Avoiding a Blue Christmas

Written by Thomas Jorno

Exercise and Seasonal Affective Disorder

Megan Cheng, SPT

‘Tis the season to be jolly – but ‘tis the season, also, for Seasonal Affective Disorder (SAD) to rear its head. Five to ten percent of people receiving outpatient medical services suffer from depression, mania or exacerbation of preexisting mental disorders in the fall and winter months.1 More people experience seasonality – mood changes in the cold months that do not affect function enough to be classified as SAD.2 Overall, there’s a high likelihood that one of your patients may be living with SAD or seasonality this winter. But the good news is, exercise helps! Physical Therapists can be on the lookout for signs of SAD in patients, refer them to the appropriate mental health professionals, and remove barriers so that they can reap the full benefits of exercise.

We are not yet sure why SAD happens, but most proposed explanations concern the shorter days of winter and fall. Our brains react to getting less light, and it is possible that in some people these reactions lead to SAD. The specific causes may be combinations of 1. Changes in circadian rhythms leading to excessive melatonin release3, 2. Insufficient retinal sensitivity to light4, and 3. Decreased serotonin levels5. Genetic factors may also contribute.6

Patients with SAD are treated with a combination of multiple therapy options, so it is important to refer these patients to mental health specialists. Treatments include spending time outdoors in sunlight, use of special lamps that imitate sunlight, sleep hygiene, psychotherapy, and prescription of pharmaceuticals, when indicated.7 But aerobic exercise is also indicated as an effective adjunctive treatment. Aerobic exercise performed in bright sunlight has been shown to be significantly more effective than relaxation exercises that are also performed in bright sunlight.6 Due to this and similar studies, medical professionals recommend that, in conjunction with other treatments, patients should:

 1. Take daily walks, even when the weather is cloudy, and 

2. Engage in aerobic exercise.

Patients should keep up these habits even when the acute phase of SAD has passed, in order to maintain their progress.7

Physical Therapists are experts in treating movement disorders that might otherwise keep patients with SAD from engaging in aerobic exercise and daily walks. PTs design exercise plans based on each patient’s medical history and needs, educate them about the health benefits of exercise, and motivate them to take charge of their own health. This is yet another reminder that a Physical Therapist does not treat just a knee or just a back, but rather a whole person. Helping patients with SAD or seasonality to move well can affect not only their biomechanical health, but their mental health as well. 

You don’t have to have a clinical diagnosis of SAD to get winter blues – especially in the winter of 2020. And you don’t have to have SAD to benefit from exercise – especially aerobic exercise, especially outside in the sun (if safely possible). If we all get moving this winter, we can all be a little more jolly. 

  1. Thompson C, Thompson S, Smith R. Prevalence of seasonal affective disorder in primary care; a comparison of the seasonal health questionnaire and the seasonal pattern assessment questionnaire. Journal of Affective Disorders. 2004;78(3):219-226. doi:10.1016/s0165-0327(02)00314-2 
  2. Bauer MS, Dunner DL. Validity of seasonal pattern as a modifier for recurrent mood disorders for DSM-IV. Comprehensive Psychiatry. 1993;34(3):159-170. doi:10.1016/0010-440x(93)90042-3 
  3. Lewy AJ, Lefler BJ, Emens JS, Bauer VK. The circadian basis of winter depression. Proc Natl Acad Sci U S A., 2006 May;103(19):7414-9. Epub 2006 Apr 28. 
  4. Roecklein KA, Wong PM, Miller MA, Donofry SD, Kamarck ML, Brainard GC. Melanopsin, photosensitive ganglion cells, and seasonal affective disorder. Neurosci Biobehav Rev. 2013 Mar;37(3):229-39. Epub 2012 Dec 31. 
  5. Willeit M, Sitte HH, Thierry N, et al. Enhanced Serotonin Transporter Function during Depression in Seasonal Affective Disorder. Neuropsychopharmacology. 2007;33(7):1503-1513. doi:10.1038/sj.npp.1301560 
  6. Sohn C-H, Lam RW. Update on the Biology of Seasonal Affective Disorder. CNS Spectrums. 2005;10(8):635-646. doi:10.1017/s109285290001960x 
  7. Avery D. Seasonal Affective Disorder: Treatment. UpToDate. https://www.uptodate.com/contents/seasonal-affective-disorder-treatment. Published August 23, 2019. Accessed December 1, 2020.
  8. Leppämäki SJ, Partonen TT, Hurme J, Haukka JK, Lönnqvist JK. Randomized trial of the efficacy of bright-light exposure and aerobic exercise on depressive symptoms and serum lipids. J Clin Psychiatry. 2002;63(4):316. 

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