Seasonal Affective Disorder (SAD) is sometimes referred to as the “winter blues” by the general public, which can be a bit misleading for those that truly suffer from the disorder. While a mild form of the “winter blues” (feeling more lethargic, sad, or unmotivated during the winter season) affects around 10-20% of the US population, full symptoms of Seasonal Affective Disorder accounts for closer to 5% of the US population and must meet the criteria for a full depressive episode.

SAD symptoms can include feeling down or sad most of the day for most days, losing interest in previously enjoyable activities, feelings of hopelessness or worthlessness, reduced energy, trouble concentrating or brain fog, increased feelings of guilt, sleeping excessively, and suicidal thoughts.

Seasonal Affective Disorder is currently diagnosed as Major Depressive Disorder with a seasonal pattern and is characterized by recurrent depressive episodes that occur at the changes of seasons, usually beginning in the fall/winter months and resolving itself in the spring/summer months. Without treatment, the depression symptoms can last for months and reoccur for years. To be diagnosed with Seasonal Affective Disorder, an individual must have previously experienced their seasonal depression episodes for at least two consecutive years.

SAD is typically an adult disorder, rarely occurring in individuals under 20, and occurring more often in women than men. It is more common in those with a personal or family history of Depression and those who have Bipolar Disorder.

While it is less common, seasonal depression can also occur at the start of the spring/summer months and resolve itself in the fall/winter. The two types may look a bit different though.

Causes and Treatments

Like many mental health issues, there is a biopsychosocial component to SAD, meaning that there are biological, environmental, and psychological factors that contribute to the illness, which is why the causes and treatments can often involve all of these areas.

Seasonal Affective Disorder is often linked to changes in exposure to sunlight, which can impact one’s internal production of melatonin, causing them to overproduce or under-produce, as well as impacting one’s ‘internal clock’ that regulates our hormones, sleep cycles, and mood. This internal clock is called our circadian rhythm. While exposure to light is not the only way our circadian rhythm is activated or inhibited, the lack of light in winter months, or regions further from the equator, can have a strong impact on our circadian rhythm. Disruptions to our circadian rhythm can have significant impacts on sleep, mood, and our mental health.

Changes in exposure to sunlight can also impact our absorption of Vitamin D, which can impact our serotonin levels and mood. Light therapy treatment is a common recommendation for SAD, which I’ll discuss further in a moment.

Also, individuals who have previously experienced seasonal depression can build negative thought processes regarding those seasons that they’re most impacted by. These negative thoughts and their desire to escape those seasons can increase their anxiety and stress leading into those months, negatively impacting depressive symptoms. This can become a vicious cycle as depressive symptoms can increase self sabotaging or maladaptive behaviors or thoughts.

Finally, a family history or personal history of Depression or Bipolar Disorder can increase one’s risk for seasonal depression, so treatment could include Antidepressants or SSRI medications to treat one’s specific diagnosis.

Treatment would be prescribed by your doctor or psychiatrist and can often include a combination of medication to treat the depressive episode, light therapy to increase exposure to sunlight, increasing Vitamin D absorption in one’s diet or through supplements, and therapy to reduce maladaptive thoughts and behaviors as well as building healthier habits and responses. It is important that your provider knows if you are suffering from Depression or a form of Bipolar Disorder because it can impact what your treatment recommendations are.

As I mentioned, many providers also recommend that you meet with a therapist to incorporate Cognitive Behavioral Therapy (CBT) strategies to address negative thoughts, feelings, and behaviors regarding your specific depressive seasons as well as your current depression needs. Your negative feelings about fall or winter could be a symptom of your seasonal depression as well as a contributing factor. If you develop maladaptive behaviors to cope with your negative feelings during those months, like increased drinking or drug use, they can also be contributing to SAD. Therapy services can help you identify and address these relationships between your thoughts, feelings, and behaviors that can be impacting your mental health.

If you’re feeling confused about the differences between a therapist and a psychiatrist or prescribing doctor, you can check out my previous blog here:

Phototherapy

Phototherapy, or light therapy, is the use of a special light to help treat seasonal affective disorder. It is considered a first line treatment choice for CANMAT Depression Treatment guidelines for seasonal affective disorder. It uses indirect exposure to a lamp above 10,000 lux for about 30 minutes daily. It is recommended that exposure occurs early in the day, often by 8 am and no later than noon and is done consistently for about 4-6 weeks. Most individuals should see improvements in 1-2 weeks.

It is believed that phototherapy impacts our neurotransmitters’ interactions within our brain and may help impact our circadian rythmn.

Before you purchase a light talk to your doctor or psychiatrist about Seasonal Affective Disorder if you are experiencing symptoms of depression. They can help you develop treatment guidelines specific to your needs as well as navigate insurance coverage. Again, it is important that your prescriber knows if you are suffering from Depression or Bipolar Disorder because it can impact what your treatment recommendations are.

If you are experiencing only mild symptoms for less than 2 weeks, these are some strategies to help you address them. If your symptoms worsen or last longer than 2 weeks, you can reach out to your doctor or provider to discuss any possibilities of seasonal affective disorder and develop a treatment plan.

• Spend time outdoors in the sunlight; try to be in the sun periodically throughout the day to improve sleep at night

• Engage in activities you enjoy, even if you’re not as motivated to do so as usual

• If you have a job that limits your exposure to natural light, be sure to take breaks outdoors or near windows when able, especially in early morning hours- even 15 minutes can be impactful to your circadian rhythm

• Eat healthy foods; avoid highly processed or high sugar foods

• Spend time with positive support systems

• Keep napping short and try to maintain a good sleep schedule

• Go for a walk or increase light activity

• Make sure you are getting enough Vitamin D in your food

• Talk to your doctor about any concerns

Also as we head into the cold and flu season, be aware of how colds and viruses can also be impacting your mental health or depression symptoms here: