By Amanda Edwards Stewart, Ph.D., ABPP
Oct. 21, 2021

U.S. Army photo by John Wayne Liston

I live in Seattle, Washington, a city known for its rain and overcast days. In 2020, Seattle only had 71 days with full sun, and in the same year, we had 41 inches of rain. To put this in the context of typical rainfall, the U.S. had an average of 30 inches of rain in 2020. When I look out my window between September and May, I usually see a gray sky with rain ranging from a fine mist to torrential downpour.

Much of the northern U.S. shares my fate, living in the same temperate climate. For some individuals, the seemingly endless gray of winter can affect their mood, especially those who suffer from major depressive disorder. Depression symptoms include a low mood or loss of interest in all activities lasting for at least two weeks, nearly every day.

Depressed individuals often experience:

• Weight loss or gain
• Sleeping too much or too little
• Loss of energy
• Feeling worthless
• Problems concentrating
• Recurring thoughts of death

Major depression is a serious issue resulting in poor quality of life, decreased productivity and could lead to thoughts of suicide.¹ An estimated 16 million American adults suffer from major depression, and one study found active duty soldiers have five times higher 30-day prevalence of depression than a comparative civilian group.² The World Health Organization identified major depression as one of the leading causes of disability.³ Depression is often underdiagnosed; only a third of individuals with severe depressive symptoms were treated by mental health professionals in the last year.

For those suffering from depression with seasonal patterns (formerly known as seasonal affective disorder), this shift in mood starts in the fall and ends in spring. These episodes of mood change are present for at least two years with no non-seasonal depressive episodes during other seasons.⁵ Research has not found a strong relationship between population rates of depression based on the seasons. However, seasonal depression is still a severe issue for some individuals.

There are effective treatments for depression. For those with major depression with seasonal patterns, there is some evidence for the effectiveness of light therapy (also known as bright light therapy or phototherapy). This treatment involves exposure to bright artificial light (2,500 to 10,000 lux) using a fluorescent lightbox once a day for 30 to 60 minutes, prescribed by a professional.⁷ There are also other effective treatments for depression regardless of its relationship with the seasons. These treatments include acceptance and commitment, behavioral activation, cognitive-behavioral, interpersonal, mindfulness-based cognitive, and problem-solving therapies, as well as medications such as bupropion.

To some extent, seasonal sadness affects everyone, but many people find ways of coping with these changes. For example, as soon as I sense fall coming, which involves a certain crispness to the air where I smell the decay of leaves and feel the nights grow colder, I start to plan what soups I will make and go on bread baking binges. Healthy coping strategies that could benefit everyone includes finding something you enjoy and relating it to this change of season. For those struggling with major depression with seasonal patterns, reach out to a mental health provider today. You don't have to struggle with depression alone.

References

1. Department of Veterans Affairs and Department of Defense (VA/DOD). (2016). VA/DOD clinical practice guideline for the management of major depressive disorder. Retrieved Oct. 6, 2021, from https://www.healthquality.va.gov/guidelines/MH/mdd/
2. Kessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullerton, C. S., Hwang, I., Naifeh, J. A., Nock, M. K., Petukhova, M., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., Ursano, R. J., & Army STARRS Collaborators (2014). Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA psychiatry, 71(5), 504–513. https://doi.org/10.1001/jamapsychiatry.2014.28
3. World Health Organization (WHO). (2017). Depression and other common mental disorders: Global health estimates. Retrieved on October 6, 2021, from https://www.who.int/publications/i/item/depression-global-health-estimates
4. Pratt, L., & Brody, D. (2014, December). Depression in the U.S. household population, 2009-2012. https://www.cdc.gov/nchs/data/databriefs/db172.pdf
5. American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders fifth edition. American Psychiatric Association.
6. Overland, S., Woicik, W., Sikora, L., Whittaker, K., Heli, H., Skjelkvåle, F. S., Sivertsen, B., & Colman, I. (2020). Seasonality and symptom of depression: A systematic review of the literature. Epidemiology and Psychiatric Science, 29(e31), 1-15. https://doi.org/10.1017/S2045796019000209
7. Psychological Health Center of Excellence (PHCoE). (2021). Light therapy for major depressive disorder. Retrieved on October 6, 2021, from https://health.mil/Reference-Center/Publications/2021/04/27/PHCoE-Evidence-Brief-Light-Therapy-for-Major-Depressive-Disorder-508