By Dr. Rachel Lowinger
With muddy slush melting occasionally, only to make room for the next layer of snow, and gray skies forming the daily background of our mornings, the winter can really feel like a never-ending test of endurance. For some of us, it may actually bring about tangible symptoms such as extreme fatigue, a tendency to overeat (especially carbohydrates), increased anxiety, irritation, or depressed mood.
Seasonal affective disorder (SAD) is currently classified as a seasonal variation in disorders such as bipolar and major depression, rather than a separate diagnostic entity. While the clinical rates of SAD patterns are quite low (0.5—2.5% in Canada and the U.S.), many more individuals may be suffering from winter difficulties that are similar to those found in SAD, but milder or “subclinical.”
Subclinical symptoms may be affecting as much as 20% of the population. They may also be more common among women in their childbearing years and have been shown to be more pervasive in populations that live further away from the equator (e.g., higher rates were found in New Hampshire than in Florida).
Symptoms include overwhelming fatigue, or a profound lack of energy that makes even the simplest daily activities extremely difficult to carry out. People with subclinical symptoms of SAD may uncharacteristically opt out of social activities they would usually welcome, or experience a general loss of interest and diminished pleasure from activities that are usually enjoyable and emotionally rewarding.
Another interesting feature of SAD symptoms is that they are very likely to co-occur with other mood disorders and conditions. This tendency is termed comorbidity, and it refers to the likelihood of certain conditions to occur together. In one study, as many as 66% of individuals with SAD suffered from an additional mood disorder–most commonly anxiety. If you are already susceptible to anxiety, panic attacks, or depression, the prolonged winter months may exacerbate these conditions.
On the biological level, it has been suggested that comorbidity may be the result of serotonergic dysregulation–i.e., changes in the secretion of hormones such as cortisol and melatonin, which are responsible for regulating sleep-wakefulness cycles as well stress responses.
On a behavioral level, the link may be related to changes in behavior that occur during the winter months. When it’s cold and gloomy, you tend to spend more time at home, you are less likely to meet up with friends or plan social activities, and you are also more likely to have extra “alone” time to ruminate on the things that stress you out.
Leah was an A student with lots of friends and a terrific family. In her senior year of high school, she felt overwhelmed by her increasing responsibilities and numerous demanding activities; during this time she began suffering from panic attacks. Her breathing would race and her heartbeat would accelerate so much that she would feel like she was about to faint or have a heart attack. After working with a therapist, Leah learned how to deconstruct her terrifying thoughts, breathe deeply and soothe herself during panic attacks, and prioritize her activities in the long run. Gaining control over the anxiety felt very empowering. The panic attacks subsided and Leah went on to seminary and to marrying a wonderful bachur.
When Leah became the proud mother of a beautiful baby girl, those panic attacks seemed nothing but a vague memory of the past. Or so she thought . . . until one late December day in a crowded store Leah felt that all-too-familiar dizzying racing sensation–sweaty palms, a knot in her throat, a desperate need to get out of the store–taking hold of her all over again. When she finally recovered from the uncomfortable sensations and made her way back home, Leah was not only feeling terrible and exhausted, but also mad with herself and ashamed for allowing herself to go back to “square one.”
Leah did not connect the long winter season and the short gloomy days with her recurring panic attack, but research tells us that a connection exists. At the time Leah experienced the recurrent panic attack, she was already feeling less upbeat and less social than her usual self. This was quite different from how she felt in the spring and summer months. Leah’s symptoms may have been seasonal. Leah can stop blaming herself and realize that biology, weather, and her coping skills are all at play. She can begin to target both her SAD-like symptoms and her panic attack as part of an integrated approach. She can also be encouraged by the fact that they are likely to get better on their own as the days get longer and the sunshine more consistent in the coming months. Sometimes feeling hopeful about the future does wonders in the present.
Something to think about:
– A little bit of awareness goes a long way. Realizing that what you are experiencing is time-limited and context-dependent–that, just like the seasons, it will pass–will make it easier to put things into perspective.
– Winter blues might cause symptoms such as fatigue or overeating, but it can also exacerbate other conditions such as anxiety and depression. Seeing the connections between the different aspects of your daily experience will help you feel less out of control and better able to make sense of what you are feeling.
– Many have similar reactions and most get better on their own without any special intervention. There is no need to feel isolated, ashamed, and burdened by your situation, and you have good reason to feel hopeful about imminent improvements. (But if symptoms do not improve, or if they get even worse, you should seek professional help.) Being hopeful is itself a great antidote.
Something to do about it:
Research shows that natural light and exercise are the two most effective ways to beat the winter blues. Bright light and exercise improve mood, energy levels, alertness, and productivity. The early-morning sunlight is optimal in terms of helping your body regulate melatonin and cortisol secretion. Melatonin secretion is affected by exposure to light, whereas cortisol secretion is affected by exercise and possibly light levels as well.
Although special lights have been created to treat SAD in medical facilities, you can orchestrate your own light therapy at home, or rather in your backyard. Consider sunlight a medication that your body and soul require in order to be well. Make it your priority to notice bright sunny days and make sure that you go outside and take in a good dose of natural light. Life gets busy and the thought of going out for a stroll in the sun might seem indulgent or inconvenient. You may decide to push the stroll to the bottom of the to-do list and find that you have missed your chance by the time you get to it. If you think of the pursuit of sunshine as claiming your free potion of Hashem’s medication, you may be more likely to give yourself the gift of light.
Try to create a routine–on your own or with a friend–that includes daily outdoor exercise, and stick to it. It may be hard at first, but once you begin feeling better, reminding yourself how good you felt afterwards should be enough incentive to do it again. v
Dr. Rachel Lowinger is a licensed clinical psychologist. She received her Ph.D. from Concordia University and has been a postdoctoral fellow at the William Alanson White Institute. She works in private practice in Lawrence and Manhattan, specializing in adults, emotional disorders, personality disorders, trauma, and women’s and young adults’ issues of identity. She can be reached at email@example.com.