When Winter Gets Heavy: Treating Seasonal Affective Disorder
Seasonal affective disorder (SAD), a form of depression (sometimes with episodes mania or hypomania for those with bipolar disorder) is a very common challenge faced by folks living in most of the United States and in Canada.
Depression of all kinds are very common in this part of the world, to be clear. But the darker, colder, and heavier qualities of the autumn and winter months do something interesting to people who are at risk: they highlight dim, cold, and heavy mental qualities that a person might already be feeling. For our friends, neighbors, and loved ones with seasonal affective disorder, the cold months of the year become a reflection of what they already feel. In Ayurvedic terms, we would call those qualities tamasic (in a sense, inert), and kaphaja (earthy). And sometimes, that all becomes a bit too much to ignore.
There are modern scientific principles and theories that put this subject into more complex language. For example, we could discuss the photoperiod hypothesis, which is all about how the shorter daylight window after the fall equinox causes more melatonin than usual to be released (due to the longer nighttime window), and that this can trigger depressive symptoms. Or we could talk about the phase shift hypothesis, which has to do with changes in circadian rhythms during the winter months causing sleep misalignment. Or we could review the science around having certain gene variants and how those increase risk for SAD. But since this is a blog post and not an exhaustive review, I’ll spare you the gritty details.
SAD does occur in people with known depression. But it also often occurs in people with no history of depression.
Of course, the seasonal nature of SAD means that it will improve on its own once we move into spring or summer. But SAD tends not to feel very good (or glad, to lean into the obvious pun), and having SAD can also cause other health issues to worsen. And it also tends to come back the following autumn/winter. So it is best not to leave it alone!
And fortunately, the tools of both Ayurveda and modern medicine, especially brought together, can be very effective for treating this suboptimal situation.
Now, we should be clear that no two cases of SAD are exactly alike. That’s because no two people are exactly alike, and no two people have exactly the same needs. So we’ll cover some of the foundational pieces of treatment here, but be aware that some folks will responds better than others to some of these tools. And other people will need additional tools, too.
Generally, though, treatments for SAD breakdown into these categories:
Lifestyle
Psychotherapy/mental health therapy
Medical (for our purposes, mostly in a non-pharmaceutical sense)
Lifestyle
Lifestyle treatments for SAD run the gamut from optimizing sleep hygiene to using heat therapy (for example, sauna) to choosing therapeutic, antidepressant foods and spices (for example, saffron) to getting enough exercise, using bright light therapy, and much more. Not all of these will be suitable in the same ways to every person and every case. Getting enough exercise is one intervention that can work wonders. But in the interest of being concise, we’ll focus on another lifestyle option that is safe and tends to be at least a bit effective for most folks is light therapy. For simplicity, we’ll focus on that intervention here.
What do we mean by bright light therapy? We mean using something like a sun lamp (at least 10,000 Lux in strength), generally first thing in the morning, for around 10-15 minutes - getting direct exposure from a specially-designed lamp while you are going through your morning routine, for instance.
What does bright light therapy do? The (very) short version is that it activates light receptors in multiple places in the body, and this has many downstream benefits: improvements in mood, focus, and memory; better-regulated sleep patterns; reduced sensitivity to pain; and more.
About 60% of people struggling with SAD respond to bright light therapy, and some experience remission (full improvement) with bright light therapy alone.
Psychotherapy (Mental Health Therapy)
Mental health therapies of multiple kinds are very beneficial additions to the plan of care for SAD. Cognitive behavioral therapy (CBT) is the most studied, but there is a lot of upside to many of them - somatic therapy, Ego States and Internal Family Systems work, clinical hypnosis, and more. You name it, it’s going to have some value. Of course, not everyone will respond the same way to all approaches, so those should be individualized to the specific person. A competent therapist can assist you in doing exactly that.
In Ayurvedic language, these therapies work by strengthening buddhi - the innate discerning intelligence present in each of us. A strong buddhi corrects and directs the flow of vata (air, movement, transport) and concentrates and targets pitta (the power to metabolize food and sensory input). When vata and pitta are regulated, together they can dispel the dark, cold, and heavy qualities of the season.
Also, basically everyone should have a good therapist. And we happen to have a fantastic one on our team! If you haven’t already, I encourage you to meet Jamie!
Medical Treatment
Again, for our purposes here, we’ll define this as anything involving giving medicine. At The Buddha’s Medicine, that is primarily whole herbal medicine with the occasional discerning supplement or two.
Our approach does not discount the fact that there are cases in which antidepressant medications are life savers, by the way. Medications have their place and their role. We are also aware, though, that long-term safety with medications is an open question in a great many cases. Moreover, forcing a change in neurochemistry through medication can also have harmful consequences, particularly in the long-term. That said, we’ll leave a comprehensive discussion on the benefits and downsides of medication for another time.
There are lots of potentially beneficial medicinal herbs that can meet the season and help in the treatment of SAD. Centella asiatica, Bacopa monnieri, and Crocus sativus (saffron) are just a few. Not all will be an optimal fit for everyone and all situations, but they will be beneficial in many different cases and for many people.
Rather than writing a whole essay on each of those, however, I’d like to focus on a supplement with nearly universal benefit for SAD: vitamin D.
Functional or outright vitamin D deficiency is incredibly common in continental North America, and often occurs alongside SAD. And in the vast majority of cases, it is super easy to correct - just by taking the right dose of vitamin D.
What is the right dose of vitamin D? Well, the exact optimal dose will depend on the person. But in most cases, it is at least safe to begin with 5,000 units of vitamin D3 daily. Ideally, this is an oil-based formulation to support absorption, because vitamin D is a vitamin that absorbs into fats.
Replacing vitamin D at the right dose (or somewhere close to it) won’t necessarily treat SAD in all cases; however, it can help prevent it from getting substantially worse. And if you’ve experienced SAD before, you’ll know that it’s best that it not get worse.
Seasonal affective disorder is incredibly common in the darker months of the year, but also very, very treatable. We’ve outlined some of the effective care modalities here, but there are many more to consider on a case-by-case basis.
Professional disclaimer: please do not initiate any herbal or other medicinal interventions without the guidance of a knowledgeable provider.
Dr. Matt Van Auken, MD, MPH
Dr. Matt is an Ayurveda-trained, triple board-certified physician.
