How to Cope with Seasonal Affective Disorder (SAD)

Understanding Seasonal Affective Disorder (SAD)

It’s supposed to be the most wonderful time of the year—except for six percent of the population that suffers from seasonal affective disorder (SAD). As winter approaches, the seasonal change can intensify or cause depression in many people suffering from SAD. But there are things you can do to take care of your mental health, such as talk therapy and antidepressant medication. As the days get shorter, the temperatures drop, and there is less sunlight, here’s everything you should know about seasonal affective disorder and steps to take if you’re experiencing the winter blues.

What is Seasonal Affective Disorder?

Seasonal affective disorder, also known as seasonal depression or SAD, is a type of depression that is triggered by seasonal changes. This mood disorder commonly occurs during the colder fall and winter months. A milder form of the condition is called winter blues. Clinical depression can last throughout the year, but if your symptoms only appear during a particular season (winter depression or summer depression), you may be experiencing SAD. 

Prevalence of Seasonal Affective Disorder

According to the American Psychiatric Association, about 6% of the U.S. population experiences seasonal depression, and another 14% suffers from a less intense form of seasonal mood changes known as winter blues.

The risk of seasonal affective disorder increases with age. This mental health condition usually begins in young adulthood (in the 20s and 30s). It is rare in people under 20 years of age. Women are affected by SAD more than men.

Notably, the terms “seasonal depression” and “winter blues” are often used interchangeably; however, it’s not entirely accurate. Even though seasonal depression and winter blues share many symptoms, winter blues are usually less intense than seasonal depression. 

Seasonal Patterns and Onset

In most cases, symptoms from SAD begin during late fall or early winter and go away during the brighter days of spring or early summer. This is called winter depression. Although less common, some people may experience spring-onset SAD—depression that occurs during the warmer months. This is called summer depression.

According to the National Institute of Mental Health, affected individuals typically experience SAD symptoms for about 4-5 months of the year. As mentioned, winter SAD is more common than summer SAD. About 30-50% of people do not have a recurrence of the depression symptoms every winter. However, roughly 40% of people with seasonal affective disorder continue feeling sad after the winter season is over and spring and summer come around, which can lead to a diagnosis of other mental illnesses such as major depression or bipolar disorder.

Impact on Daily Life

Seasonal affective disorder (SAD) causes sleep, mood, and behavior changes that can disrupt daily life. For example, you may oversleep, causing you to fall behind on work. Or you may overeat and gain weight, further worsening your depression symptoms. Irritability and other mood changes related to SAD can affect relationships and overall well-being. It’s important to have SAD treated because, if left untreated, it can put you at risk of other problems like substance abuse as a coping mechanism.

Seasonal Affective Disorder Symptoms

Common Symptoms: What Are 5 Symptoms of Seasonal Affective Disorder?

• Depression symptoms and negative thoughts such as sadness, hopelessness, and worthlessness.

• Mood changes such as restlessness, irritability, and agitation.

• Physical symptoms such as sluggishness, listlessness, and tiredness.

• Sleep changes, such as hypersomnia (oversleeping) or trouble sleeping.

• Appetite changes and weight gain.

Atypical Symptoms

The following are considered atypical or less common symptoms of seasonal affective disorder:

• Social withdrawal and loss of interest in activities.

• Increased appetite, overeating, and weight gain.

• Carbohydrate cravings for starchy and sweet foods.

• Hypersomnia (oversleeping) or other disturbances in sleep patterns.

• Fatigue, with an afternoon or evening slump.

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SAD vs Other Mood Disorders

What’s the Difference Between SAD and Major Depressive Disorder?

Major depressive disorder causes prolonged sadness that is unrelated to seasonal changes. Seasonal affective disorder is associated with depressive symptoms only during certain times of the year. Learn more: What Are The 10 Types Of Depression?

Is Seasonal Affective Disorder the Same as Bipolar Disorder?

No, seasonal affective disorder is not the same as bipolar disorder. Bipolar I disorder and bipolar II disorder are conditions characterized by extreme mood swings and alternating depressive and manic episodes. 

However, people with bipolar disorder are at increased risk of experiencing seasonal depressive episodes. Some people with bipolar have mood swings in relation to the seasons, where they experience depressive episodes during the fall and winter months and mania or hypomania in the spring and summer months. 

Causes and Risk Factors

Biological Factors

According to experts in mental health services at Cedars Sinai, less sunlight can trigger chemical changes in the brain that can make you feel sluggish and sad. SAD occurs at about the same times every year because decreased exposure to sunlight disrupts the body's internal clock and causes feelings of depression. A fall in serotonin levels is believed to play a role in the development of SAD. Serotonin is a brain chemical (neurotransmitter) that regulates mood.

There are also studies and clinical trials linking melatonin, a sleep-related hormone, to SAD. Melatonin helps to regulate the body’s circadian rhythm or natural sleep-wake cycle. Darkness prompts melatonin to be produced in the pineal gland in the brain. When the days are shorter and darker, more melatonin is made, leading to hypersomnia (increased sleep duration or excessive daytime sleepiness).

Vitamin D deficiency has been found in people with SAD. This may be due to less sunlight exposure and/or low dietary intake of vitamin-D rich foods. However, research has not shown clearly that taking vitamin D supplementation can prevent or relieve SAD symptoms.

Environmental Triggers and Risk Factors

The low levels of sunlight in the fall and winter months are the main environmental triggers for winter-onset SAD. Other risk factors include:

• Female gender.

• Age in the 20s and 30s.

• Living at northern latitudes, far from the equator.

• Family history of SAD or other mental health conditions such as depression or bipolar disorder.

Personal and Genetic Predispositions

Scientists believe that variations in certain genes that regulate the circadian rhythm and the levels of brain chemicals can make some people more sensitive to seasonal changes, leading to the development of seasonal affective disorder in these individuals. However, there is no clear pattern of inheritance for the condition. We only know that the risk of having SAD is higher in people who have a first-degree relative (parent, sibling) with SAD. 

Notably, many people with seasonal affective disorder have relatives with psychological conditions and mood disorders such as major depressive disorder, anxiety disorders, panic disorder, eating disorders, bipolar disorder, and schizophrenia.

People with seasonal affective disorder are also more likely to be diagnosed with other mental health conditions such as depression, anxiety, bipolar disorder, eating disorders, and neurological conditions such as attention deficit hyperactivity disorder (ADHD). 

Diagnosis of Seasonal Affective Disorder

Diagnostic Criteria: How is SAD Diagnosed?

A mental health professional can make a diagnosis of seasonal affective disorder based on guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). The diagnostic criteria for SAD is:

“Depression with a seasonal pattern, including having depression that begins and ends during a specific season every year (with full remittance during other seasons) for at least two years and having more seasons of depression than seasons without depression over a lifetime. Seasonal pattern disorders occur most frequently in winter, although they can also occur in summer.”

Effective Use of Diagnostic Tools

Doctors also use diagnostic tools and questionnaires such as the Seasonal Pattern Assessment Questionnaire (SPAQ) to screen for and diagnose SAD. The answers you provide to the questions in SPAQ can give your healthcare provider useful information and allow them to score you on the Global Seasonality Score or GSS. The GSS is a specific number that tells healthcare professionals if SAD is present and its severity.

Role of Healthcare Professionals

It’s important to seek care for symptoms of seasonal affective disorder. This is a treatable condition that can benefit from antidepressant medications as well as non-drug treatment options.

Treatment Options and Management Strategies: How Do People Cope with SAD?

It’s normal to feel down once in a while, but if it’s a recurring feeling, you may want to seek treatment. Light therapy, exposure to sunlight, psychotherapy, medications, stress management, a healthy diet, and physical exercise are the most popular ways to treat SAD symptoms.

Light Therapy

Light therapy, also known as phototherapy or bright light therapy, is a treatment that aims to replace the reduced amount of sunshine in the winter months with bright artificial light.

You can purchase a light box for this purpose. This device emits a full spectrum of very bright light, similar to sunlight, but filters out ultraviolet (UV) rays. Light boxes provide 10,000 lux of cool-white fluorescent light, which is 20 times more than the typical indoor light.

Sitting in front of the light box every morning for 20-60 minutes from early fall before SAD begins to the warmer spring months can help. In some Scandinavian countries, there are light rooms available for preventive treatment, where you can sit in indirect, evenly distributed light, but these are not common in the United States. 

Possible side effects of light therapy may include eye strain, headaches, difficulty sleeping, irritability, and an increased risk of eye conditions such as age-related macular degeneration.

Medication Options

Your doctor may prescribe antidepressant medications to manage the symptoms of seasonal affective disorder. These may include:

• Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs), for example, fluoxetine (Prozac), escitalopram (Lexapro), sertraline (Zoloft), and others. You may be able to take an SSRI starting in the fall months and stopping in the spring.

• Other antidepressants such as bupropion (Wellbutrin XL) extended-release tablets.

• Vitamin D supplements and other supplements such as St. John's Wort. Keep in mind that while St. John’s Wort supplements are widely accessible and can be used during the colder months to help with depression symptoms, you should check with your doctor before using these supplements as they can interact with other medications, causing harmful adverse effects.  

Psychotherapy

Cognitive behavior therapy (CBT) with a trained therapist can help you cope with SAD. This is a type of talk therapy or psychotherapy that can be provided in individual and group formats, both in-person and online. The therapist can help you understand your negative emotions and feelings and change the way you think to more positive, healthy patterns. They can also teach you coping skills for managing your sad mood and low energy. 

Lifestyle Modifications and Self-Care Habits: How Do You Overcome SAD?

Doctors recommend the following lifestyle modifications and self-care measures to manage the depression and emotional distress related to SAD: 

• Eat healthy, well-balanced meals that include proteins, fresh fruits and vegetables, and unprocessed whole foods. Limit processed foods and sugary foods and beverages.

• Get regular exercise, such as walking, preferably outdoors in natural light.

• Practice stress management techniques, such as deep breathing, mindfulness, meditation, and yoga.

• Avoid social withdrawal and maintain a sense of community by keeping in touch with family and friends.

• Spend time outdoors or plan winter trips to sunny locales.

Coping Mechanisms and Prevention

Daily Habits to Mitigate Symptoms

Dr. Norman E. Rosenthal, the psychiatrist who first identified SAD in the 1980’s recommends:

“A 20-minute early morning walk in the sun is as good as commercial light therapy, but while morning is best, whenever you can do a walk is helpful. The combination of exercise and outdoor light is crucially important. It connects you with your environment — not just the light but also the birds, trees, animal life, neighborhood — all can act as an antidote to the cocoon of isolation.”

If you live in a seasonal climate, remember that the gloominess is only temporary and there are still ways to find purpose and joy in each day. 

Support Networks and Resources

Support groups such as the Depression and Bipolar Support Alliance (DBSA) offer in-person and online resources to find a community, share your experiences with seasonal affective disorder (SAD) in a safe, welcoming space, and get tips from others with this condition on how to treat SAD.

Long-Term Management and Relapse Prevention

You can take steps to prevent or lower the risk of seasonal affective disorder (SAD) by:

• Making your home and environment brighter and sunnier. To this end, keep your blinds open, trim tree branches in the fall that might block sunlight in the winter months, and consider adding skylights to your home. 

• Spend time outdoors and get regular exercise.

• Maintain a regular sleep schedule.

• Eat a well-balanced diet.

Is Seasonal Depression a Disability?

Seasonal depression or seasonal affective disorder (SAD) may be considered a disability in some circumstances. It is a legitimate diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). Like other mood disorders, SAD can vary in severity. 

You may qualify for disability under the Equality Act 2010 if your healthcare provider diagnoses you with SAD and it impacts your daily life. The Americans with Disabilities Act (ADA) also provides employees with SAD with reasonable accommodations. In addition, SAD may be considered a serious medical condition under the Family and Medical Leave Act (FMLA), allowing up to 12 weeks of leave for treatment and appointments.

If you are experiencing a mental health crisis, go to an emergency room, call the National Suicide Prevention Lifeline (1-800-273-8255), or visit the National Alliance on Mental Illness site (nami.org) for additional resources.