Getting through winter without feeling SAD

Serotonin levels, exercise and light all play a part in Seasonal Affective Disorder, which is very treatable, a psychiatrist says.

The leaves are falling off the trees. Days are getting shorter. For many, fall’s transformation into winter feels like a descent.

In the Pacific Northwest where rainy darkness defines the season, Seasonal Affective Disorder (SAD) is common.

SAD is essentially a depressive disorder that follows a seasonal pattern. Episodes can occur in fall and winter months and then usually end in spring, said Dr. Heidi Combs, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. Combs treats inpatients at Harborview Medical Center, and many find winter difficult.

“During the winter months, people typically spend more time indoors and it can feel a bit like you are hibernating” she said.

Deciding to spend time indoors isn’t itself a problem. But if you are withdrawing from pleasurable activities or are experiencing other symptoms that negatively affect your life, it may be time to seek help.  And SAD is very treatable, Combs said.

Common SAD symptoms include a low mood, reduced interest,  fatigue, and reduced concentration. Combs said oversleeping also is more common, as well as an increased appetite, especially for carbohydrates.

SAD can be treated with light therapy, raising serotonin levels in the brain, cognitive behavioral therapy, and exercise, she said.

A person battling SAD may experience improvement with one, or all of these strategies, depending on the severity of symptoms.

The first step for many people is to seek light.

“In the winter months, with shorter days, you just may not be able to get the light you need,” Combs said.

She prescribes a light box for many patients. It needs to emit at least 10,000 lumens, she said, adding that people should not buy a device that doesn’t list its lumen level. The devices can be found for $30-$45.

Combs recommends people use the light box, with eyes open, for 30-45 minutes each morning for two weeks. The amount of light for treatment is beyond what you would get from daily light exposure, she noted.  Some may need to continue the light therapy all winter.

Light is influential because mood is connected to circadian rhythms, which correlate with light. Light also helps produce vitamin D, which helps our mood. Light also controls molecules in the brain that help maintain normal serotonin levels.

Combs said studies show that a person’s level of serotonin is cyclical, with lowest levels generally occurring in winter and spring. Studies have also found that people with SAD may have serotonin dysregulation. Serotonin is a chemical produced by nerve cells and it affects every part of your body. In the brain, serotonin stabilizes our mood, feelings of well-being, and happiness. It also stimulates the parts of the brain that control sleep and waking. Antidepressants known as selective serotonin re-uptake inhibitors, or SSRIs, help increase serotonin in the brain.

Cognitive behavioral therapy can help people replace negative thoughts with positive ones. Trying to think about things to look forward to – fires, feeling cozy, friends, and hobbies – can supplant negative thoughts about winter.

And exercise is a big contributor to boosting mood, Combs said.

“Anything you can do to get regular exercise helps with anxiety and depression,” she said. “It’s really healthy for mental health.”

[Download accompanying video soundbites and b-roll.]

-- Bobbi Nodell,, 206.543.7129

For details about UW Medicine, please visit

Tags:psychiatry & behavioral health

UW Medicine