Seasonal Affective Disorder: Responding to The Atlantic

A recent article in The Atlantic, titled “The Surprising Truth About Seasonal Depression”, has generated a lot of conversation in the therapeutic community. The article reexamines seasonal affective disorder (SAD) and whether it is true that the reduced light and cold temperatures actually has a depressogenic effect on the population. It is a reasonable question, but it causes many people to feel that their experience is dismissed. Many people do feel down winter after winter, only to experience their mood reliably return to a more positive state when the season becomes warmer and the sun comes out. In fact, the person who first described the condition, Norman Rosenthal, noticed that when he moved to the United States from his native South Africa he became much more lethargic in the winter than in warmer months.

Two Schools of Thought

Therapists discussing seasonal affective disorder tend to fall into two camps. On the one hand, some believe that the physiological effects of the winter months (i.e., less light, less vitamin D, exposure to cold weather) are direct causes of SAD. On the other hand are those that argue that SAD is a purely mental phenomena, occurring as a result of associations we have to the cold or darkness.

Both of these positions are incomplete. While it appears to be true that low levels of vitamin D are associated with depression[1] and those most susceptible to SAD live furthest from the equator[2] where vitamin D synthesis is more difficult,[3] these biological and geographical factors are present for many who are not depressed. Not everyone who longs to ski or play hockey each year, for instance, has a biological adaptation that renders them immune to the effects of low vitamin D. Similarly, although it is obviously true that everyone has their own relationship to the winter and it is important to not lose sight of people’s individuality when considering how they react to the time of year, it is not enough to claim that their specific history explains SAD. Claims that winter can remind people of painful periods in their life – death in the winter, a life-changing skiing accident – are facile because they do not explain why people do not have a similar affective aversion to summer where such events also occur.

What winter weather really does is effectively work with depression by manufacturing similar symptoms, and strengthening its self-sustaining quality.

Winter Lends Depression a Helping Hand

Depression (and anxiety) have a very familiar self-sustaining quality. Often times, when one is depressed, one feels less capable of and interested in engaging with others and begins to isolate. Sometimes this means not going to class or work, skipping the gym, and missing events that would otherwise make you happy. In the effort to feel some degree of satisfaction, people will order out more often, eat excess junk-food, and drink alcohol more. All of these behaviors end up making people feel worse… and the winter facilitates these behaviors.

Who among us has not wanted to stay in and cancel plans instead of taking the train across town in the blistering cold? Who hasn’t ordered more meals in the winter instead of braving the weather to walk to a favorite neighborhood restaurant? Winter makes us all behave as if we were depressed, and makes those who are depressed more likely to fall into patterns that resemble previous depressive episodes.

It is easy to confuse this point – behaviors that we engage in in the winter are also often behaviors that conduce to depression and so we often assume that it is winter that is the cause of the depression when really it is ways we act during the winter. Thus, although there is evidence that light therapies can be effective (though some meta-analyses question this),[4] physicians expert in SAD suggest becoming more active than one would normally be during the winter:[5] Walking, meditation, exercise, yoga, travel, as well as eating well are all considered to be elements in the treatment of seasonal affective disorder, and all are things that tend to fall by the wayside when one is trapped indoors for months.

[1] Anglin, R., Samaan, Z., Walter, S., McDonald, S. (2013). Vitamin D deficiency and depression in adults: Systematic review anda meta-analysis. British Journal of Psychiatry, 202(2), 100-107.

[2] Rosen, L. N., Targum, S. D., Terman, M., et al. (1990). Prevalence of seasonal affective disorder at four latitudes. Psychiatry Research, 31(2), 131–144.

[3] Webb, A. R., Kline, L., Holick M. F. (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: Exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. The Journal of Clinical Endocrinology & Metabolism, 67(2), 373–378.

[4] Pjerk, E., Friedrich, M.-E., Cambioli, L., Dold, M., Jäger, F., Komorowski, A., Lanzberger, R., …. Winkler, D. (2020). The efficacy of light therapy in the treatment of seasonal affective disorder: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 89, 17-24.

[5] Rosenthal, N. E. (ND). What is seasonal affective disorder: Answers from the doctor who first described the condition. Retrieved from: https://www.normanrosenthal.com/about/research/seasonal-affective-disorder/