Seasonal Affective Disorder
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. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. These symptoms often resolve during the spring and summer months. Less often, SAD causes depression in the spring or early summer and resolves during the fall or winter months.
Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.
Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.
In most cases, seasonal affective disorder (SAD) symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.
Signs and symptoms of SAD may include:
- Feeling listless, sad or down most of the day, nearly every day
- Losing interest in activities you once enjoyed
- Having low energy and feeling sluggish
- Having problems with sleeping too much
- Experiencing carbohydrate cravings, overeating and weight gain
- Having difficulty concentrating
- Feeling hopeless, worthless or guilty
- Having thoughts of not wanting to live
Fall and winter SAD
Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:
- Oversleeping
- Appetite changes, especially a craving for foods high in carbohydrates
- Weight gain
- Tiredness or low energy
Spring and summer SAD
Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:
- Trouble sleeping (insomnia)
- Poor appetite
- Weight loss
- Agitation or anxiety
- Increased irritability
Seasonal changes and bipolar disorder
People who have bipolar disorder are at increased risk of seasonal affective disorder. In some people with bipolar disorder, episodes of mania may be linked to a specific season. For example, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), anxiety, agitation and irritability. They may also experience depression during the fall and winter months.
The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:
- Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset seasonal affective disorder (SAD). This decrease in sunlight may disrupt your body’s internal clock and lead to feelings of depression.
- Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
- Melatonin levels. The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.
It’s normal to have some days when you feel down. But if you feel down for days at a time and you can’t get motivated to do activities you normally enjoy, see your health care provider. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide.
Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults.
Factors that may increase your risk of seasonal affective disorder include:
- Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
- Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
- Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.
- Low level of vitamin D. Some vitamin D is produced in the skin when it’s exposed to sunlight. Vitamin D can help to boost serotonin activity. Less sunlight and not getting enough vitamin D from foods and other sources may result in low levels of vitamin D in the body.
Take signs and symptoms of seasonal affective disorder (SAD) seriously. As with other types of depression, SAD can get worse and lead to problems if it’s not treated. These can include:
- Social withdrawal
- School or work problems
- Substance abuse
- Other mental health disorders such as anxiety or eating disorders
- Suicidal thoughts or behavior
There’s no known way to prevent the development of Seasonal affective disorder (SAD). However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time. You may be able to head off serious changes in mood, appetite and energy levels, as you can predict the time of the year in which these symptoms may start. Treatment can help prevent complications, especially SAD if is diagnosed and treated before symptoms get bad.
Some people find it helpful to begin treatment before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. Other people need continuous treatment to prevent symptoms from returning.
Even with a thorough evaluation, it can sometimes be difficult for your health care provider or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.
To help diagnose SAD, a thorough evaluation generally includes:
- Physical exam. Your health care provider may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
- Lab tests. For example, your health care provider may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
- Psychological evaluation. To check for signs of depression, your health care provider or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions.
Treatment for seasonal affective disorder may include light therapy, psychotherapy and medications. If you have bipolar disorder, tell your health care provider and mental health professional — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
Light therapy
In light therapy, also called phototherapy, you sit a few feet from a special light box so that you’re exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.
Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes very few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.
Before you purchase a light box, talk with your health care provider about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that’s safe and effective. Also ask about how and when to use the light box.
Psychotherapy
Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you:
- Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling meaningful activities
- Identify and change negative thoughts and behaviors that may be making you feel worse
- Learn how to manage stress
- Build in healthy behaviors, such as increasing physical activity and improving your sleep patterns
Medications
Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.
An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.
Your health care provider may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.
Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.
References
- Specifiers for depressive disorders: With seasonal pattern. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed July 15, 2021.
- Seasonal affective disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/. Accessed July 15, 2021.
- Seasonal affective disorder (SAD). American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder. Accessed July 15, 2021.
- Seasonal affective disorder: More than the winter blues. American Psychological Association. https://www.apa.org/topics/depression/seasonal-affective-disorder. Accessed July 15, 2021.
- Major depressive disorder with a seasonal pattern. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Major-Depressive-Disorder-with-a-Seasonal-Pattern. Accessed July 15, 2021.
- Galima SV, et al. Seasonal affective disorder: Common questions and answers. American Family Physician. 2020;102:668.
- Haller H, et al. Complementary therapies for clinical depression: An overview of systematic reviews. BMJ Open. 2019; doi:10.1136/bmjopen-2018-028527.
- Light therapy. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed July 15, 2021.
- Seasonal affective disorder and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/seasonal-affective-disorder-and-complementary-health-approaches-science. Accessed July 15, 2021.
- Safe use of complementary health products and practices. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/safety. Accessed July 19, 2021.
- Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/. Accessed July 19, 2021.
- Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression/. Accessed July 19, 2021.
- Rosenthal SJ, et al. Seasonal effects on bipolar disorder: A closer look. Neuroscience and Biobehavioral Reviews. 2020; doi:10.1016/j.neubiorev.2020.05.017.
- Gitlin MJ. Antidepressants in bipolar depression: An enduring controversy. International Journal of Bipolar Disorders. 2018; doi:10.1186/s40345-018-0133-9.
- Medical review (expert opinion). Mayo Clinic. Sept. 2, 2021.
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