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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Many of us feel a little bit sad when winter approaches. The days feel shorter, the weather gets darker and colder, schedules get busier, and the holidays add stress.
But if this sadness is severe enough to affect your ability to function on a day-to-day basis, it might be more than just the winter blues. You might be experiencing a condition known as Seasonal Affective Disorder, or SAD.
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What is seasonal affective disorder (SAD)?
SAD is a condition that causes mood disturbances—either depression, mania, or both. Roughly 5% of people in the United States experience it each year, and it’s most common between ages 20–30 (Kurlansik, 2012; Magnusson, 2005).
While SAD symptoms are similar to a handful of mental health conditions, it’s really classified as a sub-type of depression or bipolar disorder. But SAD is different from other mood conditions because seasonal changes trigger symptoms (Uher, 2013; Meesters, 2016).
Symptoms of SAD
If we look at the silver lining, symptoms of SAD aren’t constant throughout the year. They begin during specific seasonal transitions, usually starting in late fall or early winter and improving when spring starts.
You might have heard it called winter depression because it’s so much more prevalent as the days get shorter and darker. Common symptoms of SAD include (APA, 2020):
- Depressed or sad feelings
- Trouble concentrating
- Excessive tiredness
- Sleep changes, particularly sleeping too much
- Loss of interest and ability to enjoy things you usually like
- Increased appetite, especially for carbs like pasta and bread
- Abnormal movements like fidgeting, pacing, or slow speech and movement
- Suicidal thoughts
Depression vs. SAD: what’s the difference?
Some symptoms of SAD––like unhappiness, trouble focusing, and excessive fatigue––are very similar to the symptoms of major depression. However, there are some differences.
For example, SAD symptoms often decrease on days that are bright and sunny. Symptoms of Major Depression are unlikely to fluctuate based on the weather. With depression, sleep changes are common. More than 85% of people with depression experience insomnia and trouble falling asleep. In SAD, the opposite is true—most people sleep excessively and have difficulty staying awake (Geoffroy, 2018).
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Diet and appetite are also affected differently. If you’re depressed, your appetite usually decreases, which might lead to weight loss. But with SAD you often feel hungrier. Many people with SAD report uncontrollable cravings––especially for carbohydrates and starchy foods. This can lead to overeating and increased weight gain (Westrin, 2007).
How do you diagnose SAD?
If you’re experiencing symptoms of SAD, see a mental health professional who can help diagnose and find the best way to treat it.
They’ll do a careful interview with you to assess your symptoms. Then screening tools like the Seasonal Assessment Form or Seasonal Pattern Assessment Questionnaire are used to track your unique mood pattern based on the seasons.
What causes SAD?
There are several theories about what causes SAD. Many researchers suggest it’s related to the circadian rhythm, which is essentially your internal clock. These biological rhythms affect your mood, behavior, and other elements, and the changes occur on a 24-hour cycle.
Circadian rhythms are affected by the light-dark cycle. In winter there are fewer hours of sunshine, especially as you get further North, which increases melatonin production (a hormone produced when it’s dark) and reduces serotonin (a hormone that helps keep your mood stable). These hormonal changes can lead to depression (Sohn, 2005, Willeit, 2011).
Treatment options for SAD
Since darker days trigger SAD, can light exposure treat it? It turns out, it can.
Bright light therapy using a light box or SAD lamp is one of the primary treatments. Exposure to light at specific intervals, or gradually increasing light during the last hours of sleep (a technique called dawn simulation) can reverse some symptoms of SAD (Pail, 2011; Terman, 2006). Some studies suggest that dawn simulation has been more effective than other forms of SAD treatment (Avery, 2001).
Using light therapy for seasonal affective disorder (SAD)
Since serotonin levels are low in people with SAD, antidepressants that regulate serotonin (selective serotonin reuptake inhibitors or SSRIs) are another helpful option. In studies, the SSRI fluoxetine (see Important Safety Information) was as effective at treating SAD as light therapy. Another SSRI bupropion (see Important Safety Information) is FDA-approved to treat SAD (NAMI, 2016; Lam, 2006).
Psychotherapy and cognitive behavioral therapy are also helpful in treating SAD. Beyond therapy, there are also things you can do on your own to boost these effects. Regular sleeping patterns, good sleep hygiene, exercise, and time outdoors are all healthy ways that can reduce symptoms of SAD.
It’s essential to be aware that your winter blues may be something more serious––like SAD. Even though we don’t know precisely where SAD comes from, there are ways to treat it and improve your quality of life.
- American Psychiatric Association (APA). (2020). Seasonal Affective Disorder. Retrieved on Oct. 27, 2021, from https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder
- Avery, D. H., Eder, D. N., Bolte, M. A., Hellekson, C. J., Dunner, D. L., Vitiello, M. V., et al. (2001). Dawn simulation and bright light in the treatment of SAD: a controlled study. Biological Psychiatry, 50(3), 205–216. doi:10.1016/s0006-3223(01)01200-8. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11513820/
- Geoffroy, P. A., Hoertel, N., Etain, B., Bellivier, F., Delorme, R., Limosin, F., et al. (2018). Insomnia and hypersomnia in major depressive episode: Prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. Journal of Affective Disorders, 226, 132–141. doi:10.1016/j.jad.2017.09.032. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28972930/
- Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., et al. (2005). The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. The American Journal of Psychiatry, 162(4), 656–662. doi:10.1176/appi.ajp.162.4.656. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15800134/
- Kurlansik, S. L., & Ibay, A. D. (2012). Seasonal affective disorder. American Family Physician, 86(11), 1037–1041. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23198671/
- Lam, R. W., Levitt, A. J., Levitan, R. D., Enns, M. W., Morehouse, R., Michalak, E. E., et al. (2006). The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. The American Journal of Psychiatry, 163(5), 805–812. doi:10.1176/ajp.2006.163.5.805. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16648320/
- Magnusson, A., & Partonen, T. (2005). The diagnosis, symptomatology, and epidemiology of seasonal affective disorder. CNS Spectrums, 10(8), 625–14. doi:10.1017/s1092852900019593. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16041294/
- Meesters, Y., & Gordijn, M. C. (2016). Seasonal affective disorder, winter type: current insights and treatment options. Psychology Research and Behavior Management, 9, 317–327. doi:10.2147/PRBM.S114906. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138072/
- Meyerhoff, J., Young, M. A., & Rohan, K. J. (2018). Patterns of depressive symptom remission during the treatment of seasonal affective disorder with cognitive-behavioral therapy or light therapy. Depression and anxiety, 35(5), 457–467. doi:10.1002/da.22739. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29659120/
- Murray G. (2003). The Seasonal Pattern Assessment Questionnaire as a measure of mood seasonality: a prospective validation study. Psychiatry Research, 120(1), 53–59. doi:10.1016/s0165-1781(03)00147-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14500114/
- National Institute of Mental Health (NIMH). (n.d.). Seasonal affective disorder. Retrieved on Oct. 27, 2021, from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
- National Alliance on Mental Illness (NAMI). (2016). Bupropion. Retrieved on Nov. 2, 2021, from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Bupropion-(Wellbutrin)
- Pail, G., Huf, W., Pjrek, E., Winkler, D., Willeit, M., Praschak-Rieder, N., et al. (2011). Bright-light therapy in the treatment of mood disorders. Neuropsychobiology, 64(3), 152–162. doi:10.1159/000328950. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21811085/
- Sohn, C. H., & Lam, R. W. (2005). Update on the biology of seasonal affective disorder. CNS Spectrums, 10(8), 635–14. doi:10.1017/s109285290001960x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16041295/
- Terman, M., & Terman, J. S. (2006). Controlled trial of naturalistic dawn simulation and negative air ionization for seasonal affective disorder. The American Journal of Psychiatry, 163(12), 2126–2133. doi:10.1176/ajp.2006.163.12.2126. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17151164/
- Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2014). Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depression and Anxiety, 31(6), 459–471. doi:10.1002/da.22217. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24272961/
- Westrin, A., & Lam, R. W. (2007). Seasonal affective disorder: a clinical update. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 19(4), 239–246. doi:10.1080/10401230701653476. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18058281/
- Willeit, M., Sitte, H. H., Thierry, N., Michalek, K., Praschak-Rieder, N., Zill, P., et al. (2008). Enhanced serotonin transporter function during depression in seasonal affective disorder. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 33(7), 1503–1513. doi:10.1038/sj.npp.1301560. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17882235/
- Young, M.A., Hutman, P., Enggasser, J.L. & Meesters, Y. (2015). Assessing Usual Seasonal Depression Symptoms: The Seasonality Assessment Form. Journal of Psychopathology and Behavioral Assessment, 37, 112–121 (2015). doi:10.1007/s10862-014-9440-3. Retrieved from https://link.springer.com/article/10.1007/s10862-014-9440-3