What is Seasonal Affective Disorder?
Seasonal affective disorder (SAD) is a type of depression 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. Less often, SAD causes depression in the spring or early summer.
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 symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some 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.
Fall and winter SAD
Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:
- Tiredness or low energy
- Problems getting along with other people
- Hypersensitivity to rejection
- Heavy, “leaden” feeling in the arms or legs
- Appetite changes, especially a craving for foods high in carbohydrates
- Weight gain
When to See a Doctor
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 doctor. This is especially important if your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or turn to alcohol for comfort or relaxation.
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 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.
Factors that may increase your risk of seasonal affective disorder include:
- Being female. SAD is diagnosed more often in women than in men, but men may have more-severe symptoms.
- Age. Young people have a higher risk of winter SAD, and winter SAD is less likely to occur in older adults.
- Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
- Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it’s not treated. These can include:
- Suicidal thoughts or behavior
- Social withdrawal
- School or work problems
- Substance abuse
- Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad
Preparing for your appointment
Start by seeing your family doctor or primary care provider. Or you may start by seeing a mental health provider such as a psychiatrist or psychologist.
Before your appointment, make a list of:
- Your symptoms, such as feeling down or having a lack of energy
- Your depression patterns, such as when your depression starts and what seems to make it better or worse
- Any other mental or physical health problems you have — both can affect mood
- Any major stressors or life changes you’ve had recently
- All medications, vitamins or supplements you’re taking, including dosages
- Questions to ask your doctor, in order of priority
Don’t hesitate to ask questions anytime during your appointment.
Tests and diagnosis
To help diagnose seasonal affective disorder, your doctor or mental health provider may do a thorough evaluation, which generally includes:
- Physical exam. Your doctor 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 doctor 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 doctor or mental health provider asks about your symptoms, thoughts, feelings and behavior patterns. Your doctor may have you fill out a questionnaire to help answer these questions.
Treatments and drugs
Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
In light therapy, also called phototherapy, you sit a few feet from a special light therapy box so that you’re exposed to bright light. 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 two weeks and causes 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 therapy box, talk with your doctor 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.
Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year.
Psychotherapy, also called talk therapy, is another option to treat SAD. Psychotherapy can help you:
- Identify and change negative thoughts and behaviors that may be making you feel worse
- Learn healthy ways to cope with SAD
- Learn how to manage stress
Home Environment to Help Seasonal Affective Disorder
- Take a walk at lunchtime when the sun is high. Be outdoors as often as you can.
- Exercise as much as you are able.
- Take winter vacations in places with long days. If all else fails and you can manage it, spend time in a sunnier climate.
- Increase the natural light in your home by trimming low-lying branches near the house and hedges around windows.
- Paint your walls with lighter colors.
- Keep warm and enjoy the fun aspects of winter – such as wood fires, books, music.
- Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home.
- Sit closer to bright windows while at home or in the office.
- Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
Mind-body therapies that may help relieve depression symptoms include:
- Guided imagery
- Massage therapy
- Stick to your treatment plan. Take medications as directed and attend therapy appointments as scheduled.
- Take care of yourself. Get enough rest and take time to relax. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don’t turn to alcohol or illegal drugs for relief.
- Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
- Socialize. When you’re feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
- Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD or to cooler locations if you have summer SAD.
There’s no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time.
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.
If you can get control of your symptoms before they get worse, you may be able to head off serious changes in mood, appetite and energy levels.