When the Seasons Change: Depression, Seasonal Affective Disorder, and Mental Health

Depression Treatment, Seasonal Depression, and TMS in Northern Virginia and Washington, DC

As summer gives way to fall in Northern Virginia and Washington, DC, the change can feel almost immediate. The days become shorter. Morning light arrives later. Darkness comes earlier. Temperatures begin to drop, routines shift, and many people naturally spend less time outside.

For some people, these changes are simply part of the season.

For others, something else begins to change.

Energy drops. Getting out of bed becomes harder. Motivation disappears. Sleep changes. Workouts become less consistent. Social plans start getting canceled. Irritability increases. Food cravings change. The things that normally bring enjoyment begin to feel like work.

Sometimes people recognize this as depression.

Sometimes they simply say:

“I don’t feel like myself this time of year.”

There may be a biological reason.

Seasonal affective disorder (SAD) is a form of depression characterized by a recurring seasonal pattern. It most commonly begins during the fall or winter and improves during the spring and summer, although a less common summer pattern also exists (National Institute of Mental Health [NIMH], n.d.).

At Brain Treatment Center NoVA, with locations serving Ashburn, Alexandria, Northern Virginia, and the greater Washington, DC region, we believe seasonal changes are an important reminder to look at mental health comprehensively.

This may be particularly important within our military, veteran, and first responder communities.

Depression is not simply a lack of motivation, discipline, gratitude, or resilience. And for someone already managing the effects of trauma, chronic stress, traumatic brain injury (TBI), disrupted sleep, pain, isolation, or a difficult transition from military service, seasonal changes may add another layer to an already complex picture.

Seasonal Depression Is More Than the “Winter Blues”

Most people have days when cold weather, gray skies, or shorter daylight hours make them want to stay home. Seasonal affective disorder is different.

SAD is a type of depression. Symptoms may include persistent sadness, loss of interest or pleasure, fatigue, difficulty concentrating, changes in sleep, changes in appetite, feelings of hopelessness, and, in severe cases, thoughts of death or suicide (American Psychological Association [APA], 2023; NIMH, n.d.).

Winter-pattern SAD can also present with symptoms such as oversleeping, carbohydrate cravings, overeating, weight gain, and social withdrawal (NIMH, n.d.).

The distinction matters. Someone experiencing significant seasonal depression may not need to simply “push through winter.” They may need an actual treatment plan.

Why Can Changing Seasons Affect the Brain?

One of the most important environmental changes during fall and winter is not temperature.

It is light. As daylight hours shorten, the timing and amount of light reaching the eyes changes. Light is one of the major environmental signals used by the brain to regulate the circadian system, our internal biological timing system.

Research on seasonal affective disorder suggests that shortened winter photoperiods, meaning the amount of daylight between sunrise and sunset, can contribute to seasonal depression in susceptible individuals. Alterations in circadian timing are one proposed mechanism (APA, 2023).

This is important because circadian rhythms influence far more than sleep.

They interact with:

• Sleep and wake cycles

• Hormonal rhythms

• Alertness and energy

• Appetite

• Cognitive performance

• Mood regulation

• Daily behavioral patterns

When these rhythms become disrupted, the effects can show up throughout daily life.

You may not think, “My circadian rhythm is changing.”

You may think:

Why am I so tired?

Why don’t I want to work out anymore?

Why am I sleeping nine hours and still exhausted?

Why am I withdrawing from everyone?

Why does everything suddenly feel harder?

That lived experience matters.

The Military and Veteran Population Deserves Special Attention

For many veterans, depression does not exist neatly by itself.

A veteran may simultaneously be dealing with a history of TBI, blast exposure, PTSD symptoms, chronic pain, tinnitus, disrupted sleep, hypervigilance, relationship stress, loss of military identity, changes in physical performance, or difficulty finding the same sense of purpose and community they experienced while serving.

Depression can become one piece of a much larger neurobiological and psychological picture.

The U.S. Department of Veterans Affairs and Department of Defense maintain comprehensive clinical practice guidelines for the assessment and management of major depressive disorder, emphasizing evidence-based evaluation and individualized treatment planning (Department of Veterans Affairs & Department of Defense [VA/DoD], 2022).

This is one reason we believe it is important to ask a better question than:

“Are you depressed?”

We also need to ask:

What changed?

What is happening with sleep?

What is happening with movement?

What is happening with relationships?

What happened to your sense of purpose?

Are you isolating?

Is there unresolved trauma?

Is there a history of TBI?

Has your physical performance changed?

Are there medical or nutritional factors worth evaluating?

And what happens every year when the days begin getting shorter?

The answers may help determine what kind of support is appropriate.

Depression Tells You to Do the Opposite of What May Help

One of the most difficult features of depression is that it can make the behaviors associated with recovery feel incredibly difficult.

Depression says:

Stay in bed.

Skip the workout.

Cancel dinner.

Don’t answer the phone.

Stop going outside.

You can deal with it tomorrow.

And gradually, a person’s world can become smaller.

This is not an argument that someone can exercise or discipline their way out of clinical depression. Depression is a legitimate health condition, and moderate or severe symptoms warrant professional assessment. But behavior still matters.

Physical activity is included among the adjunctive approaches considered in the VA/DoD depression guidelines. Behavioral activation is also an established component of depression treatment (VA/DoD, 2022).

Sometimes the first step happens before motivation returns.

Take the walk.

Get outside in the morning.

Eat the protein.

Call the friend.

Go to therapy.

Make the appointment.

Return to training carefully.

Start rebuilding structure.

You don’t necessarily have to feel ready to begin.

Morning Light Matters

One of the simplest interventions for supporting circadian regulation is also one of the most overlooked: Light.

Natural morning light helps provide the brain with a powerful signal about the beginning of the biological day.

For individuals diagnosed with winter-pattern SAD, bright-light therapy is also an established treatment. NIMH describes a commonly studied approach involving a 10,000-lux light box for approximately 30–45 minutes, typically first thing in the morning during fall and winter (NIMH, n.d.). That does not mean everyone should purchase a random light online and begin self-treating.

Light therapy should be discussed with an appropriate health care professional, particularly for people with certain eye conditions, medications that increase photosensitivity, or bipolar disorder, where poorly managed light exposure may present additional concerns.

But the larger point is important:

Your brain pays attention to light.

Getting outside soon after waking, maintaining a consistent sleep-wake schedule, and protecting the body’s natural light-dark rhythm can be meaningful parts of a broader mental health strategy.

Movement Is Brain Health

Exercise is often discussed as though its only purpose is weight management.

It is much more than that.

Movement interacts with cardiovascular health, metabolic health, sleep, cognition, stress regulation, and mental health. And it does not have to begin with an elaborate training program.

Walk.

Lift weights.

Ride a bike.

Hike.

Do mobility work.

Return gradually to an activity you used to enjoy.

For veterans and former high-level performers, there can also be an important psychological distinction: The goal does not have to be performing at the level you did at 25.

The goal may simply be to begin using your body again.

Meet yourself where you are now, and build from there.

Nutrition and Functional Health Matter, Too

The brain is an organ.

It requires energy, oxygen, amino acids, fatty acids, vitamins, minerals, and countless biochemical processes to function normally.

Nutrition is not a replacement for appropriate depression treatment. Neither are supplements.

But mental health care should not require us to ignore physical health.

Depending on an individual’s history and symptoms, a medical provider may consider evaluating factors such as nutritional status, thyroid function, iron status, vitamin B12, folate, vitamin D, metabolic health, hormones, sleep, gastrointestinal health, medications, or other medical conditions that can overlap with fatigue, cognitive complaints, and mood symptoms.

At Brain Treatment Center NoVA, our functional and integrative health services are intended to complement, not replace, appropriate medical and mental health care.

We are interested in understanding the person behind the symptoms.

Community Is Part of Health

Isolation is particularly important within the veteran community.

Military service often creates a level of shared mission, identity, accountability, and belonging that can be difficult to reproduce after leaving service.

The transition can be jarring.

You may go from having a team around you almost constantly to spending enormous amounts of time alone. Add depression, PTSD symptoms, chronic pain, TBI symptoms, or disrupted sleep, and isolation can become increasingly easy.

Community does not mean having hundreds of friends.

Sometimes it means having a few people around whom you do not have to perform.

Train with someone.

Call the friend.

Attend the group.

Go to church.

Volunteer.

Find other veterans.

Reconnect with people who understand you.

Human beings regulate in relationship with other human beings. Recovery does not always happen alone.

Therapy: Work on What Is Underneath the Symptoms

Depression can coexist with trauma, grief, moral injury, relationship difficulties, major life transitions, chronic stress, or a loss of identity and purpose.

Psychotherapy can help people identify behavioral and cognitive patterns, process experiences, improve coping, and develop practical strategies for moving forward.

Cognitive behavioral therapy has also been specifically adapted for seasonal affective disorder. Research supported by VA investigators has found CBT to be a useful treatment approach for SAD (U.S. Department of Veterans Affairs, n.d.).

For some individuals, trauma-focused therapies may also be appropriate depending on diagnosis, history, symptoms, and clinical assessment.

Sometimes improving depression means treating depression.

Sometimes it also means addressing what happened before the depression began.

When Depression Persists: TMS and Neuromodulation

For some people, psychotherapy, lifestyle interventions, and medications provide substantial improvement.

For others, depression persists.

This is where additional treatment options such as transcranial magnetic stimulation (TMS) may be considered.

TMS is a noninvasive form of neuromodulation that uses magnetic pulses to influence targeted brain regions and networks involved in depression.

The VA/DoD clinical practice guideline includes repetitive transcranial magnetic stimulation among treatment options for major depressive disorder, particularly within advanced treatment management when previous treatment approaches have not produced sufficient improvement (VA/DoD, 2022).

At Brain Treatment Center NoVA, neuromodulation is not viewed in isolation.

Depending on the individual, a comprehensive plan may incorporate:

• TMS or personalized neuromodulation

• qEEG brain mapping

• Psychotherapy

• Occupational therapy

• Nervous system regulation

• Functional and integrative health evaluation

• Sleep and circadian support

• Movement and physical activity

• Nutrition

• Community and social connection

There is rarely one intervention that answers every part of a complex human problem.

Treat the brain. Support the body. Work through the experiences. Rebuild the life.

Depression, PTSD, and TBI Can Overlap

This is especially important for military populations.

Poor sleep.

Irritability.

Difficulty concentrating.

Low motivation.

Social withdrawal.

Fatigue.

Memory complaints.

Emotional dysregulation.

Loss of interest.

These experiences can occur across depression, PTSD, TBI, chronic stress, sleep disorders, pain conditions, and other medical or psychological concerns.

That does not mean these conditions are interchangeable.

It means assessment matters.

Someone with a significant history of blast exposure, concussion, trauma, sleep disruption, and depression deserves more than an assumption about which single diagnosis explains everything.

At BTC NoVA, our goal is to understand as much of the picture as possible and collaborate across disciplines when appropriate.

Don’t Wait Until Winter to Pay Attention

If you already know that every October, November, or December you begin to struggle, that pattern is information.

Pay attention to it.

You do not have to wait until you are deeply depressed to begin rebuilding the habits and support systems that help keep you well.

Start protecting sleep.

Get outside.

Prioritize morning light.

Keep moving.

Eat intentionally.

Stay connected to people.

Schedule therapy.

Talk with your medical provider.

And if depression continues despite the things you are already doing, consider whether it is time to explore additional treatment options.

Getting uncomfortable in order to get better is different from suffering unnecessarily. Asking for help is an action.

Comprehensive Depression Treatment in Northern Virginia and Washington, DC

Brain Treatment Center NoVA provides comprehensive brain and mental health services for individuals and families throughout Ashburn, Alexandria, Loudoun County, Northern Virginia, and the Washington, DC metropolitan area, with a particular commitment to our active-duty military, veteran, special operations, first responder, and military family communities.

Our model brings multiple disciplines together because the symptoms people experience rarely fit neatly into one box. If you are noticing that the changing season is affecting your mood, motivation, sleep, energy, relationships, or ability to function, do not dismiss it simply because “this happens every winter.”

And if you have been struggling with depression for much longer than one season, there may still be additional options to explore.

Nothing changes if nothing changes.

Start somewhere.

We Can Help.

Brain Treatment Center NoVA

Ashburn + Alexandria, VirginiaBTCNVA.com | 703-857-2560

References

American Psychological Association. (2023, October 30). Seasonal affective disorder. American Psychological Association.

National Institute of Mental Health. (n.d.). Seasonal affective disorder. National Institutes of Health.

U.S. Department of Veterans Affairs. (n.d.). Depression. Office of Research & Development.

U.S. Department of Veterans Affairs, & U.S. Department of Defense. (2022). VA/DoD clinical practice guideline for the management of major depressive disorder. Department of Veterans Affairs.