As the pandemic marches on, and our work and play remain restricted, Seasonal Affective Disorder, or SAD, is likely darkening the outlook for some of us within the University of Iowa community.

SAD was first characterized in 1984 by Dr. Norman Rosenthal, a professor of psychiatry at Georgetown University Medical School, after he reviewed the attitudes of people in different latitudes to see the effects of light on mood. When he compared a group of Floridians to a cohort of East Coasters in seasonal mood states, he noticed that the members of the warmer, sunnier group were less depressed (Rosenthal, 1984). While many people say that they prefer the long, bright days of summer to the short, sunless days of winter, when do the “winter blues” become SAD, a mental health concern for which there are effective treatments.

SAD is a form of depression that is considered cyclical, presenting in the fall and remitting by spring. It is found in 5% to 10% of the U.S. population and effects women at four times the rate of men, with onset mostly in adulthood.

Symptoms include changes in mood, outlook, and physiology over at least a two-week period. Central to the diagnosis of SAD is exposure to sunlight. Our sleep-wake cycle, or circadian cycle, is roughly a 24-hour internal clock run by contact with light. Important hormones such as serotonin (mood regulation) and melatonin (the sleep hormone) fluctuate through the day informing our bodies when to rise, eat, and sleep. Rosenthal also notes stress and biological predisposition, in addition to environmental light can cause SAD (Rosenthal, 2012). Given how, in Iowa, we spend roughly 40% of the year in seasons with fewer daylight than dark hours, diagnosing and treating SAD is important to our well-being.

So, what can be done to improve the symptoms of SAD? Here are five ways to manage symptoms:

1. Light exposure: While we may know that getting more light helps SAD, exactly how is the question. While it would be lovely to have weekly trips to warmer climes, doing so isn’t realistic for most. Instead, daily light therapy is recommended. The Mayo Clinic outlines practical recommendations here. Consistency in regimen is important, starting in early fall when natural light starts to diminish, and ceasing treatment as the days lengthen. UI Student Wellness in collaboration with University Counseling Service (UCS) and the Undergraduate Student Government (USG), has light boxes available at no charge to UI students. More information can be found at https://studentwellness.uiowa.edu/programs/light-therapy.  
2. Talk therapy or cognitive behavioral therapy: Therapy can be helpful in developing emotional and behavioral strategies to cope with the symptoms of SAD. Research conducted by Kelly Rohan, PhD, demonstrated that teaching people “to challenge negative thoughts about dark winter months and to resist behaviors like social isolation” is equally effective to the use of daily light therapy (AJ of Psychiatry 11.15). Talk therapy resources on campus can be found at here.
3. Stress management: Setting realistic goals about projects through the winter is recommended. In addition, managing stress by getting a handle on our thoughts can be helpful. Employees may find a number of resources on mindfulness to help manage stress at https://hr.uiowa.edu/livewell/mindfulness and https://hr.uiowa.edu/well-being/employee-assistance-program/campus-support-and-critical-incident-response/taking-care.
4. Diet and exercise: Rosenthal reports people with SAD often crave sweets and starches. In line with general recommendations for good dietary health, eating protein, vegetables, and complex carbohydrates will prevent energetic peaks and valleys that accompany the consumption of sweets and starches. He recommends daily exercise in any form, but walks early in the day and outdoors, if possible. 
5. Medication: People with significant impairment in their work or personal life due to symptoms of SAD may need to consider medication. This option, as with the treatment of any mental health condition, is determined through conversation and consultation with your doctor.  

What can you do if you feel blue or more depressed this winter? First and foremost, consult your physician for an assessment and to learn what might be helpful for you. For additional information or resources, your UI EAP (free counseling for UI employees) is here for you and can be contacted at 335-2085 or eaphelp@uiowa.edu.  

Resources

• Seasonal Affective Disorder: Steven D Targum, MD and Norman Rosenthal, MD (Psychiatry (Edgmont) 2008, May; 5 (5): 31-33.
• Seasonal Affective Disorder: Kathryn A. Roecklein and Kelly Rohan, Phd. Psychiatry (Edgmont). 2005 Jan; 2(1): 20-26. 
• Talk Outshines Light in Preventing Return of Winter Blues. UVM Today. 11.5.2015

Websites

• Seasonal Affective Disorder. Norman Rosenthal, MD. 
• Mayo Clinic Season Affective Disorder and Light Therapy 
• Mental Health America 
• American Psychiatric Association 
• Medline 
• Winter Blues: Everything You Need to Know to Beat SAD, Norman Rosenthal (Guilford 2006)