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In late October, “Adam,” a 43-year-old man, consulted me.
“I don’t know what’s wrong,” he said. “It seems like every fall, I just don’t feel like myself.”
He pulled out his list of symptoms: “I have less energy. My mood is lower and I’m more irritable. I sometimes procrastinate and avoid social activities. I’m distracted and it’s harder to focus. Things don’t seem to interest me very much and stuff that used to bring me a sense of pleasure just doesn’t. I feel sluggish even though I’m sleeping more than usual, and by the time winter sets in, I’m really depressed. All these things get worse. I just don’t get it. In early spring, I gradually come out of it. I’m like a different person by April. I feel good, energized, and motivated, but then, come October… I just don’t know. What’s wrong with me?”
I asked Adam a number of questions. I found out that he met the criteria for a particular type of recurrent depression with a seasonal pattern, as described in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5-TR). The condition is better known “seasonal affective disorder (SAD)” or “the winter blues.”
“Is that a real thing?” he asked. “I thought it was all in my head.”
It’s not. Adam and others like him have a very real condition that negatively affects their mood, sleep, appetite, fatigue, motivation, focus, activity level, connection to other people, and sense of interest and pleasure. People with SAD may find that their sleep becomes negatively affected as well, decreasing their energy and sense of well-being. Some experience differences in appetite, eating either more or less, and their weight may change.
Adam becomes quite self-critical and feels guilty for procrastinating, being irritable with his family, and avoiding social connection. Fortunately, Cognitive Behavior Therapy (CBT) has been demonstrated in several randomized controlled trials to effectively treat this disorder, either alone or in combination with light therapy or medication. Research shows that individuals have a greater ability to avoid relapse in the future when CBT is used alone or in combination with other treatments, but not when CBT isn’t part of their treatment plan (Rohan et al., 2022).
Medical and mental health providers with specialized training may prescribe light therapy, which involves daily exposure for 30 to 120 minutes to a box containing 10,000 lux of full-spectrum lights or cool white fluorescent lights, starting in the fall. SAD tends to be triggered as the days grow shorter, and especially around daylight savings time, when people have less exposure to sunlight.
Whether or not you use light therapy or another treatment, it’s important to institute a CBT treatment plan, which is likely to include:
- Spending more time outside in natural sunlight.
- Exercising regularly and eating a healthy diet.
- Using good sleep habits, including limiting time in bed so it’s equivalent to your sleep schedule during the months that you’re not depressed.
- Making specific daily plans to engage in activities that, in the summer, bring you a sense of pleasure, accomplishment, connection to others, purpose, and meaning.
But when you’re depressed, you may feel hopeless or helpless. You’re likely to have negative thoughts that interfere with your ability to engage in these activities. Adam, for example, had many interfering thoughts:
- “Nothing I do seems to help.”
- “I’m too tired to exercise.”
- “If I get together with a friend, I won’t have enough to say.”
- “I can’t control my irritability.”
- “Working on my car won’t help me feel any better.”
- “I’m not motivated to change my diet.”
- “I can’t concentrate well enough to pay the bills.”
Most of these thoughts were largely untrue, though Adam believed all of them. During sessions, I helped him evaluate his thinking. When I asked him, for example, if there was any evidence that some activities actually did help, he thought about it and replied, “Well, I did feel better when I helped my son put together the model car he got for a present. And I did get a sense of accomplishment when I helped my neighbor. He was having a problem with his car.”
As we spoke, Adam recognized that he wasn’t completely helpless in taking control of his depression. Next I helped him formulate a response for the next time he thought, “Nothing I do seems to help.” He came up with this statement: “It’s true that many things aren’t as pleasurable or interesting or give me a sense of accomplishment, but I’ve demonstrated to myself that I definitely do feel better when I decide to do something productive or something that lets me interact with other people.” He wrote this response in a notebook and agreed to read it every morning (and during the day, if needed).
Adam was also willing to test some of his negative thoughts by doing experiments. Although he predicted he’d run out of things to say if he spent some time with a friend, he recognized after a brief discussion that they could watch a football game together and have enough to talk about. He did the experiment and found it significantly improved his mood.
Another difficulty that Adam had was making decisions based on how he was feeling at the moment instead of how he wanted to feel after engaging in an activity. His negative thought, I don’t feel like [taking a shower, exercising, skipping that extra dessert, spending time with family and friends, doing desk work, cleaning up the house, going outside], had been preventing him from many common-sense activities that could make him feel better. Reading a response in his notebook helped: “Focusing on what I feel like doing will keep me depressed. I need to do the experiment of doing [a given activity] to see what happens to my mood.”
Adam was also highly self-critical, blaming himself for being unmotivated and inactive, especially around his family. Following our discussion, he put the following note in his notebook: “It makes sense that I’m having a lot of difficulty getting myself activated. That’s definitely a sign of depression, which is a very real condition. If my brother were depressed and struggling the way I am, I would tell him to recognize that the struggle is understandable. After all, he probably would struggle if he had a bad case of the flu, but it wouldn’t be his fault. And if he listened to his doctor, he’d recognize that the struggle would most likely be temporary. It’s the same for me. It’s not my fault and fortunately, there’s something I can do about it.”
If you suspect that you have the winter blues, you can start to overcome it today by acting as if you’re not depressed and making decisions about how to spend your day to increase your sense of well-being, instead of making the depression worse. If your negative thoughts interfere too much, ask for help from a family member or close friend. And if that doesn’t work, seek out a CBT therapist.
To find a therapist, visit the Psychology Today Therapy Directory.
