Preparing for Seasonal Depression
In my practice, I often notice a serious downshift in the moods of my patients in November. This is only anecdotal, regional evidence, but it pops up year after year. November seems to be when most of my patients are finally noticing the negative impacts of the seasonal shift into autumn in their daily lives. Less sunlight disrupts our circadian rhythms, our melatonin and serotonin production, and our exposure to vitamin D. I hear complaints of low mood, fatigue, isolation, disinterest, and sleep & appetite disruptions.
Colloquially this is known as seasonal depression. You may have heard it referred to as seasonal affective disorder. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, there is actually not a disorder by that name. Clinicians diagnose this as a specifier, which is defined as “extensions to a diagnosis that further clarify the course, severity, or special features of the client's disorder or illness” (National Board for Certified Counselors, 2023). The specifier for seasonal depression is called “with seasonal pattern.” This may look in a medical record like “Major Depressive Disorder, recurrent episodes, moderate, with seasonal pattern.”
DSM-V criteria for “with seasonal pattern” is as follows:
A. There has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year (e.g., in the fall or winter).
Note: Do not include cases in which there is an obvious effect of seasonally related psychosocial stressors (e.g., regularly being unemployed every winter).
B. Full remissions (or a change from major depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
C. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major depressive episodes have occurred during that same period.
D. Seasonal major depressive episodes (as described above) substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual’s lifetime.
I offer the DSM-V criteria to those who do not have regular access to this information. I encourage you not to get too caught up in the rules or timelines. Instead, I ask that you consider your overall mood, appetite, sleep, daily habits, and energy levels during seasonal shifts. Keep in mind, this is not limited to fall and winter! Summer depressive episodes are quite common.
What should you be looking for during changes in season?
pervasive feelings of sadness, emptiness, hopelessness
diminished interest or pleasure in your normal activities
weight loss or gain, changes in appetite
sleeping too much or too little, disrupted sleep
feeling restless, feeling physically slowed down
social isolation, loneliness
fatigue, loss of energy
feeling worthless or guilty
difficulty thinking or concentrating
thoughts of death or suicide
What can be done to prepare for seasonal depression?
Vitamin D supplements (if physician approved) can help maintain what has been lost through natural sun exposure during the darker the winter months.
If you already take psychotropic medications, discuss with your psychiatrist if any adjustments need to be made during your seasonal episodes that can be adjusted again when your episodes predictably end (like in the spring).
If you do not currently take psychotropic medications, discuss with a physician if this may be a good idea for you seasonally.
Light boxes can mimic outdoor light and can be used for 20-30 minutes at a time. They vary greatly in price, style, and wattage. You must check with your healthcare provider first to approve your use of a light box. Clients with known bipolar disorder can induce manic episodes through incorrect use of light boxes.
Regulating your sleep/wake pattern and making it as consistent as possible will help keep your body’s circadian rhythm in check despite the change in natural sunlight. Going to sleep and waking up at the same time is recommended.
Resist your urge to take melatonin to help you sleep as much as possible, unless otherwise directed by a physician. Your body is naturally producing more melatonin right now to compensate for the decrease in daylight.
Spending time outdoors more often than you normally would, and taking advantage of daylight hours.
Resisting your urge to shut in and isolate, and remaining socially engaged with your loved ones. Cider mills, ice skating, game nights, or just staying in touch with phone calls all helps combat isolation.
What questions do you have about seasonal depression?
