Latest Treatments for SAD From Dr. Norman Rosenthal

M.A., Health Writer

You've probably heard of seasonal affective disorder or SAD, a type of depression motivated by the seasons. As the days get shorter and darker in fall and winter, SAD starts to kick in for approximately five percent of the U.S. population.

A qualified health professional must diagnose SAD: Please don't do it yourself, even if you think you've got winter blues. A SAD diagnosis also requires exhibiting criteria for major depression, along with specific symptoms, for at least two years.

The National Institute of Mental Health says you may have winter SAD if you have low energy, want to sleep a lot, crave carbohydrates, overeat and gain weight, and want to be alone or hibernate.

He wrote the book on SAD

An internationally-recognized expert on SAD, psychiatrist Normal E. Rosenthal, M.B.B. Ch. (the South African equivalent of M.D.), is currently clinical professor of psychiatry at Georgetown University School of Medicine. He first diagnosed and named SAD and was the first to use light therapy to treat it. He also has SAD himself.

Dr. Rosenthal has determined that:

  • SAD runs in families
  • Women between age 20 and 40 are twice as likely as men to have SAD

SAD causes include light deprivation, especially after a change in latitude, and stress.

Treatments may include, in addition to light therapy:

  • Psychotherapy
  • Healthy diet and regular exercise
  • Antidepressant medication
  • Reducing stress
  • Meditation

Finally, if it's possible, you should try a change of scene, e.g., taking winter vacations or even relocating to a sunnier climate.

Surprising new facts about SAD

Health Central reached Dr. Rosenthal by phone to ask about recent SAD research while he was presenting at a conference in London, England. Here are some takeaways from that conversation:

Try to stop it before it starts

A July 2017 study in BMC Psychiatry looked at preventive treatments, which Dr. Rosenthal supports.

"Put a strict management plan in place," he says. "Purchase a light box and start light therapy early, but remember it’s often used in conjunction with other treatments. Get your exercise program lined up, including people to support you — a friend or trainer — and make a schedule to stick to."

Possible link between vegetarianism and SAD

In 2016 in Neuropsychobiology, researchers presented the results of a study that compared Finnish and Dutch SAD patients who were vegetarians.

"The percentage of SAD patients among Finnish vegetarians was four times higher than in the normal population," the researchers say. "The percentage of vegetarians among the SAD patients in a Dutch outpatient clinic was three times higher than in the normal population. In the Dutch population, the seasonal loss of energy, in particular, is related to vegetarianism."

"A higher-carbohydrate diet may not give you enough protein," Dr. Rosenthal says. "Plus carbohydrates can make you hungrier, so you'd eat more. I recommend cutting down on carbohydrates and focusing on protein."

Sunshine duration is linked to SAD

In a study published in Psychiatry Research, authors suggested that "the variable sunshine duration, for both the current and previous week, and global radiation for the previous week, are significantly linked to SAD symptoms."

What does that mean exactly?

"It makes incredibly good sense to focus on sunshine duration, because limited hours of sunshine are the biggest contributors to SAD. Early mornings are important to SAD — getting more light exposure during the day. That's why, often during January and February, people feel worse even though days are getting longer. Duration of sunshine can also be shorter because of cloud cover."

Newest recommendations about SAD

Tipping his hat to the findings of another renowned SAD specialist, Kelly Rohan, Ph.D., of The University of Vermont, Dr. Rosenthal offers these additional suggestions:

1. Educate yourself about SAD. Knowledge is power and the more you know about the condition, the more you can consider how your thoughts and activities contribute to symptoms.

Do the harder thing. If you can't bear to get out of bed in the morning, put your bedside light on a timer so it gets up before you do. Then open your eyes and let the light in. Now get up.

2. Eat well, move well. If you're tempted to veg out on the couch watching old movies and eating candy, turn off the TV and gift that chocolate to someone. Eat smart and remember to eat enough protein. Get out of that dark room, call a friend and go for a walk. Accomplishing that can make you feel great.

3. Like your awesome self. Correct erroneous thought patterns of "I'm no good." Challenge your distorted thinking so those thoughts don't cluster to constitute an ongoing and incorrect core belief, i.e., "Nobody likes me here." No one is liked by everybody, and as George Bernard Shaw said, "You have enemies? Good. That means you've stood up for something, sometime in your life."

4. Meditate. Either transcendental or mindfulness meditation can reduce stress. Read more about meditation and the development of consciousness in Dr. Rosenthal's book, "Super Mind."

5. Ask about Botox. Dr. Rosenthal partnered on a study with dermatologist Eric Finzi, M.D., Ph.D., that was published in the Journal of Psychiatric Researchin 2016. (Yes, Botox is normally injected to treat wrinkles by blocking nerve signals to the affected facial muscles.)

The two concluded that facial muscles influence the emotional centers of the brain, and suggested that Botox, injected into the brow muscles, may be considered a potential prescription for depression.(Note: Dr. Finzi did disclose that he is a paid consultant for Allergan, the company that manufactures Botox.)

Finally, Dr. Rosenthal says, remember that there is help for SAD, so reach out for it if you feel it's affecting you physically or emotionally.

See more helpful articles:

The Effects of Time Transitions on Depression

Ask the Doctor: Treatment-Resistant Depression

5 Things You Didn't Know About SAD and Sleep