You may brush it off as the “winter blues,” but the feeling of depression, moodiness, and depleted energy that plagues you during the winter months can negatively impact your quality of life.
Seasonal affective disorder, commonly known as SAD, is a form of depression that comes around the same time of year. As the name suggests, SAD is impacted by the change in seasons, typically in the fall and winter, and can last into the spring and early summer. The Diagnostic Manual of Mental Disorders (DSM-5) identifies it as “major depressive disorder with seasonal pattern.”
Seasonal affective disorder that begins in the late fall or early winter is called winter-pattern SAD or winter depression and is the most common; however, some will experience it during the summer months. When these symptoms of depression occur in the spring and summer, it is known as summer-pattern SAD.
Each year, millions of Americans suffer from SAD though the majority don’t have a formal diagnosis or know they have it. Estimates suggest that 5% of adults in the United States deal with SAD, lasting about 40% of the year.
According to the National Institute of Mental Health, SAD affects more women than men, and it’s more likely to impact those who live north and experience harsher winters. For example, those living in Alaska or New York are more at risk for SAD than those living in Florida.
Symptoms of SAD
Many of the symptoms of SAD are similar to depression. This can include:
- Changes in appetite
- Difficulty concentrating
- Weight gain or weight loss
- Feeling depressed (almost every day)
- Thoughts of death or suicide
- Insomnia or trouble sleeping
- Daytime sleepiness and fatigue
- Aggressiveness or violent behavior
- Persistent low energy
- Feelings of hopelessness or worthlessness
- Increased anxiety
- Difficulty making decisions or concentrating
- No longer interested in activities you were interested in previously
These symptoms are used to diagnosis a person with SAD. A mental health specialist or health care provider may diagnose an individual with SAD if they have many of the symptoms listed here and they occur during specific months for a minimum of 2 consecutive years. This is how a health care provider can differentiate between SAD and standard depression. These symptoms will often begin to appear between 18 and 30 years of age and can potentially worsen with age.
SAD Risk Factors
As mentioned previously, millions of people suffer from SAD, and women in northern locations are more likely to experience it. Further, there are additional risk factors that can make individuals more prone to seasonal affective disorder.
People with major depressive disorder or bipolar disorder are at a higher risk. More specifically, those with bipolar II disorder, which is characterized by hypomanic and depressive episodes, are at the highest risk. In addition, other mental illnesses like panic disorder, anxiety disorder, eating disorders, or attention-deficit/ hyperactivity disorder (ADHD) can make individuals more at-risk for SAD.
Many mental health disorders can run in families, and SAD is one of them. The NIMH has stated that SAD is more common in people who have family members with other mental health issues like schizophrenia or major depression.
Causes of SAD
Though it’s clear these symptoms come on during certain seasons, the reason why isn’t as obvious. Scientists have not pinpointed the cause though some research suggests it has to do with serotonin. Serotonin is a neurotransmitter that regulates mood, and studies have found that those with SAD have reduced serotonin activity.
Sunlight helps maintain normal serotonin levels, but it appears that with SAD, the regulation doesn’t function as it should, which causes serotonin to decrease in the winter.
Additional research has found that those with SAD may have too much melatonin. Melatonin is a hormone needed to maintain normal sleep-wake cycles and is commonly found in natural sleep aids. When you don’t have enough melatonin, you can have trouble sleeping, but when there is an overproduction, it can increase daytime sleepiness.
The combined changes in melatonin and serotonin disrupt the body’s daily rhythm. This makes it difficult for these individuals to adjust to common seasonal changes like reduced daylight and sunlight, less time outdoors, and cooler temperatures.
Other research suggests that a deficit in vitamin D can exacerbate these issues. Vitamin D is believed to promote serotonin activity and is produced when your skin is exposed to sunlight. When fewer daylight hours and less time are spent outdoors, many people's vitamin D levels drop, hindering serotonin activity.
With a vague understanding of the cause of SAD, there isn’t a simple cure. That said, there are ways that you can fight it and improve your quality of life during the winter months. The most common strategies to treating seasonal affective disorder fall into four categories: psychotherapy, prescription medication (antidepressants), light therapy, and vitamin D supplementation.
There are different types of psychotherapy that may be used to treat SAD, but the most common is Cognitive Behavioral Therapy (CBT).
This form of talk therapy helps individuals cope with difficult situations. In addition, a form of CBT has been developed to treat SAD specifically and is known as CBT-SAD. These sessions are typically held in groups for a period of 6 weeks and focus on replacing negative thoughts about winter with more positive ones. It also encourages people to engage in different activities to fight the loss of interest they may be experiencing.
CBT-SAD can be delivered on its own or combined with other remedies like light therapy, supplementation, or medication. Light therapy has been the most common treatment for SAD since the 1980s. During a light therapy session, a person will sit in front of a lightbox for 30 to 45 minutes first thing in the morning. These lightboxes are very bright at about 10,000 lux, which is 20 times brighter than ordinary indoor lights. They filter out damaging UV light, making it a safer option than tanning beds. Many see an improvement within two weeks of use and can continue to benefit as long as light therapy is completed every day throughout the winter.
Additionally, individuals with SAD may be prescribed an antidepressant. As it is a form of depression with disturbances in serotonin activity, certain medications like selective serotonin reuptake inhibitors (SSRIs) can help. These medications aim to enhance an individual’s mood and reduce symptoms of SAD. In addition, the FDA has approved an antidepressant known as bupropion to prevent recurrences of seasonal major depressive episodes. This medication is taken daily from the fall to early spring.
Lastly, increasing vitamin D is an easy and natural option to fight SAD. Because those with SAD often have a deficiency, supplementing can reduce symptoms. You can take vitamin D supplements on your own or look for a multivitamin that contains it.
If you regularly take melatonin to help with sleep but experience increased sleepiness in the winter, you should cut back. If you have an overproduction of melatonin, taking melatonin supplements could be making you even more tired.
If you know you have SAD, you can put these measures in place before it begins. The predictable nature of seasonal affective disorder allows individuals to take preventative measures to prevent or reduce the depression they experience in the winter months. It is best to speak with your health care provider to determine which treatment option is best for you.
Some mental health experts believe there are additional “SAD hacks” to reduce the symptoms. For example, psychiatrist Melva Green told the Washington Post that cleaning and organizing your home could help improve mood. Removing the clutter, tossing away broken items, and doing a deep clean can make you feel more positive.
Start in your bedroom and try moving your furniture around to get more natural light. In the same article Kate Hanselman, a psychiatric mental health nurse, suggests moving your bed closer to the window so you can see as much sun as possible.
You can also brighten up your space with a fresh coat of paint in a light color and new, crisp white Tencel sheets.