Seasonal Affective Disorder (SAD) is a type of depressive illness that often follows the pattern of the seasons.  Most commonly, symptoms begin in the fall and last through the winter. Symptoms often improve during spring and summer months, although spring-onset, or “summer depression” can occur (Johns Hopkins Medicine). Females, those under the age of 35, those living far away from the equator, and those with a family history of SAD, Bipolar Disorder and depression are most vulnerable (Melrose, 2015).SAD can impair sleep, appetite, energy levels, and mood, impacting many aspects of one's life, from relationships and social life to job, education, and self-worth. One may feel helpless, unhappy, uncomfortable, or agitated, with no interest in friends or engaging the activities they typically enjoy during the summer.While the exact cause is unknown, Harvard Medical School says that the shortened days of fall and winter cause changes in brain chemicals, specifically increasing melatonin and decreasing serotonin, which increase feelings of fatigue, lethargy, and low mood. SAD is more common for people who live in areas with prolonged darkness during winter.  For example, SAD is more common in Alaska and Canada compared to Florida due to higher latitude and smaller amounts of daylight.SAD is typically diagnosed by a mental health provider or your primary care physician, and evaluation may include:

1. Physical examination to rule out any biological or medical cause for your symptoms.
2. Routine lab work of common health markers such as Vitamin D levels, blood glucose, thyroid functioning, and hormone panels, to further eliminate any medical causes.
3. Psychological assessment via clinical interview and/or questionnaire for SAD.

Common Symptoms

(Melrose, 2015)

Fall-Onset

Summer-Onset

· Sad mood

· Low energy

· Fatigue

· Irritability

· Frequent tearfulness

· Difficulty concentrating

· Increased sleepiness/sleeping more than normal

· Social withdraw

· Cravings for sugar and simple carbohydrates

· Sudden weight gain

· Lack of sexual interest

· General feeling of malaise or dissatisfaction

·  Irritability

·  Agitation

·  Anxiety

·  Poor appetite with unintentional weight loss

·  Insomnia or sleep disturbance

·  Restlessness

·  Episodes of rage or even violent behavior

Prevention and Management Strategies

1. Physical: A regular exercise routine and eating a well-balanced diet are known to boost mood and energy levels during the winter months. It is also crucial to keep track of and maintain healthy sleeping patterns with consistent bedtimes and wake times.
2. Emotional: Keeping a gratitude journal, spending time with friends and loved ones, and working with a therapist can all help prevent the onset on SAD.  Also, making and sticking to a schedule can help a person feel in control when aspects such as the weather or one’s mood can feel overwhelming.
3. Vocational: Request to sit by a window at work, eat your lunch outside if possible, and invite a coworker for a brief walk to chat (and get sunshine and fresh air, more on that below). Even working outside during the warmest part of the day can give your mood a boost.
4. Intellectual: Give yourself a challenge and set a goal that feels motivating and personally valuable, especially during seasonal changes.  Make sure that the goal is SMART: Specific, Measurable, Attainable, Realistic, and Time-limited.
5. Spiritual: Practice mindfulness and focus your attention to the present moment. Rather than focusing on the unpleasant aspects of winter, identify what feels cozy, warm, or pleasant in each moment of awareness.
6. Environmental: Get some fresh air and as much natural light as possible! The fresh air and sunshine can help you feeling more energized, even if it's only for a few minutes.  Consider switching your light bulbs to daylight vs. soft white, and open blinds and drapes when you can.

Treatment Options

1. Pursue Therapy: People with SAD can benefit from engaging therapy that provides support and cognitive-behavioral strategies for managing symptoms of SAD.
2. Medication: Antidepressant medication can help increase levels of serotonin in the brain that get disrupted with time changes and reduced daylight.  Many individuals begin medication in the early fall, and reduce medication in the summer to reduce the impact of seasonal depression.
3. Supplement Your Vitamin D: Vitamin D supplementation before the onset of increased winter darkness may help reduce depressive symptoms, especially if getting outside is not feasible due to weather or there is limited sunlight available.  Discuss options for dosage with your healthcare provider.
4. Increase Your Mind-body connection: Mindfulness and relaxation techniques such as breathing exercises or yoga, music or art therapy, and Guided Imagery of sunny scenes are examples of mind-body approaches that prove to be beneficial for people to cope with SAD.
5. Consider Light Therapy: Also known as “phototherapy,” light therapy involves sitting in front of a special lightbox that delivers light up to ten times the intensity of regular light bulbs (don’t worry, harmful ultraviolet (UV) rays are filtered out).  Engaging light treatment at the start of the day mimics natural sunlight and helps to maintain your natural circadian rhythm.  Talk to your therapist or medical provider about light therapy and recommended brightness levels.

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References

Harvard Medical School (2019). Shining a Light on Winter Depression.  https://www.health.harvard.edu/mind-and-mood/shining-a-light-on-winter-depression

Robinson, L. & Segal, J. (Oct 2021). Seasonal Affective Disorder (SAD). HelpGuide.org. https://www.helpguide.org/articles/depression/seasonal-affective-disorder-sad.htm

Johns Hopkins Medicine.  Seasonal Affective Disorder. https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-affective-disorde

Melrose, S. (2015).  Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression Research and Treatment, vol. 2015, Article ID 178564.  https://doi.org/10.1155/2015/178564. https://www.hindawi.com/journals/drt/2015/17856

Nussbaumer-Streit, B., Pjrek, E., Kien, C., Gartlehner, G., Bartova, L., Friedrich, M. E., Kasper, S., & Winkler, D. (2018). Implementing prevention of seasonal affective disorder from patients' and physicians' perspectives - a qualitative study. BMC psychiatry, 18(1), 372. https://doi.org/10.1186/s12888-018-1951-0. https://pubmed.ncbi.nlm.nih.gov/30477472/