Daily light therapy from a tabletop light box and walks in bright winter sunshine lead the way in relieving seasonal affective disorder—even during the COVID-19 pandemic.
Editor’s note: This article was updated from an earlier version posted in November 2020.
The dark days of winter.
It’s hard not to notice the sun rising later and setting earlier each day. As darkness takes over through the fall and winter months, it may take over your mood as well—especially as the COVID-19 pandemic continues to rage. If you’re someone who loses energy and begins to feel tired and depressed during the winter months only, you may have seasonal affective disorder (SAD). But that’s not necessarily a condition you have to worry about or accept until spring arrives.
“There are normal mood changes that occur during different seasons,” says Dr. John Lauriello who heads Jefferson’s Psychiatry & Human Behavior department. “It is very normal for someone not to feel as energetic, or maybe even as happy, during the winter months, as they might in the spring and the summer. Part of that has to do with the weather, peoples’ ability to get out of the house—which is further complicated by the pandemic—and, often, their exposure to sunlight. It’s also a time when people get sick more, with things like the flu. And as winter becomes more difficult, they become more clinically depressed.”
SAD vs. ‘Winter Blues’
It’s important to realize that some mood changes aren’t diagnosable as depression, explains Dr. Lauriello. You might feel “cooped up” during the winter, more fatigued, and less sociable; the “winter blues” refers to a milder shift in mood. When these things reach the extent where they permeate your life and your ability to function, it could be indicative of depression.
Common symptoms of SAD may include disinterest in activities once previously enjoyed; irritability; isolation; feelings of worthlessness; disrupted sleep habits; weight gain and more. However, SAD can look different every year, with fewer, more, or entirely different symptoms, adds Dr. Lauriello.
[Editor’s Note: Seasonal affective disorder, like any clinical depression, may give rise to suicidal ideations. If you experience new suicidal urges or thoughts, you should seek help immediately through your mental or behavioral health provider or the National Suicide Prevention Hotline (1-800-273-8255).]
Not All Depression Is Seasonal
“For many patients,” emphasizes Dr. Lauriello, “depression is not merely seasonal. Some people may think it is, but actually, if they really chart it out, their depression occurs at random times throughout the year. During fall and winter, light therapy cannot completely replace antidepressant treatment, although it can certainly be of added value.
“Simply charting your mood on a paper or electronic calendar is a good way to see how it is fluctuating during the year. Sometimes your friends and family can tell you whether your mood is seasonal or more randomly distributed throughout the year.”
Let There Be Light
For those patients who clearly have a seasonality to their depression, driven by less exposure to sunlight, light therapy can make a huge difference.
Light therapy is delivered by a tabletop light box (or light therapy lamp). Light from one of these boxes is not the same as that delivered by everyday lamps and overhead lights – it’s much more intense.
“The amount of illuminance provided by a normal light bulb is about 80 lumens, or lux,” says Dr. Lauriello. “An effective light therapy box or lamp offers 10,000 lux. This is really important because, although you should first consult with your doctor, you can self-treat your SAD to some extent with a light box, but you have to make sure you buy the right one. The critical feature to look for is whether it says ‘10,000 lux’ on the box it comes in or in the product description. A 5,000 lux lam could help, but that isn’t really the standard of care for treatment of SAD. “
Light therapy is easy to do. Place your light box facing you on a table or desk, and stay in front of it for 30 minutes a day, every day, until late March/early April. You can do it while eating breakfast. For it to be effective, you must keep your eyes open—it’s not like sunbathing. For it to have the greatest impact on SAD, light therapy should ideally be started immediately after Labor Day, although it can still be helpful this time of year. But remember, after storing away your light box, come spring, you need to get it back out in early September and start using it again. For those unable to afford or otherwise have daily use of a light box, Dr. Lauriello suggests walking or other exercise outdoors in the sunshine daily for 30 minutes—which is also recommended even for those who do have light box access.
Walk in the Sunshine
Along with light therapy and supervised psychopharmacology, depression, whether seasonal or year-round, can also be helped by what Dr. Lauriello calls “a good lifestyle portfolio”—especially walking or participating in other exercises, in the sun.
“Even in New York City last spring, during the height of the pandemic, people were still going out walking where transmission was low but sunlight was great,” recalls Dr. Lauriello. “That was probably one of the smartest things they could do to ease their depression. Benefits-wise, sunshine and outdoor exercise go hand-in-hand—even in the winter. Hibernating in your house because the weather’s cold instead of going out for walks can adversely affect your mood.”
Another helpful lifestyle change is a healthier diet. Don’t worry, that doesn’t just mean more fruits and vegetables. A little dark chocolate and red wine can actually be helpful in moderation.
A consistent sleep regimen is also important. Identify the bedtime that’s right for you—but not too late—and try to stick to that same time, and the same amount of sleep, every night. That also means not having a job that requires extreme or frequent variations in schedule, or frequent, jetlag-inducing travel.
COVID-19: A Double-Edged Sword
You might assume that the COVID-19 pandemic has only aggravated patients’ SAD or ongoing clinical depression. The fact is, however, that it probably doesn’t impact everyone the same way psychologically.
“We don’t really know everything we need to know about COVID,” admits Dr. Lauriello. “We’re really dealing with an entity that’s fairly new to us. What we do know is that isolation and quarantining are a dual-edge sword for patients. Some have a hard time under these conditions – for example, major disruption in their schooling can be very troubling to some kids, teens and young adults. But other patients actually do better, partly because they may suffer from anxiety and social issues that now are being normalized because they can take classes and work from home.”
The saying, “We’re all in this together,” is something frequently stated with regard to COVID, and another benefit of walking can be the realization that that’s true.
“I’ve actually gotten to know my neighbors better because of the pandemic than I would have otherwise because we’re all out there strolling around the neighborhood or walking our dogs, saying hello and briefly chatting from a safe distance,” observes Dr. Lauriello. “It helps us to not feel so alone, that we’re not the only ones having a problem. So I do think there can be some benefit from a shared crisis.
“Of course, there are a lot of negatives too. Isolation can be really devastating for people who really need the social interactions. It can be really quite devastating for them. So is disruption from being able to hold or attend important rituals like marriages and funerals.”
“When it comes to SAD,” reemphasizes Dr. Lauriello, “you really have to be thinking about getting light—actual sunlight, in combination with light exercise, as well as a daily half-hour in front of a light box, if possible. This puts you in the best possible position to avoid depression. It may not prove one hundred percent effective, but it improves your chances dramatically.”