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Seasonal Affective Disorder (SAD)

What is Seasonal Affective Disorder (SAD)?

It’s the middle of winter. It’s cold, it could be snowy or icy out, and it’s dark for more hours than it’s light. You may have to turn on your car lights on when you’re driving to work in the morning and home at night. By the time you get home, all you want to do is crawl under the covers and watch some television. Even on your time off when the sun is out, it’s too cold to spend much time outside. Does this sound like your life right now? Do you feel down or depressed more often than not this time of year? If so, you are most likely suffering from Seasonal Affective Disorder (SAD). And if you do, you’re not alone. About 14-26 percent of the American population suffers from some form of SAD each winter.

SAD is more than just a case of the winter blues, though it is sometimes referred to as winter depression. This is because it is a depressive disorder that emerges more often in the winter when the weather is cold and the days are short. A few people experience SAD in the spring/summer seasons. Let’s examine some of the most asked questions about SAD.

What are the most common symptoms of SAD?

SAD symptoms might include:

  • depressed mood
  • feelings of hopelessness
  • low energy
  • difficulty concentrating
  • changes in sleep and appetite
  • a loss of pleasure in activities you once enjoyed
  • thoughts of death or suicide

Persons experiencing SAD in the winter months might also notice these symptoms:

  • heaviness in arms and legs
  • frequent oversleeping
  • cravings for carbohydrates/weight gain

Is SAD the same or similar to major depression?

According to Arnold Lieber, MD in Seasonal Affective Disorder, A Guide to Treating SAD, while it is often misconceived as a milder form of depression, SAD is actually a subtype of major depression. Persons with SAD experience a seasonal pattern to their symptoms, most often occurring in late fall and winter and subsiding in spring or summer when the days become longer. If you notice this pattern of depression and remission several times over a two year period, visit your doctor to find out if you have SAD.

What causes SAD?

While the exact cause of SAD is still unknown, there are a few key causes linked to SAD.

  • Decreased sunlight in winter can throw your biological clock–also known as your circadian rhythm–out of sync.
  • Reduced levels of serotonin (a brain chemical that regulates mood) can cause Seasonal Affective Disorder.
  • Reduced levels of the hormone melatonin (a chemical which regulates sleep and mood) can also affect your susceptibility to develop SAD.

What are the most common risk factors for SAD?

According to the National Institute of Mental Health (NIMH), the common risk factors for SAD include:

  • Being female. SAD is diagnosed four times more often in women.
  • Living far from the equator. SAD is more frequent in people who live far north or south of the equator. For example, 1 percent of those who live in Florida and 9 percent of those who live in New England or Alaska suffer from SAD.
  • Family history. People with a family history of other types of depression are more likely to develop SAD than those who do not.
  • Having depression or Bipolar Disorder. The symptoms of depression may worsen with the seasons if you have one of these conditions (but SAD is diagnosed only if seasonal depressions are the most common).
  • Younger age. Younger adults have a higher risk of SAD than older adults. SAD has been reported even in children and teens.

When should I call a doctor?

Of course, we all may have days in the winter when we getting out of bed and getting motivated can be a challenge. However, if your symptoms are impacting your ability to fulfill your responsibilities and carry out activities of daily living (showering, dressing, hygiene, eating/preparing food, interacting with family), it may be time to reach out to a professional for help.

If symptoms occur for days at a time, you notice major differences in your sleeping and eating habits, you are withdrawing socially, or the activities that used to make you feel good no longer have the same effect, then it’s time to pick up your phone and call your doctor.

Contact your doctor right away if you are using alcohol or drugs to manage symptoms.

Call 911 or go to your local emergency room immediately if you are experiencing suicidal thoughts. Find your nearest emergency room.

How do I get the best care for SAD?

If you’re already experiencing SAD symptoms, getting help can prevent them from becoming worse and break the endless cycle of hopelessness you may be feeling. You deserve to be happy and healthy throughout the entire year.

Schedule an appointment with your primary care physician or find a mental health professional, like a psychiatrist, psychologist, or licensed counselor who specializes in Depression and/or SAD treatment. You can also inquire with your HR department if your workplace has an Employee Assistance Program with free counseling services or referrals to providers in your area.

What to Do Before Your Appointment

To get the best level of care, set aside a few minutes of quiet to think about your symptoms before your appointment. Take some notes about the frequency and nature of your symptoms, any other health concerns you have–physical or mental, observations about what triggers depressive episodes or lessens your depression, and any other details you feel might be relevant.

You can also write down specific questions for your doctor. These might include:

  • What might also be causing my symptoms instead of SAD?
  • What treatments have your patients found helpful in the past?
  • Would you recommend a mental health provider in the community?
  • Are there any behavioral changes I can make today to help my mood?
  • Are there any written resources you’d recommend?

Your doctor may conduct a physical exam or tests to rule out physical causes for your depression. They may also recommend that you see a mental health professional to receive a more thorough assessment. If this is the case, you can ask for a referral to a provider covered under your insurance plan.

What treatments might work for me?

There is no one treatment that will work for everyone. Work with a healthcare professional to find the best solution for you. According to Arnold Lieber, MD in Seasonal Affective Disorder, A Guide to Treating SAD, here are a few SAD treatment options to discuss with your doctor:

  • Medication – Antidepressants have been proven to be effective for people with SAD, especially those with intense symptoms. One thing to remember is that medication requires patience because it can take several weeks before you notice any effects. You also have to work with your doctor to find the medication that works best for you. Lastly, it’s important not to stop taking the medication if you feel better. Consult with your doctor before you change your dosage, and let him or her know if you experience any side effects. Try not to be discouraged if it takes some time to get everything just right. Finding the right medication and dosage that works for you is a process, and you should prepare yourself for this going in.
  • Psychotherapy – Talk therapy, such as Cognitive Behavioral Therapy (CBT), can be extremely helpful for those with Seasonal Affective Disorder. With the guidance of a psychotherapist, you can uncover negative thought patterns and behaviors that contribute to your depression, learn positive ways to cope with symptoms, and incorporate relaxation techniques into your daily life to boost your energy.
  • Light therapyPhototherapy involves exposing yourself to bright light via a special light box or lamp. Phototherapy devices produce similar effects to natural light, triggering chemicals in the brain that help regulate mood (Serotonin) and helps put your circadian rhythm back in sync. This treatment has proven effective, especially for those who experience the winter version of SAD, but do your research and talk to your doctor first. Phototherapy usually isn’t an end all be all treatment, and you also want to make sure if you do decide to give it a try that the device you’re purchasing is effective and safe.
  • Vitamin D – The jury is still out on this treatment. Currently, vitamin D supplementation alone is not regarded as an effective SAD treatment. Some recommend its use because studies have shown that low blood levels of vitamin D were found in people with SAD. However, the low levels can be attributed to diet or insufficient exposure to sunshine in many cases. Evidence for its use has been mixed. While some studies suggest vitamin D supplementation may be as effective as light therapy, others found vitamin D had no effect. Check with your doctor before using vitamin D as a treatment for SAD.

What can I do now to help my symptoms?

In addition to seeing a doctor, there are lifestyle changes you can implement right now to help alleviate your symptoms and boost your mood and energy levels. You might try such natural remedies as going outside more often, getting plenty of sunlight, exercising, avoiding drugs and alcohol, getting plenty of sleep, and practicing relaxation exercises.

Engaging in a healthier lifestyle is always a good thing to do. Once you start that, however, don’t be too hard on yourself if your symptoms don’t improve immediately. And don’t ignore them or assume they’ll go away when spring arrives. Asking for help is a sign of strength, not one of weakness. Consider how you can start managing Seasonal Affective Disorder today and live a healthier life in every season.

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