a few extra pounds or an inch or two on your waistline. Recognize that your metabolism has slowed and your activity is less. Be cautious not to eat more, because you are using less.
  7. Join a gym or invest in home equipment. This will help to ensure you are getting daily exercise. This is important to your daily cycle and will tire you out for the evening.
  8. Join a religious organization. Whatever you believe, there is likely a group of like-minded folks out there that can help support you, especially during the winter months.
  9. Be careful with too much alcohol. Over the holidays, people tend to drink too much. This exacerbates the depressive symptoms and can push you too far. Avoid the night cap to get you to sleep. There are so many problems with this.
  10. If you are having trouble with your sleep/wake cycle, there are some cool new gadgets. I have seen a couple that simulate sunrise by increasing light in the bedroom in the morning. Check one of these out.
  11. Consider taking a melatonin, not daily, but when you are having trouble getting to sleep as this can help regulate your circadian rhythm. Don’t use it every day, but for a short period, it can help you get on track.
  12. Avoid toxic foods, high in animal fat, fried or greasy. Try to eat health fresh fruits and vegetables. Smoothies can help combine many fruits, berries into your morning routine. Go for it. Frozen items help to ensure winter freshness.
  13. Try to beautify your home. Decorating for winter doesn’t have to be only religious. Make your home beautiful with fresh cut flowers, plants with flowers and pleasant smells. This helps when you feel confined.
  14. Embracing the coziness. You may have heard of the Danish concept of hygge. This comes from a dark part of the world, not surprisingly. It means to set the mood of coziness, comfortable, which create feelings of wellness and contentment. Break out the candles (although be very safe with them…that’s another story.) Put that log on the fire and enjoy the coziness that is winter.

[1] Darren Cotterell. “Pathogenesis and management of seasonal affective disorder.” Progress in Neurology and Psychiatry, Volume 14, Issue 5, Version of Record online: 7 OCT 2010

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