Now is the time of year to talk about seasonal affective disorder. Craig Sawchuk is a clinical psychologist and co-chair of Mayo Clinic's Division of Integrated Behavioral Health.

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Jill Riley: We've heard of seasonal affective disorder, but what is it?

Craig Sawchuk: We think of seasonal affective disorder as a recurrent mood disorder. What's unique about seasonal affective disorder is: a mood reliably changes during a certain time of the year. Typically when we think of winter depression, or typical seasonal affective disorder, we think of our mood just gradually declining around fall, late fall or early winter months, and then that mood just naturally improving right around late spring, early summer, and that the changes in our mood really are tied in with the changes in the season rather than other stressors or other things going on.

How common is this? It sounds like just about anyone could suffer from it.

Oh, very much so. We think of standard winter blues — you know, where we all start to feel a little more sluggish and our mood kind of bogs down a little bit. Anywhere between 15-20% of us will report that, but it may not necessarily get in the way of our day-to-day functioning. For people that experience the severity and the weight of those symptoms, to the point where it does get in the way of their functioning, that could be anywhere between 1-3% of the population. Lucky us, we're in Minnesota, so we're in more the northern hemisphere, so those rates actually tend to go up; but if you actually travel southward during the winter months, those rates of seasonal depression actually go down.

When does it go beyond standard winter blues? How do you know if you're suffering from [seasonal affective disorder]?

One of the unique features of seasonal depression is, it creates symptoms that we think of almost like a hibernation syndrome. Our mood may start to feel more blah — not necessarily depressed, but a lot more flat, more blah. Then you tend to see just a lot of fatigue and wanting to sleep more; carbohydrate cravings, loading, weight gain. So you just really slow down. Where it really gets to the point where it's a clinical problem is when it does start to get in the way of day-to-day activities. So it could lead to work absenteeism, not taking care of things around the home, a lot more social avoidance or withdrawal. When it really starts to get in the way of our functioning on a day-to-day basis, then that's when it becomes a problem.

I would think that there are some people listening right now that are thinking, ooh, that's maybe where I'm going. What course of action should someone take if they're kind of relating to what you're saying right now, where it's like, yeah, this might be going on a little more than standard winter blues but really that full-blown seasonal affective disorder?

We have three options. The first pass is some of these low-intensity things that all of us can do, and that honestly are helpful to us really at any point in our lives: these are more just health behavior changes. Remember, one of the big things about seasonal depression is it tries to get us to slow down and get to sleep and hibernate, so make sure we have a reliable mornings routine. Getting up early, going to bed at the same time every evening, kind of avoiding the naps. Exercise, eating healthy, always helpful for us — and also staying socially connected, which can be a little bit more challenging these days during the pandemic. These are some of the low-intensity habit changes we can make. Even getting outside for a little bit every day can be helpful.

If we need to kick it up a notch, then we want to think about using light therapy. Light therapy can be a great intervention. What we encourage people to do is first off, get a light box that's 10,000 lux in intensity, and then we start using it right around that time of year when our mood starts to reliably go down, that we use that light box for about 20 minutes, maybe a half hour within the first hour of waking up in the morning. That's really important that we really start to use it right at the start of the day. You want to keep that light box about an arm's length away from you, you want to keep your eyes open. You don't have to stare at the light, but keep your eyes open and doing other things. Keep using that throughout the entire winter, until the time where your mood starts to reliably improve, so, again, maybe in that spring, summertime. So that's kind of that next level. Light boxes are really well-tolerated, too, so that's a great low-intensity intervention.

The third option is, if we need to step it up from there, that's where I would encourage people to speak with their primary care provider, family medicine provider, and consider additional treatment options. A couple of treatment options that can also be helpful [are] one, referring to a counselor or therapist who has expertise in cognitive behavioral therapy. This is a skill-building approach that can really help people work on changing behaviors and working on their thinking, that can help them actually reduce those symptoms of seasonal depression. Then another potential option is being prescribed an antidepressant medication. That can actually be helpful as well.

Does vitamin D play into any of this? I remember talking with my primary care physician and having my vitamin D level checked, and it was way low.

Yeah, welcome to the northern hemisphere! We do know that vitamin D gets depleted among folks with lower light exposure, and that's, again, what happens this time of year. Interestingly enough, when we've looked trials of vitamin D supplementation, we actually don't usually see that that has clinically significant effects on treating seasonal depression. It's one of those types of interventions that falls in potentially that wellness category. It probably doesn't hurt to give it a try, because vitamin D also influences other systems in our body, but I think for people that are experiencing clinically significant symptoms, we don't just want to hang our hat on a vitamin D supplement. That could be part of a larger package, and especially a larger package of health behavior changes, like light box therapy, that we know are more evidence-based.

It sounds like some of those self care habits are effective: the exercise, the nutrition, even vitamins. At first when you said "light therapy," I thought, oh, a little light therapy! But actually light therapy...but then a little light therapy after that, maybe another way to intervene. I wonder, as we wrap up here talking about seasonal affective disorder, also known as s.a.d. — because of course it is — is there anything else people should be watching out for? We're at that time of year where we're heading into those cold winter weeks here in Minnesota.

Exactly. As we get into the colder winter weeks, it gets harder sometimes to justify getting outside, so it's normal for most of us to kind of stay indoors, but we're all going to hope for a milder winter, because we know that actually being able to get outside, say, on a cloudy day, the light intensity is around 3,000 lux. If it's actually a clear blue sky day where the sun is coming down but it's really cold outside, that's actually 50,000 lux. So even being able to get outside on those really cold days, even if it's just for a little bit of time, maybe puttering around in your yard, that would be great.

I think it's really, really important that we get up and get going first thing in the morning. Have that normal routine, watch that urge to sleep in, get those lights on, get a shower, get dressed: all of these behaviors that signal to the brain, oh, it's time to wake up and get going. Even just turning on the lights and opening up the blinds can be helpful, but all those other behaviors that are part of our normal wake-up routine will actually be very helpful with helping to wake up the brain and get going first thing in the morning.

You mentioned connection, and that is difficult during this time with the global pandemic, but I would think that isolation would just amplify some of this stuff.

Learning how to be creative with that is a huge thing, because this is actually a way that we go about treating seasonal depression, and depression in general, is really fostering social connections and making sure that we have a routine and goals and setup for social accountability. In order to treat the pandemic, we're really strongly encouraging people to not congregate and be socially distant, so doing things virtually remains extremely important.

I think this is where we are seeing rates, clinically, of more people coming in with seasonal depression complaints. Part of it maybe is that people have been operating at a deficit, heading in from what they have been dealing with with the pandemic: that we've been in probably a lower gear physically, maybe our eating habits have been thrown off. A lot of our normal daily rhythms and routines such as going in to work, a lot of those have been disrupted well before the season changes occurred. So we've been in probably a little bit more of a deficit mode, so that may be leading to some amplification in some of the cases that we've been seeing at this juncture.