A Guide To Seasonal Affective Disorder Therapies And Treatment Options

As the leaves begin to fall and the days grow shorter, you might notice a change in your mood and energy levels. If you find yourself feeling persistently sad, drained of energy, and disinterested in hobbies during these darker months, you might be experiencing seasonal affective disorder (SAD). 

What is seasonal affective disorder (SAD)?

Seasonal affective disorder is a type of depression that occurs during specific seasons, typically beginning in late fall and continuing through the winter months. SAD can cause changes in mood, energy levels, and sleep patterns, potentially affecting a person's ability to engage in daily life. 

SAD affects around 5% of adults in the United States, with women being up to four times more likely to experience SAD than men. Therefore, SAD can be a significant mental health concern for many people during the fall and winter. Let’s discuss some of the common symptoms and potential causes.

Common symptoms

Individuals with seasonal affective disorder may experience a variety of symptoms, which can include:

• Feeling hopeless or worthless
• Losing interest in activities previously enjoyed
• Experiencing irritability and difficulty concentrating
• Oversleeping or insomnia
• Overeating, particularly with carbohydrates
• Weight gain
• Social withdrawal
• Low energy levels

Symptoms may often start as mild and gradually increase in severity as the season progresses. It may be important to recognize these symptoms as they arise, as detecting them early may help you seek the appropriate treatment. 

If left untreated, SAD may lead to serious complications, such as:

• Difficulty functioning in daily life
• Strain on personal and professional relationships
• Increased susceptibility to other mental health conditions
• Substance abuse, particularly alcohol
• Suicidal thoughts or behaviors

Potential causes

The exact cause of SAD is not fully understood, but several factors may contribute to its development. One possible factor is reduced sunlight exposure during the shorter fall and winter days. A decrease in sunlight may disrupt the body's internal clock, or circadian rhythm, which may result in depressive symptoms. In addition, changes in the brain's melatonin levels and serotonin production might also contribute to the development of SAD. This is because during the winter months, the decrease in light exposure may cause imbalances in the brain chemicals, preventing them from functioning properly, thus impacting mood levels. Many people notice improvement when longer daylight hours return in spring.

During the summer months, people in the Southern Hemisphere may experience summer-onset SAD or "reverse SAD." This is a rarer form of seasonal affective disorder that occurs in warmer seasons, causing similar symptoms to its winter counterpart.

SAD vs. other mood disorders

You may be wondering, “How is SAD diagnosed? How does it differ from other mood disorders?” SAD has many similarities with other types of depression, but the key difference is its seasonal pattern. Unlike other depressive disorders, SAD symptoms typically arise during specific times of the year, often worsening as the season progresses and generally improving once the season changes. 

Other mood disorders, such as major depressive disorder or bipolar disorder, do not typically follow a seasonal pattern, although it must be noted that SAD can be diagnosed as major depressive disorder with a seasonal pattern, and that symptoms can resemble clinical depression outside of seasonality. It’s important to consult a mental health professional for an accurate diagnosis, which can allow you to get the right treatment.

Winter-pattern vs summer-pattern SAD

Winter SAD is more common and widely recognized than its counterpart summer SAD, but both of these conditions can negatively impact daily life, so it can be important to recognize the symptoms of both, and why they might occur. 

Winter SAD and why symptoms often start late in the fall

Symptoms of winter-pattern SAD typically begin to show up in late fall, as the daylight hours wane. Experts believe that sunlight affects serotonin levels and that shorter daylight hours impact molecules that help to maintain normal serotonin levels. Vitamin D deficiency may also play a role, as people generally spend less time outdoors. Symptoms of winter SAD typically resolve with the return of longer daylight hours and include:

• Hypersomnia (oversleeping)
• Overeating
• Social withdrawal

Summer SAD and summer SAD symptoms and triggers

Because summer SAD is less common than the winter pattern, it can be difficult for individuals to recognize. Less is known about its causes, and more study is necessary to determine why people experience this condition. Scientists conjecture that it has something to do with reduced melatonin levels coupled with long, hot days disrupting the sleep cycle. 

Summer SAD symptoms can also slightly differ from those of winter SAD, and include:

• Poor appetite
• Difficulty sleeping
• Agitation and restlessness
• Violent or aggressive behavior 

What are the best seasonal affective disorder therapies?

Various treatments may help with relieving SAD symptoms. However, the best treatment will depend on the severity of symptoms and other factors. In some cases, individuals might benefit from a combination of therapies.

Light therapy

Light therapy, also known as bright light therapy or phototherapy, is often the first choice for treating SAD. It may use artificial light from specialized light boxes to mimic natural sunlight. Light therapy is believed to work by triggering a chemical change in the brain, which may help alleviate symptoms of depression. Typically, individuals sit in front of the light box daily for 20 to 60 minutes each day.

Light therapy basics and safety checklist

Light therapy is conducted by sitting in front of a light box that emits 10,000 lux of UV-filtered light. This is usually done first thing in the morning to mimic the benefits of morning sunlight in the body. While safe for most, there are some individuals who may need to limit or avoid exposure or consult a doctor before light therapy treatment. This includes people with certain eye diseases or people who take medications that cause photosensitivity. 

Psychotherapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy or talk therapy that may help treat symptoms of SAD. This therapy may help individuals identify and change negative thoughts while learning healthy coping skills and ways to manage stress. With the help of a therapist, a person may be able to change their behavioral patterns to address seasonal depression.

Medication

Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), may be prescribed for SAD patients. Fluoxetine (Prozac) and bupropion (Wellbutrin XL) have been found to be effective medications for SAD. It's important to consult with a healthcare provider before taking any medication. Your provider will need to determine the appropriate medication and dosage, as getting the right medication can depend on different factors, including the presence of other types of clinical depression. SAD often co-occurs with major depression, bipolar disorder, anxiety, or ADHD.

Exercise as one of the alternative treatment options

Physical activity may help alleviate depression symptoms, including those caused by SAD. Aerobic exercises, such as walking, running, and swimming, may help boost serotonin levels and improve mood. As one of the effective treatment options for Seasonal Affective Disorder, exercise is recommended for at least 150 minutes of moderate-intensity activity per week to help combat symptoms and enhance overall well-being.

Vitamin D supplementation

A possible link between low vitamin D levels and symptoms of SAD has been explored. While more research is needed, some individuals might benefit from vitamin D supplementation, especially during the darker months when sunlight exposure is limited. It’s important to consult with a healthcare provider to determine the right dosage.

Meditation as one of the seasonal affective disorder therapies

Studies suggest that practicing mindfulness meditation, especially in combination with cognitive behavioral therapy, may help reduce symptoms of SAD. Regular meditation can help people become more aware of their thoughts and feelings, promoting a sense of well-being and relaxation even during darker months.

Complementary and integrative health approaches for SAD

Certain complementary health approaches may support mood when used alongside evidence-based treatments. 

Complementary health products and safety considerations

Certain mind-body techniques such as progressive muscle relaxation and herbal remedies are sometimes used to manage depression symptoms. Omega-3 supplements, and herbs like St. John’s wort are commonly sought to offer relief. However, the FDA doesn’t monitor supplements the way they do food products, so it can be difficult to know if what you’re getting is safe. In addition, certain herbal supplements can interact with prescription medications, so it’s important to consult your doctor before starting any herbal regimen. 

Where to research complementary and integrative health approaches

Visit a trusted site such as the National Center for Disease Control, NIMH, or SAMHSA to learn more about different types of complementary treatments and their potential benefits and side effects. And if you are taking any kind of medication, speak to your primary care physician before exploring any of these options. 

Prevention and lifestyle changes

Making some simple lifestyle changes may help prevent or reduce the severity of SAD symptoms. This section will discuss the potential benefits of a healthy diet and nutrition, maintaining a regular sleep schedule, and avoiding excessive alcohol and drug use.

Healthy diet and nutrition

A well-balanced diet may be helpful in preventing severe SAD symptoms. Foods like fatty fish, egg yolks, and fortified dairy products may contain sufficient levels of vitamin D and can be incorporated into your daily meals. As appetite and weight changes can also be symptoms of SAD, maintaining a consistent eating schedule with nutrient-dense foods may help support overall mood and well-being.

Regular sleep schedule

Keeping a regular sleep schedule may help prevent SAD symptoms involving disruptions in sleep. Maintaining a consistent bedtime and wake-up schedule may help improve sleep quality and prevent negative thoughts associated with SAD. Additionally, getting exposure to natural sunlight in the morning can help regulate sleep-wake cycles.

Creating a relaxing bedtime routine, such as unwinding with a warm bath or reading a book, can also promote restorative sleep. You may want to keep your sleep environment comfortable, cool, and dark to encourage a healthy sleep pattern.

Avoiding excessive alcohol and drug use

Refraining from excessive alcohol and drug use may also help prevent or manage SAD. Alcohol and drugs can disrupt sleep patterns, increase negative thoughts, and worsen depressive episodes. Instead, consider healthy coping strategies like exercise, meditation, or spending time with loved ones to manage the emotional challenges that come with seasonal affective disorder. 

By making these lifestyle changes, individuals can take steps toward preventing or managing SAD symptoms and improving their overall mental health.

When SAD overlaps with major depression, and when to seek care

As mentioned earlier, seasonal affective disorder commonly co-occurs with other mental health disorders. Types of clinical depression including SAD can overlap, and navigating the different symptoms can require professional support. 

Signs that symptoms may be more than seasonal

When your symptoms don’t resolve or improve with the return of longer daylight hours, or are so severe that they negatively impact your daily life, including your professional life and relationships, it may be time to get a professional assessment. Another indicator might be the use of illegal drugs, alcohol, or nicotine as self-medicating tools for persistent or severe symptoms. 

Why a structured assessment matters

Assessment and diagnosis by a medical or mental healthcare professional can be essential when symptoms are intense or persist, as you may be experiencing multiple conditions. Seasonal depression is different from clinical depression, and different from calendar-based depression around the holidays. What kind of support you need can depend on a variety of factors, and a provider can offer in-depth assessment and targeted, effective treatment options.

Finding support from a mental health professional

If you’re living with SAD, it can be difficult to manage mental health challenges on your own. A mental health professional can provide expert guidance and support to help you improve symptoms. You can find support from a mental health professional through in-person or online sessions, including options for affordable therapy depending on your needs and location. Consulting a professional is better than just trying a variety of herbal remedies and dietary supplements for your condition. Some dietary supplements are not even FDA approved and might increase your risk of worsening symptoms.

Online therapy has emerged as a convenient and effective approach to receiving support and treatment for SAD. An increasing number of mental health professionals have started to offer their services through digital platforms, allowing clients to get therapy from the comfort of their homes.

Is online therapy effective for seasonal affective disorder?

Mental health professionals can assess symptoms, provide guidance on coping skills, and monitor progress through online therapy. Sessions can be conducted through video calls, live chats, or email exchanges, making online therapy a versatile way to get support.

One meta-analysis found that guided cognitive behavioral therapy delivered online can be an effective way to treat symptoms of depression. The analysis looked at almost 40 different studies that included nearly 10,000 participants. However, the most benefits were seen in participants with moderate to severe depression. 

Platforms like BetterHelp may help those seeking online therapy for SAD. BetterHelp connects clients with licensed mental health professionals who specialize in treating SAD, among other conditions. One advantage of using BetterHelp is that clients can be matched with a therapist based on their individual goals and preferences. You can also switch therapists if a particular professional doesn’t seem like a good fit.