Skip to Main Content
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

Helping Your Patients Navigate Winter Blues, Holiday Blues, and Seasonal Affective Disorder (SAD)

Date: 11/08/24

‘Tis the season for joy, happiness, and time spent with family and friends. However, for some of your patients, this can be a difficult season to enjoy. Below we discuss winter blues, holiday blues, and Seasonal Affective Disorder (SAD), and ways to help your patients navigate through the season.

Winter Blues

You may have heard your patients say that they have the “winter blues” or “winter sadness.” This is a common occurrence during the winter season, when the days are shorter and there is less natural light. Symptoms are mild, and the patient will typically feel better when spring returns and the days lenghten.1, 2

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is depressive disorder that lasts for four to five months, typically beginning in late fall/early winter and ending in the spring. If patients are complaining of depression, or discuss signs of depression (Table 1), a physical exam can be conducted and laboratory tests can be ordered to rule out medical conditions for the symptoms such as hypothyroidism, anemia, or low vitamin D. The Patient Health Questionnaire-9 (PHQ-9) can also be administered to assess the patient’s mental health, aid in the diagnosis of depression, and develop a treatment plan.3

Treatment

Phototherapy has shown to be highly effective in alleviating symptoms due to SAD. The patient should sit in front of a full spectrum lightbox for 30 minutes every day. If the patient is unable to obtain a lightbox they can also try standing in front of a sunlit window or taking daily early morning walks. They should continue daily phototherapy until the spring. It was noted that SAD symptoms improved by as much as 70% after a few weeks of this treatment.3

Patients can be referred to counseling to work with a therapist to identify negative thoughts and implement behavioral changes to help improve their mood. They should also be encouraged to continue or re-engage in social activities such as going to lunch with friends or volunteering for local organizations.

If the patient is capable, initiating an exercise regimen can help lighten their mood by increasing endorphins, increasing energy, and relieving stress and anxiety.

For patients with moderate-severe depression, selective serotonin re-uptake inhibitors (SSRIs), selective norepinephrine re-uptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs) have shown to be beneficial. Fluoxetine, paroxetine, sertraline, and bupropion, specifically, have shown benefit for SAD patients. These medications should be initiated prior to the fall, as they can take 4-6 weeks to have a full therapeutic effect. The side effects the patient can experience from these medications are nausea, vomiting, headache, anxiety, reduced sexual drive, and risk of suicidal ideation in teens and adults.4

Holiday Blues

The “holiday blues” typically starts in November and December and eases shortly after the new year. Symptoms are generally mild and linked to a specific event or the absence of a loved one during the holiday season. There are also other documented causes of holiday blues such as lack of sleep, excessive eating and alcohol use, financial stress, isolation and loneliness, unrealistic expectations for the holiday season, and over-committing to activities during this season.5

Treatment

For patients who experience holiday blues, the following can be recommended to help ease symptoms:

  • Drink alcohol in moderation or not at all
  • Do not isolate yourself from others
  • Exercise
  • Learn to say, “no,” to avoid over-commitment
  • Find time to relax
  • Set realistic expectations for the season

 

Table 1. Signs and Symptoms of Depression

Fatigue or decrease in energy

Difficulty waking up in the morning as compared to the summer months

Difficulty doing things that are usually easy or enjoyable

Not being as social with friends or family

Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least two weeks

Feelings of irritability, frustration, or restlessness

Difficulty concentrating, remembering, or making decisions

Somnolence or appetite or unplanned weight changes

Suicidal ideation or suicide attempts

 

In summary, encourage your patients to speak with you regarding their signs and symptoms of depression. If a patient or someone they know is having suicidal ideations they can call or text the Suicide Crisis and Prevention Lifeline at 988 or chat online.

 

References

  1. Beat the Winter Blues. Accessed September 7, 2024.
  2. A cure for the wintertime blues? Accessed September 7, 2024.
  3. Seasonal affective disorder (SAD). . Accessed September 10, 2024.
  4. Macchiarulo M, et al. Seasonal Affective Disorder: Focus on the Winter Blues. US Pharm. 2017:42(11):8-14
  5. The Holiday Blues: Feeling Sad Amid the Festivities. Accessed September 7, 2024.

 

PDL Changes

Effective November 1, 2024, certain medications on Meridian’s PDL have new quantity limits. Please click the link for more detailed information.

Effective November 11, 2024, the formulary status of some of Meridian’s preferred OTC medications have changed. Please click the link for more detailed information.

Effective December 1, 2024, the formulary status of some of Meridian’s preferred vitamin products have changed. Please click the link for more detailed information.

Effective December 1, 2024, the formulary status of some Amladex has changed. Please click the link for more detailed information.

Effective December 1, update prior authorization criteria for GLP-1 agonists. Please click the link for more detailed information.