How to manage pain if you have winter blues or diagnosed with seasonal affective disorder?

Radhika Kishore, MD
Kedar Angirus, MD
April 19, 2022

My friend of many years who has been living with chronic pain was experiencing waves of low emotion during the winter months. She was brushing it off as the blues, something that she needed to rough it out on her own during these darker months. She was recently diagnosed with Seasonal Affective Disorder (SAD) which is making pain management even harder. Can you tell me what’s the difference between Winter Blues and SAD and can you suggest some simple techniques to help manage pain?

As summer gives way to fall and winter, the days start getting shorter and the air colder.  The icy cold weather and the lack of sunlight can dampen your spirits, leaving you feeling languid and less motivated.  It may trigger a sense of dread and you may start feeling a bit moodier and irritated as well.  There is often a strong desire to hibernate through the cold season until spring arrives.  These feelings can be annoying, they may be intermittent and you may be able to brush them off yourself.  These waves of “feeling low” come with these winter days and we call them Winter Blues.  It can cause a lack of motivation to move around, low energy levels, constant fatigue, disrupted sleep and overeating. You may also not “feel” like talking to your family and friends as you once did before. These feelings could gradually become overwhelming. Do you find yourself experiencing these symptoms? Then, it is probably a case of winter blues. Winter blues can happen to anyone. However, don’t just brush it off as it can progress towards a more serious disorder known as Seasonal Affective Disorder (SAD for short), also known as Seasonal Depression. Read on to learn more about this condition.

Sometimes, you may find yourself feeling hopeless, unable to sleep or you find yourself sleeping all the time or feeling depressed. Others who are close to you may notice that you have started to avoid phone calls or you don’t socialise as you once used to.  You may have also observed that you are not giving  proper attention to your career which you had loved and felt very passionate about. The goals that you had set for yourself are taking a back seat and just trying to get through the day the best you can. Finally,  you may feel like you’re having to push yourself really hard to do basic things like take a shower, make meals for yourself or your family or even smile. If you’ve been experiencing these symptoms with a seasonal pattern over the last few years, you may be dealing with SAD and you will need medical attention for it.

In Canada, 15% experience winter blues (20% in the USA), while only about 2-3% experience SAD (4-6% in the USA). It’s natural to feel a little less motivated during the wintertime. The darker days, the cold weather and less socialisation can all contribute to less energy, motivation, and your usual levels of pep! In this article, we go on to explain the impact these conditions can have on your chronic pain and as well as simple tips to help break the depression-pain vicious cycle.

How do these conditions impact your chronic pain?

If you are suffering from chronic pain, you are aware of how pain can impact your physical and mental health. As we begin to understand how the brain works and interacts with the rest of the body, researchers have discovered that anxiety, depression and chronic pain are interlinked. Evidence from new research suggests there is a biological mechanism that links pain with anxiety and depression.

The combination of depression and chronic pain can create a vicious cycle wherein pain can worsen depression and the ensuing “feeling low” can worsen the feelings of pain. Even a slight reduction in physical activity can lead to stiff and achy joints which only further aggravates pain. But it’s not all doom and gloom.  There are things that you can do to beat the blues. Read on below to find out how.

How do I break the cycle?

Winter Blues and SAD are usually treated with not just one but a combination of different treatment options. Remember that it’s not a one-size-fits-all. What worked for others may not work for everyone. The key here is not to lose heart and to keep trying even if you think it did not help the first time. There’s always something that’ll always work.

1. Bring the light inside

Research has shown that light can have a positive effect on your mood. Open up the drapes or your window blinds to let the sunlight in. Move your workstation, chair or kitchen table closer to a window to get that extra dose of sunshine. In fact, a recent meta-analysis (one of the highest forms of scientific evidence) showed that light therapy or Phototherapy (a form of therapy where you sit in front of a very bright light source for several minutes to hours a day) is a first-line and incredibly effective treatment that is often prescribed for SAD. Starting your day this way can set the mood for the rest of your day.

2. Staying Active, that includes going for a walk outdoors

Lace-up your shoes and take a walk outside, even if it is only for a few minutes a day.  With the temperatures plummeting, it will be hard to bring yourself up for a walk, but don’t give up!  Find a moment to step outside for some fresh air; it will help you to clear your head and can become a game-changer in your fight against the blues or SAD.  Going for a walk will also give your body much-needed exercise.  This will help stall off joint stiffness and pain and keep a check on your weight as well.

The key here is to remember that studies have shown that exercise promotes mental well-being as well. Even as little as 20 to 30 min a day can do you wonders. Dr. Norman Rosenthal, the Psychiatrist who discovered SAD in the early 80s, recommends simple exercises like walking outdoors as a great blues/SAD buster. Exercise is known to release feel-good hormones also known as endorphins in your body which are naturally occurring anti-depressants. Exercise may also help you socialize, take your mind off of stress and who knows, maybe you’ll even get to know your neighbours!!

3. Talk to someone or try Cognitive Behavioural Therapy (CBT)

Keeping your feelings bottled within you is probably not a good thing anyway. If you have the blues, it just makes it worse. Confide in someone you trust.  It often is a relief to just talk about what you are going through; it might help you to see that you're not alone.  Surround yourself with friends who know how to cheer you up.  A close friend or a family member can help you challenge your negative thoughts and put a distance between you and the bad feelings when you have trouble doing it yourself.

If you have SAD, CBT is known to be highly effective. CBT, also known as talk therapy sometimes will help you understand triggers that cause or exacerbate the “feeling low” symptoms and will teach you to modify your behaviour and thoughts accordingly. A clinical trial conducted in 2018 showed CBT to be equally as efficacious as light therapy in keeping SAD symptoms at bay. CBT can also help you with techniques that will help you from relapsing into SAD in the following winter and thereafter as well.

4. Eat Nourishing Foods

Research has shown that when people experience SAD the tendency is to crave certain foods which may lead to an increase in overall weight. SAD is a medical condition therefore the pull to eat more calorie-dense foods is biologically linked. It can feel very difficult to pull back on this drive and therefore result in weight gain and which adds more stress on your already burdened joints.

Did you know you can boost your mood through food? Over the past few years, studies have shown a strong relationship between what you eat and the quality of your mental health. Eating more fruits and vegetables to balance out your other choices is one way to boost your mood. Being mindful in your occasional indulges is always a smart idea. Research suggests that the Mediterranean-style diet that is made up of a daily intake of fruits, vegetables, whole grains, low processed foods, legumes, nuts, seeds, fish, white meats, and olive oil, a moderate intake of fermented dairy products, and a low intake of red meat can contribute to a healthy mind and body. Trying foods high in protein and complex carbohydrates such as steel-cut oats or beans would also be great additions to a balanced approach to mindful eating.

5. Getting adequate sleep

Do you remember how we earlier said that the body needs to adapt to a circadian rhythm? Getting a good night’s sleep is essential in maintaining this pattern. A 2014 study conducted in Italy established SAD to be a strong predictor of sleep quality. By making sure that your sleep/wake-up routine is consistent, you are also able to maintain a consistent circadian rhythm. A few things you can do to ensure a good night’s sleep such as:

  • sticking to a regular sleep schedule
  • avoiding alcohol before you hit the bed (no night-caps!!)
  • avoiding smoking before bedtime
  • decreasing or best, avoiding any screen-time before bedtime
  • Sleeping only until you feel well rested

6.  Anti-depressant medications

Your doctor may choose to put you on anti-depressant medications. Remember that the medications are only a part of your overall treatment. The more effective your anti-SAD regimen is, the fewer anti-depressants you will need. The type and strength of these medications will be determined by your doctor. If and when you are put on anti-depressants, please make sure that you take them as directed to avoid side effects or relapses.

7. Taking a trip or relocation to sun destinations

Once again, this goes back to exposure to sunlight. As previously mentioned, a lack of proper sunlight is what brings about the blues and if left to fester, can progress into SAD. Do remember to plan your travel well in advance. If possible plan to travel in mid-late fall. Lack of planning can lead to a lack of motivation to travel.

Emerging New Evidence

1. Taking vitamin D supplements

We know from research that individuals suffering from depression are known to have low Vitamin D levels. A study involving ~2,000 women diagnosed with SAD in their 70’s concluded that there’s little to no improvement in symptoms of SAD after Vit D supplementation in some older women. That said though, Health Canada and the NIH recommend 600-800 IU daily for most adults for overall health promotion.  

2. Dawn simulation devices

These are devices that help you wake up naturally by gradually increasing the brightness in your bedroom. There was a 2001 study that showed these devices to be equally or more effective than lightbox or phototherapy. Research regarding dawn simulation is still in its early stages.

Key takeaways

The winter blues and SAD can be harsh on your physical and mental health. Couple it together with chronic pain, and your mood is bound to falter.  While you can’t change the season, the treatment and coping options presented here can help minimize the effects on chronic pain and all winters to follow.

You’re not alone! There are millions of people who get the winter blues hundreds of thousands that suffer from SAD and find this time of year to be difficult. Reach out and find a support system that works best for you.

Remember, it is never too late to seek help.  Don’t let the winter blues and SAD worsen your chronic pain and keep you from enjoying the things you love to do.  Keep a lookout for the warning signs and act at once!  Winter blues and SAD don’t last forever and with spring on its way, you’ll start feeling better before you know it.

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