Seasonal Affective Disorder: Symptoms And Treatment

“SAD is clinical depression—that’s one thing that’s commonly not understood,” says Kelly J. Rohan, Ph.D., professor and director of clinical training in the Department of Psychological Science at the University of Vermont.

“Most people have some symptoms in winter, especially at high latitudes,” she says. “The only thing that makes it different from regular depression is that it resolves as the seasons change.”

SAD was initially identified and named in the 1980s. Now, it’s officially recognized and identified in the Diagnostic and Statistical Manual for Mental Disorders as major depressive disorder with seasonal pattern.

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The cause of SAD is still largely unknown, but some studies suggest there may be a connection between SAD and reduced serotonin in the brain, a chemical that helps regulate mood. Research has shown sunlight helps maintain proper serotonin levels and people with SAD may suffer from lower levels during the winter. Other studies show that people with SAD produce too much melatonin—a hormone that helps the body keep a healthy sleep cycle—which can cause drowsiness.

Both of these chemicals are important in keeping a regular sleep cycle and daily rhythm. Altered levels of serotonin and melatonin could impact a person’s ability to adjust to seasonal shifts, resulting in changes in sleep, mood and behavior.

While 6% of the U.S. population experiences SAD, another 14% of Americans are thought to suffer from winter blues, a lesser form of SAD. Winter blues can cause the same symptoms as SAD, like decreased energy and productivity, but these signs aren’t as severe. For example, it was reported that while the general population sleeps 0.7 hours more in the winter, people with SAD sleep 2.5 hours more. However, people with the winter blues only sleep 1.7 hours more, when compared to those with SAD.

Contrary to popular belief, SAD isn’t exclusive to the colder weather seasons. In fact, about 10% of people with SAD have symptoms in the summer instead of winter. Similar to winter SAD, researchers aren’t entirely sure what triggers summer SAD, though heat and humidity, lack of structure and pressure to participate in social activities are thought to have an impact, among other reasons.

There’s not a lot of research around summer SAD. However, some studies suggest that climate change is making this depression more common, with one study finding the number of emergency room mental health-related visits linked to periods of high heat^[1]Lõhmus, M. Possible Biological Mechanisms Linking Mental Health and Heat–A Contemplative Review. Int J Environ Res Public Health. 2018 Jul;15(7):1515. . Additionally, climate change is worsening pollen seasons, and some studies have linked mood sensitivity and summer SAD to pollen.

SAD shares the same symptoms as depression. According to the National Institute of Mental Health, these include:

• Feeling depressed most of the day, almost every day
• Loss of interest in activities you once enjoyed
• Weight or appetite changes
• Sleep problems
• Low energy levels
• Sluggish or agitated feelings
• Difficulty concentrating
• Feelings of hopelessness or worthlessness
• Frequent thoughts of death or suicide

In addition to these symptoms, there are unique signs of both winter and summer SAD.

Fall and Winter Symptoms

Specific colder weather SAD symptoms can include:

• Oversleeping
• Social withdrawal or a desire to “hibernate”
• Overeating, specifically craving carbohydrates
• Weight gain

Spring and Summer Symptoms

Specific symptoms of warmer weather SAD can include:

• Insomnia
• Poor appetite and weight loss
• Restlessness and agitation
• Anxiety
• Episodes of violent behavior

No matter what time of year you’re experiencing symptoms, you don’t have to suffer through SAD alone. It’s important to seek help should you need it. If you feel you may be suffering from SAD, consider speaking with your doctor or a mental health specialist to review your symptoms and ways to manage them.

Who Is at Risk for Seasonal Affective Disorder?

SAD is more common in young people and women. If you or your family members have depression, you may also have a higher risk of SAD.

It’s also more likely for people living farther from the equator to experience winter SAD. The shorter daylight hours can make a big impact, and people who have experienced SAD in the past are likely to develop it again.

How is Seasonal Affective Disorder Diagnosed?

To be officially diagnosed with SAD, you must have symptoms of major depression during specific seasons for at least two years, and episodes must happen more frequently than other depressive episodes during the year, throughout the person’s lifetime. However, not all people with SAD experience it every year.

“I strongly advise people not to self-diagnose,” Rohan says. “SAD is a serious health condition and best left to trained professionals to evaluate and treat.”

Can Seasonal Affective Disorder Be Prevented?

People who have experienced SAD in the past can establish healthy habits to make the depression less likely. Being proactive can help prevent SAD from becoming deeply ingrained.

“If someone feels like they’re developing this pattern, act early—get evaluated and [get] treatment in place to head it off,” Rohan says. “The longer it goes untreated, the more ingrained the pattern becomes. But that doesn’t mean it’s hopeless. I’ve talked to people who said they’d felt this way for 40 years and we can still make a difference.”

There are therapies and lifestyle changes that can help improve the quality of life for people with SAD.

Diet

Eating a healthy diet can help prevent and treat depression. Studies have shown that the Mediterranean diet, some fish, and fresh fruits and vegetables can decrease the risk of depression. Green tea may reduce risk, due to its antioxidants that are thought to potentially improve symptoms of depression. On the other hand, high-fat Western diets have been linked to an increase in depression.

However, research hasn’t identified how diet can specifically help with the symptoms of SAD. Studies show that people with SAD often have specific food preferences, like craving carbs. And a 2016 study in Neuropsychobiology linked vegetarianism to an increased risk of SAD^[2]Targum SD, Rosenthal N.. Seasonal Affective Disorder . Psychiatry (Edgmont). 2008 May;5(5):31-33. . More research is needed to fully understand the relationship between nutrition and the disorder.

Light Therapy

With light treatment, people are exposed to bright, artificial light. Light therapy devices filter out ultraviolet rays and cast a controlled amount of white fluorescent or full-spectrum light. Sixty to 80% of people with SAD can benefit from light therapy, according to a 2008 study published in Psychiatry MMC^[3]Meesters ANR, Maukonen M, Partonen T, et al. Is There a Relationship between Vegetarianism and Seasonal Affective Disorder? A Pilot Study . Neuropsychobiology. 2016;74;202-206. .

But that doesn’t mean you should go out and buy a light therapy lamp. Instead, ask your doctor for a recommendation, as light products aren’t regulated by the U.S. Food and Drug Administration (FDA) and they aren’t all tested for efficacy. Finding the right dosage and timing for maximum benefits and minimal side effects requires a professional. So while light therapy can improve SAD symptoms, it’s not a DIY fix. Talk to your health care provider to learn more.

Sunlight Exposure

Spending time outside in the sunshine can help ease SAD symptoms. On a sunny day, the sun gives off 100,000 lux—compared to only 2,500 to 10,000 lux from a light therapy lamp. Taking a walk outside can couple sunlight exposure with exercise, which has antidepressant properties.

“Those of us who work in this field frequently recommend that therapy,” Rohan says. “You get two birds with one stone, especially with people who enjoy exercise.”

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a kind of talk therapy that develops mental and behavioral skills. When used for SAD, sessions focus on coping with the seasons. Skills like identifying, scheduling and engaging in enjoyable activities help patients fight the tendency to hibernate and the depressive moods that often come with SAD.

CBT has been shown to be just as effective against SAD as antidepressant medications. Research has also suggested that people who have CBT are less likely to relapse than those who just took medication.

Medication

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are often used to treat SAD. Examples of SSRIs are fluoxetine, citalopram, sertraline, paroxetine and escitalopram.

The FDA has also approved extended-release antidepressant bupropion to treat SAD. When taken daily, the medication can help prevent seasonal affective disorder from reoccurring.

Being self-aware and proactive can help you manage SAD.

“Find a professional and then work together on a treatment plan that’s right for you, whether it’s CBT, light, medication or a combination of those things,” Rohan says. She also suggests developing healthy habits to help fend off SAD.

“Stay active, see people and find ways to enjoy life in the winter whether it’s inside or outside,” Rohan says. “Resist the urge to hibernate, because that breeds depression. Be proactive—join a gym, take a class, have something in place to provide enjoyment in winter.”