Snow functions as an antidote for the winter-onset seasonal affective disorder (SAD) by increasing photoperiod; associating good memories with the season; going outdoors which produces necessary neurotransmitters that help combat its symptoms.
According to Mayo Clinic, a health care non-profit, “seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons— SAD begins and ends at about the same times every year… [where] symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody” (Seasonal, 2017). There are two types of SAD— winter and summer-onset. The former is more prevalent than the latter (Rohan and Rough, 2016) due to the latitude hypothesis which states that people living in the northern latitudes are more susceptible to winter-onset SAD due to its shorter days in the season. In addition, there are more prevalent cases of winter-onset SAD as compared to summer-onset SAD overall (Seasonal, 2017). Therefore, this piece is going to discuss more on winter-onset SAD.
Winter- onset SAD, more commonly known as winter depression, has symptoms that include “oversleeping, appetite changes (especially… foods high in carbohydrates), weight gain, and tiredness” (Seasonal, 2017). On the other hand, summer-onset SAD, otherwise known as summer depression, has the complete opposite symptoms that include “insomnia, poor appetite, weight loss, and agitation/ anxiety” (Seasonal, 2017). Knowing its symptoms, SAD causes a change in the body’s circadian rhythm, your biological clock; serotonin levels which are the neurotransmitters (brain chemicals) that affect mood; and melatonin levels which are the chemicals responsible for sleeping patterns. Doctors and co-authors, Kelly Rohan and Jennifer N. Rough, wrote a chapter on SAD, published in The Oxford Handbook of Mood Disorders, wrote that, to be diagnosed with SAD, psychiatrists must comply with the Statistical Manual of Mental Health Disorders (DSM-5), meeting two criterias: “[individuals must have] experienced a major depressive episode (MDE) in the same season(s) for two consecutive years,” and “[those] seasonal episodes [must] substantially outnumber nonseasonal episodes”; “diagnosis is not warranted if the apparent seasonal pattern is attributable to seasonal variations in psychosocial stress [such as] holiday stress or seasonal unemployment” (Rohan and Rough, 2016).
Treatments for SAD include: light therapy, antidepressant medications, cognitive-behavioral therapy, dawn simulation, negative air ions, and exercise (Rohan and Rough, 2016). According to psychologist Di Westaway, exercise improves your physique by burning more fat, calories, and gives you higher endurance by strengthening your respiratory and circulatory systems. All of which release endorphins (a hormone that elevates your mood), and adrenaline; those hormones are good for the human body regardless of being diagnosed with SAD (Westaway, 2017). Likewise, its benefits are more heavily emphasized for individuals with SAD, because exercise and going outdoors in “the cold stimulates the release of endorphins (as mentioned earlier), dopamine, and serotonin [which help combat its symptoms]” (Westaway, 2017).
This is extremely crucial because SAD patients have altered neurotransmitter levels. “[serotonin, otherwise known as 5-HT] fluctuates across seasons, with the highest 5-HT levels… [are the] lowest in winter” (Rohan and Rough, 2016). In addition, according to a research done by the European College of Neuropsychopharmacology (ECNP), SAD patients have 5% higher levels of SERT activity in the winter than other seasons; in comparison, healthy individuals show no fluctuations in SERT activity with the changing seasons (European, 2014). This is because “sunlight keeps [SERT activity] naturally low, but when nights grow longer during the autumn [or winter months], the SERT levels increase, resulting in diminishing active serotonin levels” (European, 2014). Moreover, a research done by Michelle Solis, renown author of medical journal, Scientific American, “people scanned in the fall and winter had an average dopamine signal [otherwise known as dopamine receptors] 4.3% greater than those scanned in the spring and summer” (Solis, 2011).
To better understand this phenomenon, we would have to backtrack a little, and refer to a lecture by Professor Victoria Chavez on the topic. Our body’s neurons in the peripheral nervous system (PNS) have synapses/ gaps between one neuron to another. And neurotransmitter receptors are located on one end of a neuron, waiting for a neurotransmitter (chemical messengers) to bind to it, then soon releasing into the synapse where it exerts its effects on the body (The Biological, 2019). As mentioned in the previous paragraph, healthy individuals produce the same amount of neurotransmitters and its respective receptors throughout seasons (Rohan and Rough, 2016; European, 2014; and Solis 2011). However, people with SAD produce more neurotransmitter receptors in the body, specifically serotonin and dopamine receptors, causing more of its respective neurotransmitters to bind to it, lessening its effect on the body. Hence, causing the subsequent symptoms of SAD in patients (The Biological, 2019).
There is no way to decrease the number of receptors, but increasing the number of neurotransmitters in the body is totally possible! Psychiatrists often prescribe an antidepressant called a selective serotonin reuptake inhibitor (SSRIs), more commonly known as Prozac (Rohan and Rough, 2016). However, this must be prescribed with caution since you would have to take it for as long as you live, because you would be highly dependent on it, and there would be severe withdrawal symptoms upon the stopping of its administration, but most importantly, it does not teach patients adaptive skills to survive in the cold (Healing, 2019). Therefore psychiatrists who have logged more hours in their field would prescribe SSRIs as the last resort, and opt for exercise, since its effects are phenomenal (The Biological, 2019 and Westaway, 2017).
Not only do SAD patients have an altered neurotransmitter and receptor productions, but they also tend to exhibit three distinctive psychological factors that subsequently cause certain cognitive behaviors (Rohan and Rough, 2016). They are dysfunctional attitudes, negative attributions, and rumination as a cognitive process. For instance, a patient previously diagnosed with winter-onset SAD would feel fine in warmer climates, but once leaves change color and the temperature gets colder, anticipating winter, they would feel sad and consequently think deep thoughts resulting in depression (figure 1 in the appendix illustrates this example). This cycle is called cognitive-behavioral model; psychologists remedy this by giving patients cognitive-behavioral therapy (CBT), which is there to restructure your thoughts to avoid the subsequent behavior (Healing, 2019). This therapy could be simplified into a cycle diagram (refer to figure 2 in the appendix), where it explains how what you feel, think, and do interlink each other, and upon breaking its chain (modifying your negative beliefs), your action would change, forming a new cycle and soon would be in remission (Healing, 2019).
In modifying patients’ feelings towards the anticipation of winter, psychologists often let them reminisce about their childhood then bring them back to the present, showcasing the peace and serenity one feels in the snow. In an article Korin Miller wrote for the Huffington Post, she said that people are so excited for big snowstorms because according to Miami-area licensed clinical psychologist Erika Martinez, Psy.D. “Snowstorms in particular take us back to our childhood and the carefree feelings that often come with it,… we used to have that excitement of not having to go to school… which gets ingrained [into our minds] as an adult.” Hence, sparking the same feelings in adulthood. In addition, clinical psychologist John Mayer, Ph.D., explained that “snowstorms have the rare mixture of stimulation, fear, and power, yet beauty… [which] stimulates us in a unique way psychologically” (Miller, 2017). SAD patients tend to focus more on the fear aspect of snowstorms (i.e. property damage and even death) in conjunction with their anticipation for a depressive episode (Healing, 2019). So, psychologists try to remind SAD patients of the instant gratifications of snow to break the chain as mentioned in the previous paragraph.
The step following this would be to bring them into the present and open their eyes to the beauty of snow, the serenity and sense of peace it brings (Healing, 2019). Christoper Bergland, author of Psychology Today, reiterated the scientific aspects of snowstorms in relation to serenity. He featured a Ph.D. Candidate studying “acoustic materials,mufflers and silencers, and structural dynamics,” David W. Herrin, who said that snow because it absorbs 60% (0.6) of the noise pollution in the air (Bergland, 2016). As a reference point, on a scale of 0-1, 0 is concrete floor and 1 is silence; putting snow in a relatively high position in the scale, mirroring the effects of “commercial sound absorbing materials” like “fibers and foams used in cars and HVAC systems.” Following this idea, Bergland said that everything goes to a grinding halt during snowstorms, with everyone staying inside coupled with the absent need to do anything remotely productive; giving them the chance to do anything they’ve always wanted to do with the sense of satisfaction (Bergland, 2016).
With this sense of satisfaction, most patients would stop going through the distressing cognitive-behavioral cycle and into remission (Healing, 2019). They would be able to express themselves better and could fall into involuntary behaviors exhibited by healthy individuals. According to psychologists Jessica L. Tracy and Alec T. Beall, “women are particularly motivated to enhance their sexual attractiveness during their most fertile period,” by wearing red pieces of clothing. Hence calling this the “red-dress effect” (Tracy, 2014). In conjunction with this newfound knowledge, they replicated the research whilst modifying a variable— the current weather climate (warm vs. cold), and found its correlation. Their initial hypothesis was that women would wear more red pieces of clothing in warmer climates- summer and spring- since they have a more fit and toned body, and able to wear clothing of less coverage (i.e. cropped tops and shorts). However, the result was that women would prefer wearing red in colder climates— during autumn and winter seasons (Tracy, 2014). The results were graphed, and is posted in the appendix as figure 3. This led to the conclusion that women wear more red-colored clothing in the winter to compensate for the inability to wear clothings of less coverage in order to enhance their sexual appeal. In the same way, SAD patients who are in remission are in a better mental health space and are more motivated to increase their sexual appeal or appearances in general; hence following the red-dress effect (Healing, 2019).
While CBT is an effective method of psychotherapy in treating SAD (this specific branch of CBT is called CBT-SAD), a crucial stepping stone in this method is to reminisce in the patient’s childhood (Miller, 2017 and Healing, 2019). And it would only work if they had a positive experience with snow, but what if patients have only ever had negative experiences with snow? Or even the absence of one (i.e. patients just moved from a tropical country with only one hot season all year to a country with four seasons)? This is not uncommon, as a matter of fact, “CBT is a combination of cognitive restructuring [which is a therapeutic technique to modify negative beliefs with more rational and adaptive ones] with behavioral treatments” (Healing, 2019).
The most effective treatment for SAD is to increase an individual’s photoperiod. It is the amount of time each day an individual receives illumination, regardless of its form (Rohan and Rough, 2019). This is supported in the latitude hypothesis which stated that the amount of photoperiod an individual receives depends on where they are located geographically (i.e. living in the northern or southern latitude), and “serves as a proxy for photoperiod in epidemiological studies” which will be mentioned later in the paper. With regards to this, psychologists have proven its relation to the retinal subsensitivity hypothesis which “proposes that SAD patients have impaired retinal adaptation (retinal subsensitivity) or heightened sensitivity (supersensitivity) to low light levels, resulting in problems when photoperiod is short during winter” (Rohan and Rough, 2016).
Moreover, an individual’s photoperiod is the only significant environmental condition when finding the cause of SAD. It outweighs older researches that claim temperature and light intensity were factors as well (Rohan and Rough, 2016). This led to psychologists recommending exercise as a means of treatment as mentioned earlier. Likewise, “winter ambient light” (i.e. any form of illumination happening at any time of day— evening light) counts toward an individual’s photoperiod (Rohan and Rough, 2016), helping an individual’s circadian system. This led psychologists Lewy, Sack and Singer to propose the phase shift hypothesis in 1988. It stated that “SAD results when later dawns in winter trigger a pathophysiological phase delay in circadian rhythms relative to external light/ dark cycle and/or the internal sleep/wake cycle” (Rohan and Rough, 2016). There are two types of phase shifts— phase advanced, when an individual starts their sleep/wake cycle (circadian cycle) earlier, which is common in summer-onset SAD; and phase delayed, when an individual’s circadian cycle starts later, which is a symptom in winter-onset SAD. To help remedy this, psychologists prescribe patients with light therapy or dawn simulation. The former, light therapy, is the use of light boxes to emit artificial light for 30 minutes upon waking up in the morning to compensate for shorter photoperiods in the winter and counteract the earlier hypothesis on phase delay, and move their circadian clock earlier to prevent oversleeping. It is relatively effective, with 53% of the patients fully remit (Rohan and Rough, 2016).
Similarly, dawn simulation “uses a device to program the onset of an artificial summer dawn by gradually increasing ambient light intensity in the bedroom up to 250 lux by the desired wake time”. It is less effective compared to light therapy, however, a combination of both resulted in a small-scale improvement, but a significant phase advance of 30 minutes in individual’s circadian clock (Rohan and Rough, 2016). In regards to increasing ambient light intensity and how effective it is, winter ambient light (i.e. day, evening, and midday light) is increased when snow is falling from the sky and the same goes for when it accumulates on the ground for the next day(s) following the night of snowfall. According to meteorologist, Jacob Beitlich, “if you have snow falling, all those tiny ice crystals scatter (reflects) a lot of light, and a lot of it gets scattered back down to the ground” (Nelson, 2018). In addition, the presence of low- lying clouds keep the “scattered light” in the sky, hence keeping it brighter for a longer period of time; when show isn’t falling and is just accumulating on the ground, the street lights will reflect light back up into the atmosphere, keeping it bright (Nelson, 2018). Jumping back to the beginning of the article, talking about photoperiod (with its length being relatively shorter in the winter), this evening light that resulted from the reflection/ scattering of light into the atmosphere, would increase an individual’s photoperiod so long as they come outdoors to take it in (Westaway, 2017). Therefore, “evening light administration improves SAD symptoms… [and helps with] phase delay” (Rohan and Rough, 2016).
In the past, the correlation of shorter photoperiods in the winter to the prevalence of suffering from SAD would lead psychologists to believe that those individuals would be better off living in countries with warmer climates, where there are longer photoperiods. However, recent studies proved this hypothesis null because epidemiological studies on SAD stated that although prevalence of winter-onset SAD is low in tropical countries in Asia, there are significantly higher numbers of summer-onset SAD, due to its low latitude position (Rohan and Rough, 2016). Likewise, SAD in general is more common in northern latitudes, and this is because “photoperiod varies more starkly across seasons,” and has different sociocultural factors. According to a lecture professor Chavez taught, older generation Asians generally do not believe in the idea of mental health, and would brush them off, because “if it is not visible, it does not exist” (The Biological, 2019). Hence, the subsequent dip in numbers for countries in low latitudes due to cases flying under the radar, causing the numbers to not be accurate.
In addition, summer-onset SAD is triggered by high heat and humidity, and is proven by psychologists Li, Ferreira, and Smith, when they used the data gathered over the course of 17 years (from 1993 to 2010). They cross-matched three million Americans’ (both mentally stable and unstable) self-reported number of bad mental health days, to the daily weather climates at the time. And found that the “human comfortable temperature range” is 60oF to 70oF, where the number of bad mental health days are at its minimum. However, deviating from this range- getting colder or warmer- resulted in an increase of bad mental health days; as the climate gets colder (60oF to -20oF), the number increases exponentially; as the climate gets warmer (70oF to 80oF), the number increases exponentially at an even steeper rate than when it got colder (Li, et al., 2020). Refer to figure 4 for a mock up presentation of data. Couple the warmth with precipitation, humidity, and cloud cover, and you would have an even worse mental health.
The increase in bad mental health days during warmer weather is called heat stress, which brings up complications in the body’s physical and mental states. Going with physical health first, heat stress causes heat rash and muscle cramps that affect the central nervous system (CNS), circulatory system, and other organ systems. Likewise, the mental health outcomes appear to be worse, with people expressing negative sentiments, leading to higher suicidal rates (Li, et al., 2020). Therefore the hypothesis stating that winter-onset SAD patients should simply move to a tropical country is false, the ramifications involved far outweigh its single benefit of getting longer photoperiods.
Hence, going back to using light therapy as a means of increasing photoperiod. After all, it is the most researched treatment for SAD. Psychologists even went to lengths to combine light therapy with CBT-SAD, and “showed fewer depression recurrences (27.3% vs. 45.6%) and less severe symptoms than light therapy… [results are] promising, especially with regard to long-term SAD outcomes” (Rohan and Rough, 2016). However, “getting natural [or ambient] light showed greater improvements in depression and a larger proportion in remission relative to the light therapy group”(Rohan and Rough, 2016). This proved my latest argument to be true, since snow brightens the sky, providing natural/ ambient light, and increases photoperiod, which helps combat symptoms of SAD and advance the circadian clock, providing a longer state of remission.
In summation, snow functions as an antidote for the winter-onset seasonal affective disorder (SAD) by increasing photoperiod; associating good memories with the season; going outdoors which produces necessary neurotransmitters that help combat its symptoms. Firstly, psychiatrists reserve prescribing antidepressants to treat SAD for those exhibiting extremely harsh symptoms and would resort to sending patients to psychologists for psychotherapy. Psychologists would usually ask patients to go outdoors in the cold, since it stimulates the release of endorphins, serotonin, and dopamine; all of which are essential in keeping spirits high, hence alleviating symptoms. Secondly, CBT-SAD is often used by psychologists to re-structucture patient’s thoughts to stop the distressing cycle which always ends in a depressive episode. They often pair CBT-SAD with helping patients reminisce about their childhood and all the fun times they had, or involve cognitive restructuring in the absence of a positive memory. Lastly, snowfall and its subsequent accumulation on the ground the next day(s) cause the sky to be brighter due to reflective particles in snowflakes that scatter light back into the atmosphere, trapped by low-lying clouds. Hence, causing photoperiods to be longer in the winter, without the need for moving into warmer climates, since they have ramifications that far outweigh its single benefit of getting longer photoperiods.
