Article
Outsmarting Seasonal Depression: A Psychiatrist's Guide to Protecting Your Mood This Winter
Depression
Depression
- Seasonal depression is driven by daylight, not weakness. Less winter light disrupts your body clock, which knocks on to melatonin and serotonin. Around 2% of people in the UK experience SAD and roughly 20% get the milder winter blues.
- It often looks different to other depression. Instead of insomnia and lost appetite, expect atypical symptoms: sleeping more but waking unrefreshed, low energy, carb cravings and weight gain.
- Winter blues and SAD are not the same thing. Blues come and go. If low mood or loss of interest is there most of the day, most days, for two weeks or more, speak to your GP.
- You can see this one coming, so plan early. Light therapy, seasonal CBT (as effective acutely and more durable over later winters), lifestyle changes, vitamin D, medication and at-home tDCS can be layered together with your doctor's input.
- Think small, not ambitious. Map how your light, activity, sleep, diet, social contact and alcohol shift between summer and winter, then make one realistic change in each area. A predisposition is not a life sentence.
Every year, as the clocks go back and the afternoons draw in, I see the same thing in my practice. Some people feel a quiet dread, immediately feel the dread setting in, because they know from experience that the darker months take something from them. Seasonal depression is real, serious, but it is not inevitable. There is a great deal that you can do to support yourself, and most of it works best when you start early.
This is a guide to the theory and what we know actually happens in your brain as the days get shorter, how to tell ordinary winter blues apart from something that needs treatment, and the practical, proactive steps that can help you go into the season in a stronger position.
How common is seasonal depression?
Seasonal depression, or seasonal affective disorder (SAD), is a form of depression with a seasonal pattern, usually starting in autumn and winter and lifting again in spring [Ref 2]. How common SAD is depends a lot on where you live, with the proportion of the population affected varying from 1% to 10%, depending on what studies you look at and whereabouts in the world you're looking at.
The pattern is driven by daylight. The further you are from the equator, the bigger the swing in daylight hours between summer and winter, and the more common seasonal episodes become [Ref 3]. In the United Kingdom, research suggests around 2% of people experience SAD, while roughly 20% experience the milder winter blues [Ref 3]. So if the winter genuinely pulls your mood down, you are far from alone.
What is happening in your brain during winter?
We do not fully understand every mechanism, but the trigger is clearly linked to the drop in daylight. Reduced light exposure disrupts your circadian rhythm, your internal body clock, and that has knock-on effects on brain chemicals that regulate mood and sleep, including melatonin and serotonin [Ref 2][Ref 3].
"The theory is that there are biological changes that happen related to a disruption in our circadian rhythm in our brains from the change in the daylight, and that has a knock-on effect on melatonin and neurotransmitters, like serotonin, so that they are not regulated in the same way."
There is also a genetic component. People who have seasonal episodes often have a family history of depression or bipolar disorder, and specific genes have been linked to a raised risk [Ref 1][Ref 3]. But a predisposition is not a life sentence. Having had these episodes several times does not mean you are destined to have them forever, and there are many ways to address seasonal depression.
Why winter depression can feel different
Winter depression often looks a little different from depression at other times of year. People might have a slightly different presentation of their symptoms. Instead of the poor sleep and lost appetite people sometimes expect, many experience what we call “atypical symptoms”: sleeping more than usual yet still feeling unrefreshed, low energy and sluggishness, craving carbohydrates, and eating more, often with some weight gain [Ref 3][Ref 2].
"It's almost like, if you imagine someone hibernating in that depressed state, that's what it's like for people. It can be a really, really difficult type of depression to have."
COMMON SIGNS OF WINTER DEPRESSION
Winter blues or seasonal depression? When to seek help
A lot of people get the winter blues: real, sometimes troublesome dips that do not meet the diagnostic threshold for a depressive episode. This group will still benefit from the proactive steps below. A persistent presentation is what causes more concern, where the low mood is there most of the day, most days, and does not pick up even when things around you are going well.
If low mood or loss of interest lasts most of the day, most days, for more than two weeks, that is the signal to speak to your GP or a healthcare professional [Ref 2].
If you are struggling to cope, or you are having thoughts of harming yourself, please do not wait. Contact your GP, call 111, or in an emergency call 999. In the UK you can also call Samaritans free on 116 123, at any time. Reaching out early is a strength, and depression is easier to treat when help comes sooner.
The dread before the season even starts
It’s really natural for people with prior experience of seasonal mood dips to approach the winter season with a degree of anticipatory fear.
If you have experienced an episode of depression that lasts for a whole winter, and you’ve had that a couple of times or even more, that’s a lot of your life that has been significantly impacted. This is a very serious condition, and it can be very distressing for people, disrupting their lives, work, income, and also often affecting family and relationships.
But there is a catch. The more we rehearse the thought that this is coming and it is inevitable, the more our mindset can work against us, adding stress and leaving us less resilient just as the season arrives.
This is why proactive planning matters, and it is also something you can get tailored help with. There are forms of cognitive behavioural therapy designed specifically for seasonal patterns, which target that pre-emptive thinking directly.
The evidence here is encouraging: for example, the effect from CBT for SAD combined with light therapy in the winter, appears to be more durable in the winters that follow, with fewer recurrences the next year [Ref 5].
What actually helps
The good news about seasonal depression is that, unlike a lot of depression, you can often see it coming; giving you a chance to prepare. Many people do best combining more than one strategy, and most of these can be safely used together. Always check with your doctor about what is right for you.
Light therapy
Light therapy, using a light box first thing in the morning, has reasonable evidence behind it and is generally well tolerated [Ref 3]. The practical details matter. It needs to be a certified light box with the right light intensity (measured in lux), used in the morning, consistently, and up close. Timing matters, as used later in the day may push your body clock the wrong way.
Of course, there are some caveats. First, adherence can be hard: sitting still near a light for 30 minutes every morning is not realistic for everyone, especially parents of young children.
Second, while reviews confirm it helps many people, the quality of the underlying evidence has limitations, and we still do not know exactly how well it prevents episodes from starting [Ref 4]. In the UK, light therapy is not usually available on the NHS for this reason [Ref 2].
Talking therapy
CBT tailored to seasonal patterns helps you challenge the negative beliefs about winter and resist the pull to withdraw and shut down. As above, it is as effective as light therapy acutely and tends to hold up better over subsequent winters, which makes it a strong option for anyone who wants lasting tools to draw on rather than a treatment to repeat every year [Ref 5].
Lifestyle, vitamin D and medication
Movement, daylight exposure, sleep routines and attention to diet all support your mood through winter. A lot of people with seasonal mood episodes will benefit from combining several strategies and treatment options with a range of lifestyle interventions.
Some people benefit from vitamin D supplementation, and some will need antidepressant medication, which your doctor can prescribe and supervise [Ref 3][Ref 2]. None of these are mutually exclusive. A well-built winter plan usually layers a few of them together.
At-home brain stimulation
As well as my clinical work as a psychiatrist, I work as UK Medical Director at Flow Neuroscience. The Flow headset is a medical device that people wear to treat depression at home. It uses a treatment called transcranial direct current stimulation (tDCS), to deliver a tiny electrical current to the area of the brain involved in mood and motivation that is less active when people are depressed [Ref 7]. Because it is not medication based, it is well tolerated with few side effects, and it can be used on its own or alongside other treatments.
The Flow headset very gently encourages activity to be restored in an area of the brain called the dorsolateral pre-frontal cortex (DLPFC). This helps to relieve symptoms of depression for people.
Flow
Could it be right for you?
Find out in 2 minutes with our quiz.
Seasonal depression or SAD are forms of depression, so for some people Flow becomes part of their winter plan. In Flow's real-world data, 77% of users see their depression score improve within about three weeks, and in a robust clinical trial 57% of people with major depressive disorder were in full remission after ten weeks [Ref 6]. Flow works across all levels of depression, from mild to severe. As with any treatment for depression, it should be discussed with and supervised by your doctor.
Your proactive winter toolkit
Here is the approach I recommend to my own patients. Rather than waiting to see how you feel, sit down before the season bites and make an honest inventory of how your life looks in summer versus winter. For most of us, me included, they are very different.
Then, for each area where winter pulls you in the wrong direction, decide on one small, doable change. The mistake people make is aiming too big.
"When people are depressed or struggling, they don't want big things, because it's too overwhelming. I do encourage people to think really small."
The point is not to overhaul your life. It is to make small changes that are realistic and that you can keep up. Could you move your desk nearer a window for more daylight? Could you have your morning coffee outside, (with your coat on!), for ten minutes? Small and consistent always beats ambitious and abandoned.
One area worth singling out is screens. In winter we tend to stay in and scroll more, and blue light in the evening undoes a lot of the good work of protecting your body clock. You do not have to be perfect about it.
Try night-time filters, app time limits, or simply removing a distracting app for a week as a reset. Different things work for different people, so treat it as an experiment and keep what helps.
Closing thoughts on Seasonal Depression
The real takeaway is that it's not inevitable that you will get depressed. There are lots of things within your gift. Take care of your future self and make sure you're proactive.
If symptoms develop, please reach out for help at an early stage. It's often much easier to treat depression if people seek support when they first recognise a problem is developing and recovery tends to be quicker with early action.
Make a plan before the season starts. Talk to your healthcare professional in advance, and do not wait until you are in the thick of it. As a psychiatrist, I am always glad when someone checks in early and says they are a bit worried, because that is when we can step in and make the biggest difference. Winter depression does not have to take the season from you.
Flow is a medical device approved for the treatment of depression. Approved treatments for depression should be discussed with and supervised by your doctor.
References
- [1] Live Happy Now podcast, episode 543: "Outsmarting Seasonal Depression with Dr Hannah Nearney". Source of all Dr Hannah Nearney quotes. https://www.livehappy.com (episode 543)
- [2] NHS, Seasonal affective disorder (SAD): symptoms, causes (daylight, melatonin, serotonin and circadian rhythm) and treatments, including why light therapy is not usually available on the NHS. https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/
- [3] Melrose (2015), Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches, Depression Research and Treatment: UK prevalence (about 2% SAD, 20% winter blues), the latitude effect, atypical symptoms, circadian and neurotransmitter mechanisms, morning light timing, and CBT as effective as light therapy. https://pmc.ncbi.nlm.nih.gov/articles/PMC4673349/
- [4] Nussbaumer-Streit et al. (2019), Light therapy for preventing seasonal affective disorder, Cochrane Database of Systematic Reviews: evidence for prevention rated very low quality, so conclusions are limited. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011269.pub3/full
- [5] Rohan et al. (2016), Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder, American Journal of Psychiatry: CBT-SAD as effective acutely and more durable, with second-winter recurrence of 27.3% versus 45.6% and remission of 68.3% versus 44.5%. https://psychiatryonline.org/doi/10.1176/appi.ajp.2015.15060773
- [6] Flow Neuroscience, Evidence: 77% see their depression score improve (real-world, n=14,383), 57% in remission after 10 weeks, about twice as likely to reach remission versus a control group, and 95% report no side effects. https://www.flowneuroscience.com/evidence/
- [7] Flow Neuroscience, How It Works: tDCS delivers a gentle electrical current to the dorsolateral prefrontal cortex (DLPFC). https://www.flowneuroscience.com/how-it-works/