Seasonal Affective Disorder (SAD) is a form of depression also referred to as seasonal depression or winter depression. Individuals with SAD experience mood changes and depression-like symptoms. Symptoms of SAD typically occur in seasons with less sunshine (autumn and winter) and generally let up with the coming of spring. In the United States, January and February are thought to be the most difficult months for individuals with SAD. Although it is significantly less frequent, some people experience SAD in the summertime.

SAD is more than just “winter blues”—symptoms can be debilitating and may interfere with daily functioning. However, it may be treated. Approximately 10 million Americans are affected by SAD. Another 10 percent to 20 percent may have mild SAD. It is more common in women.

SAD has been linked to a biochemical imbalance in the mind prompted by shorter daylight hours and a decrease in sunshine. As seasons change, individuals experience a shift in their own internal biological clocks (or circadian rhythm), creating a shift in daily experiences. SAD is more prevalent in people living far from the equator where there are fewer daylight hours in the winter.

As the days grow shorter and light becomes scarce, we often react by placing ourselves in front of the TV or burrowing under covers to stay warm. How can you tell if it’s a seasonal slump or a more significant issue?

SAD symptoms predominately start in the autumn and intensify throughout winter. Some people experience SAD during the spring/summer, however, this is rare.

You may have SAD if you’ve felt depressed during either the past two winters but better in the springtime (most common), or the past two summers but better in the wintertime.

Anyone can get SAD, but it is more common in:
• Women.
• Individuals living far from the equator, where winter daylight hours are much shorter.
• Those related to someone with SAD.
• SAD may begin at any age, although it typically starts between the ages of 18 and 30.

SAD is also referred to as “winter depression” or “seasonal melancholy”.

Causes of SAD

Experts aren’t certain what causes SAD, but suggest it is caused by an absence of sunlight. Deficiency of light can upset your “biological clock,” which controls your sleep-wake pattern and circadian rhythm. Sunlight is also connected to our serotonin levels—the neurotransmitters in our brains that create mood and happiness. A decrease in sunlight may lead to a decrease in serotonin, triggering feelings of depression or moodiness.

Low levels of sunlight in fall and winter are best known to cause winter-onset SAD. The reduction of sunlight disrupts your body’s internal clock, leading to feelings of “being off”, which often leads to melancholy.

A drop in serotonin, the brain neurotransmitter which affects disposition, could play a role in SAD. Reduced sunlight can cause a drop in acidity that may also trigger depression. Similarly, changes in seasons may disrupt the balance of melatonin in the brain. Melatonin plays a prominent role in deciding sleep patterns, stress levels, and overall mood.

Symptoms of SAD

You may have SAD if you’ve experienced:

• A decrease of interest in usual activities.
• Excessive eating and craving of carbohydrates, such as pasta and bread.
• Unexpected weight gain.
• In increase of sleep but a lack of energy.
• Troubles concentrating.
• Feeling of heaviness in the arms and legs.
• Periods of oversleeping.
• Relationship Issues.
• Feelings of worthlessness or guilt.
• Troubles concentrating or making decisions.
• Thoughts of death or suicide, or attempts at suicide.

SAD symptoms are similar to the symptoms of a clinical depression. Clinical depression symptoms include a depressive mood, feelings of despair, a lack of energy, trouble concentrating, changes in appetite and sleep, a lack of enjoyment or interest in activities and hobbies, and thoughts of suicide or death.

Those with the common wintertime SAD will experience depression starting around the same time and getting better when the seasons change for a minimum of two consecutive years.

It can be difficult to distinguish the difference between SAD and other kinds of depression because many of the signs are exactly the same. To diagnose SAD, your physician will typically perform a mental health assessment to get a better idea of how you are feeling in order to recognize patterns in your moods.

Again, SAD is a kind of depression that is related to changes in seasons—it begins and ends about the same time each year. If you’re like many people with SAD, your symptoms begin in the autumn and continue in the winter months, sapping your energy and making you feel stressed.

Treatment for SAD

Light therapy

Light therapy involves artificial exposure to “sunlight” via UV lamps emitting at least 2,500 lux. “Sad lamps” are particularly helpful in the winter when we are expected to start our days but it is still dark outside. These lamps will help to restore our out of sync circadian rhythm. In order for sad lamps to be effective, make a routine of getting at least 10-30 minutes of exposure in the morning before starting your day.

There are two variations of light therapy:

• Bright light therapy. For this therapy, set the light box on a table or nightstand and get at least 20 minutes of bright lux.
• Morning simulation. With this treatment, a dim light goes on in the morning as you are sleeping, and increasingly becomes brighter, simulating a sunrise.

Light boxes use fluorescent lights which are brighter than indoor lights, although not as bright as sunlight.
Light therapy is typically prescribed for thirty minutes to two hours per day. The quantity of time depends on how strong the light is and where you are in your daily routine.

In order for light therapy to be effective, a daily habit of using the box should be established. Talk to your doctor if you need help finding which light box is right for you.

Antidepressants

Antidepressants have been shown to be effective for people demonstrating extreme symptoms of SAD. With any medication, you should be certain that this is something you want to take. Patience will also be important when discovering which medication and dosage works best for you. Ask your doctor if you’re interested in antidepressants, and together you can figure out which path is best to take.

• Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and sertraline (Zoloft). SSRIs are often tried first.
• Other antidepressants, such as bupropion (Wellbutrin) and venlafaxine (Effexor).

If your doctor prescribes an antidepressant, follow the dosage and instructions carefully. Don’t stop taking them suddenly, as this could cause symptoms to worsen. The key to success with antidepressants is incremental change and following instructions carefully, and knowing your body and its limits.

Counseling

Counseling may also help. Some types of counselling, such as cognitive-behavioral therapy (CBT) and interpersonal therapy, can help you learn how to control your symptoms and how to help prevent future episodes. Group therapies can also be helpful, especially if you are still trying to figure out how to live with SAD. A psychotherapist can help you identify patterns from negative thinking and behavior that impact melancholy, learn positive methods of coping with symptoms, and also institute comfort methods which could help you restore missing energy.

Other ways of treating SAD

Along with seeking help from your physician, it is important to consider how lifestyle changes can improve symptoms or prevent future episodes. It is important to get as much exercise and exposure to the outdoors as possible. Avoiding drugs and limiting alcohol will be beneficial in keeping your brain healthy and happy. You should also maintain a healthy, balanced diet. Make sure to get plenty of sleep (while not oversleeping) and maintain a healthy sleepy schedule. Developing healthy patterns of thought will also be beneficial—many people look into meditation therapy as a means of keeping a calm and clear mind.

Planning a healthier lifestyle is never a bad idea, but don’t beat yourself up if your symptoms don’t improve straight away. Asking for help and making small lifestyle changes is the best place to start. With determination and work, SAD can be managed and begin to take smaller effect on your life.

Moderate exercise like walking, riding a stationary bike, swimming or walking are excellent forms of exercise. The relationship between exercise and brain health has been continuously researched. Getting a good, regular amount of exercise can help minimize the effects of seasonal depression.

Individuals may wish to try alternative treatments. For example, the hormone cortisol may help regulating stress levels. If you wish to explore alternate medications or remedies, make sure you consult your doctor first. These medicines can interact with medications and possibly cause more severe problems.

Is SAD a “lighter” version of big depression?

No, this is a common misconception. SAD is a sub-type of clinical depression. Individuals who have Seasonal Affective Disorder undergo symptoms of depression for only part of the year. When the season shifts, symptoms of depression decrease. If you find this change occurring several times over a couple of decades, you likely have some form of Seasonal Affective Disorder.

When to Call a Physician

It is common to have days in the wintertime when you feel sluggish or melancholy. However, if these days add up and occur for weeks at a time, this can be a larger issue. If you begin to notice major changes in your eating or sleeping, or a general disinterest in daily routines and activities, you may want to seek physician care. Catching SAD early may allow for easier treatment and a quicker return to your normal routine. If you are having suicidal thoughts, seek professional help immediately.

How do I get the best care for SAD?

It is never too late to seek care in treating SAD. Looking into your options is the best way to start recovering from recurring SAD. UV light boxes/sad lamps are an easy step you can take in insuring your brain gets the amount of sunshine its used to getting in summer months. Making sure you take the time to care for yourself and your body is the most important. Be sure you get plenty of rest, exercise, and maintain a well-balanced diet. For further care, consider finding a therapist knowledgeable on depression and treating SAD. There are many options for receiving help.

There are things to consider during your initial meeting with your physician, including:

• What may be causing symptoms instead of SAD?
• What treatments have your patients found helpful in the past?
• Are there any lifestyle changes I should make today to help my mood?
• Is there beneficial reading material on SAD that they would recommend?

When you’re at the doctor’s office, they may conduct a physical exam or lab tests to rule out other causes for your symptoms. The physician may also suggest that you see a mental health professional in order to receive a more thorough assessment.

In Summary

SAD can be effectively treated in a number of ways, including light therapy, antidepressant medication, therapy or some combination of treatments. While symptoms will generally improve by themselves with the changing of the seasons, symptoms can improve more quickly with external help.

Light therapy involves sitting in front of a light box (“sad lamp”) which emits very bright light, emulating sunlight. Most people sit in front of light boxes for about twenty minutes each morning. With regular use, you may see improvements from light therapy within a couple of weeks. However, to keep the benefits and prevent relapse, treatment is generally continued throughout winter. Because of the anticipated return of symptoms in late fall, some people routinely begin light therapy in early autumn to help prevent early symptoms.

Therapy, especially cognitive behavior therapy, is beneficial in treating and dealing with SAD.

Caring for your overall health and wellness can also help—regular exercise, healthy eating, getting enough sleep, and staying busy and connected (such as volunteering, participating in class tasks and getting along with family and friends) can also help.

If you think you have symptoms of SAD, seek the support of a trained medical practitioner. Just as with other forms of depression, it is important to make sure there is not any other medical condition causing your symptoms. A mental health professional will diagnose the condition and discuss therapy options. With the correct therapy, SAD can be manageable, and a healthy life can be lead.