Signs & Symptoms Of SAD

Do you experience notable changes in mood during certain times of year—especially winter? If so, you’re not alone. According to the American Psychiatric Association, approximately 5% of people in the United States experience seasonal affective disorder (SAD). More than just sadness in winter, SAD is a serious mood disorder that can produce a variety of concerning symptoms, such as low mood, lack of energy, and loss of interest in activities once enjoyed. Despite these challenges, it’s often possible to manage seasonal depression symptoms with the right support. Below, we’ll take a look at seasonal affective disorder, its key symptoms, and how it can be treated. 

A brief overview of seasonal affective disorder (SAD)

For many people, the variations in weather and sun exposure that often accompany seasonal changes can have an impact on their mood. However, if you feel persistently sad and tired as fall and winter approach—or the spring and summer months, in rarer cases—it might be more than just the winter blues. You might be experiencing symptoms of seasonal depression (SAD)—sometimes called winter depression or summer SAD—which is a diagnosable mental illness in the category of depressive disorders.

It can be easy to miss a diagnosis of SAD because those living with the condition may not experience symptoms for most of the year. If you’ve noticed symptoms, it’s generally recommended that you meet with a mental health specialist for evaluation and treatment advice.

Differences between SAD and major depression

What can be confusing about seasonal affective disorder, or “winter depression”/”summer depression”, is that it’s considered a form of major depressive disorder (MDD). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists seasonal affective disorder as “major depressive disorder with seasonal pattern.” The primary difference between SAD and major depression is that SAD begins and stops at specific times of year, while symptoms of major depression without seasonal patterns tend to persist year-round. The symptoms of these depressive episodes themselves, however, are typically the same or similar. 

Another common difference between seasonal depression and major depression is the way in which emotional symptoms tend to arise. People with seasonal depression may feel more sad rather than irritable or angry, in contrast to the way many people experience the onset of major depression. There can also be differences in physical symptoms. For instance, an individual with SAD may start sleeping significantly longer than normal and develop an increased appetite rather than experiencing insomnia and a decrease in appetite. 

Recognizing key symptoms

The core DSM criteria for a diagnosis of major depressive disorder with seasonal pattern are as follows: “Depression that begins and ends during a specific season every year (with full remittance during other seasons) for at least two years and having more seasons of depression than seasons without depression over a lifetime.” 

The National Institute of Mental Health lists the following symptoms of seasonal affective disorder:

• Lack of energy
• Disrupted sleep patterns, like trouble sleeping or excessive sleepiness
• More carbohydrate cravings than normal
• Poor appetite or significantly increased appetite
• Significant weight gain or weight loss
• Withdrawing socially
• Feelings of irritation or agitation
• Negative feelings about the self
• Restlessness
• Anxiety
• Suicidal ideation

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

What causes SAD?

Researchers are still not sure why exactly some people develop seasonal affective disorder and others don’t, but various theories are currently being studied. For one, disruptions in an individual’s circadian rhythm or body clock—which often occur with changes in light exposure—are thought to play a role. These disruptions may be partly due to alterations in melatonin levels, which can make you feel listless and tired.

There is also evidence that specific populations of people tend to be more at risk for SAD than others. For instance, some research suggests that women may be four times more likely to experience SAD than men, and younger adults are also thought to be more likely to develop the condition than older adults. People who work evening or night shifts are typically considered to be at a greater risk for experiencing seasonal depression as well. 

Individuals who live further north or south of the equator—where climates tend to be colder and light tends to be less plentiful in the winter months—may be more prone to symptoms of seasonal affective disorder, too. Findings from one study indicate that only 1% of Florida residents experience SAD compared to 9% of residents of New England and Alaska. Many experts also believe that people with a family history of depression may be at greater risk for SAD. Those who have already been diagnosed with depression or bipolar disorder may experience worse symptoms in the colder months as well. 

Finally, as noted earlier, people with SAD may have low levels of vitamin D, which is another of the common risk factors. This is because vitamin D is connected to serotonin, a chemical in your brain that helps control mood. Research suggests that people with seasonal depression may have increased levels of serotonin transporter, also called 5-HTT, which can reduce the amount of serotonin available for the brain to use. The causes of these increased levels are still being investigated but could be linked to genetics and environmental factors.

Treatment for SAD

There are various research-supported treatment methods for when SAD occurs. The right one for a given individual may depend on their symptom severity, when symptoms begin, and other elements of their mental health.

Light therapy

If the dark days of winter tend to bring about symptoms of seasonal affective disorder (SAD) in an individual, exposure to light may have a positive effect on symptoms. Research suggests that bright light therapy—in which participants expose themselves to artificial light or sunlight for prescribed periods—may effectively reduce symptoms of seasonal depression. 

Light therapy dates back to the 1980s when SAD was first officially classified as a mental health condition. It typically involves using a box that emits strong light and is made specifically for the purpose of light therapy. The average lightbox produces 10,000 lux of cool-white fluorescent light and emits up to 20 times more light than regular indoor lighting. When the sun doesn’t shine as often in the fall and winter seasons, safely exposing oneself to this type of bright, artificial light may significantly improve SAD symptoms. It’s thought that this type of therapy may work by stabilizing an individual’s circadian rhythm and/or increasing serotonin levels. 

A common light therapy treatment regimen consists of sitting in front of a lightbox first thing in the morning for 30 minutes. If you’re experiencing seasonal affective disorder, a healthcare professional can help you develop a treatment plan that may include light therapy. Be sure to consult with a licensed professional before starting light therapy, and take care to only use a lightbox intended for light therapy and according to the included directions. 

Vitamin D supplements

Research suggests a correlation between low levels of vitamin D and symptoms of seasonal affective disorder. Vitamin D—which is important for immune health and other vital functions—may be difficult to obtain in the winter months in the absence of sun. For this reason, vitamin D supplements are often incorporated into treatment plans for SAD.

Medication

Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may also help decrease symptoms of seasonal affective disorder—particularly when used in combination with psychotherapy. Many providers will prescribe light therapy first and medication and talk therapy later if it doesn’t work. 

Antidepressant medications generally work by balancing serotonin levels, which are often deficient in people with depressive disorders. Always consult with a healthcare provider before starting, stopping, or changing any medication. 

Psychotherapy

Many people who live with seasonal affective disorder experience improvement after engaging in psychotherapy, or talk therapy. One common type of psychotherapy for SAD is cognitive behavioral therapy (CBT). A therapist may use CBT to help you identify distorted, negative thoughts and replace them with more positive, realistic ones. This technique may be used in conjunction with another therapeutic technique called behavioral activation. 

For example, your therapist might help you reframe negative thoughts about cold weather that may be causing or contributing to sadness or a lack of energy. Then, they may guide you through a behavioral activation component. It might help you identify activities that you can enjoy inside or outside to help you cope with the winter weather, for instance, or positive sleep hygiene practices like going to sleep and waking at about the same times each day to improve the quality of your rest.

Therapy options for “winter depression”

Research suggests that cognitive behavioral therapy (CBT) may be the most effective form of treatment for seasonal depression for many, but attending in-person sessions isn’t always an option. Some people might not have mental health care providers in their area, while others may struggle to travel to and from in-office appointments because of their symptoms. Online therapy can be a more convenient alternative in these kinds of situations.

With an online therapy platform like BetterHelp, you can talk to a licensed therapist from home via video call, voice call, or in-app messaging. Research suggests that virtual talk therapy can be an effective way to address a variety of depressive symptoms. In one wide-ranging review, researchers indicated that online therapy may be effective and more affordable than in-person treatment for addressing symptoms of depression and other mental health conditions.