Seasonal affective disorder
April 4, 2023
Written by: CHIRATHI WIJETHUNGA , CLASS OF 2025.
What is Seasonal Affective Disorder (SAD)?
Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons. SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months; sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.
SAD was first systematically reported and named in the early 1980s by Norman E. Rosenthal, M.D., and his associates at the National Institute of Mental Health (NIMH).
Rosenthal and his colleagues then documented the phenomenon of SAD in a placebo-controlled study utilising light therapy. A paper based on this research was published in 1984.
His 1993 book, Winter Blues, has become the standard introduction to the subject.
What are the causes for SAD?
The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:
Your biological clock (circadian rhythm) : The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.
Serotonin levels: A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
Melatonin levels : The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.
What are the risk factors for SAD?
Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults.
Factors that may increase your risk of seasonal affective disorder include:
Family history: People with SAD may be more likely to have blood relatives with SAD or another form of depression.
Having major depression or bipolar disorder: Symptoms of depression may worsen seasonally if you have one of these conditions.
Living far from the equator. : SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.
What are the symptoms of SAD?
Feeling depressed most of the day, nearly every day.
Losing interest in activities you once enjoyed.
Having low energy.
Having problems with sleeping.
Experiencing changes in your appetite or weight.
Feeling sluggish or agitated.
Having difficulty concentrating.
Feeling hopeless, worthless or guilty.
Having frequent thoughts of death or suicide.
Symptoms may also vary depending on the type of onset such as:
Fall/Winter onset
Oversleeping
Appetite changes, especially a craving for foods high in carbohydrates
Weight gain
Tiredness or low energy
Irritability Fatigue and low energy
Hypersensitivity to rejection
Heavy “leaden” feeling on arms or legs
More sensitive to pain
Spring/Summer onset:
Trouble sleeping (insomnia)
Poor appetite
Weight loss
Agitation or anxiety
Depression
In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression.
Over a third of those aged 16 either have SAD, suspect they have it or suffer from low moods in Autumn and winter
More than 1 in 20 people in the UK have been diagnosed with Seasonal Affective Disorder
Men are twice as likely to have been diagnosed with SAD (over 9% say they have) as women (4.5%)
But women are likelier to say they suffer more with low moods in Autumn and Winter (18.28%) than men (12.87%)
People in London are significantly likelier than those anywhere else in the UK to have been diagnosed with SAD (over 11% of people in London).
(Source: via microbizmag 2021)
When to see a doctor?
It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide.
How can we diagnose SAD?
Physical exam : Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
Lab tests : For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.
Psychological evaluation : To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions.
DSM-5 : Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
It is important to take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it's not treated. These can include:
Social withdrawal
School or work problems
Substance abuse
Other mental health disorders such as anxiety or eating disorders
Suicidal thoughts or behaviour
Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.
Treatment and Therapy:
Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
Light therapy
In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.
Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box.
Medications
Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.
An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.
Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.
Psychotherapy
Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioural therapy can help you:Identify and change negative thoughts and behaviors that may be making you feel worse
Learn healthy ways to cope with SAD, especially with reducing avoidance behaviour and scheduling activities
Learn how to manage stress
Mind - Body Connection
Relaxation techniques such as yoga or tai chi
Meditation
Guided imagery
Music or art therapy
What kind of lifestyle changes and home remedies can we use to combat this disorder?
Make your environment sunnier and brighter: Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.
Get outside: Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
Exercise regularly: Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
Can we use alternative medications?
Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder.
Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements.
Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.
Coping and Support:
Stick to your treatment plan: Follow your treatment plan and attend therapy appointments when scheduled.
Take care of yourself: Get enough sleep to help you feel rested, but be careful not to get too much rest, as SAD symptoms often lead people to feel like hibernating. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don't turn to alcohol or recreational drugs for relief.
Practice stress management: Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
Socialize: When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
Take a trip : If possible, take winter vacations in sunny, warm locations if you have winter SAD or to cooler locations if you have summer SAD.
When someone experiences a monumental shift in their emotional and mental health during specific times or seasons, it is called Seasonal Affective Disorder (SAD). It is important to consider the role that weather plays in the onset of SAD symptoms and why, how, and when it happens. Primarily, SAD is highly common during the fall and winter seasons and affects a huge population every year. Moreover, this affliction can drastically impact someone's ability to function in normal life. As foreign students in our Medical University and since most of us are from tropical parts of the globe, we are at a higher risk
When someone is affected by SAD, they can have symptoms that mimic depression – overwhelming sadness, sluggishness, disconnection, neglecting daily responsibilities, ignoring healthy habits, a feeling of melancholy, a lack of interest in engaging in activities, suicidal thoughts, and more. These symptoms correlate to SAD when they begin to prevent someone from fully participating in their life, and, unfortunately, they are directly related to changes in weather.
“THE COLD WEATHER IS MAKING ME DEPRESSED!”
When the weather gets colder, people stay inside more. Consider times when the weather has drastically shifted or when the weather stays cold and gloomy for a significant time. You may have found yourself thinking, "the cold weather is making me depressed" or "this cloudy weather makes me depressed."
When you stay inside due to poor weather, this leads to a lack of fresh air and increased feelings of isolation and can induce symptoms of depression. These symptoms are often temporary and usually resolve when poor weather lifts or when you get increased sun exposure. Light deprivation depression is a very common affliction and can arise from not getting enough sun providing Vitamin D
Knowing that this lack of exposure and isolating inside more frequently when it is not warm continues to beg the question: can cold weather cause depression or not? Surely, we have all felt an emotional or mental shift when the weather changes in some way. (via carex 2022).
The role weather plays in our emotional and mental health is significant and can lead to the onset of SAD, which is a recognized affliction by medical professionals. While we cannot change the weather, we can implement strategies to improve our response and increase our defence against SAD symptoms. Ensure that a medical professional is aware of your symptoms so that you can develop a plan for how to respond to them. Identify your coping strategies, what makes your emotions heightened or resolved, as well as a social support system for when symptoms get overwhelming.
Cold weather, cloudy weather, shifting seasons, shorter days, and less light directly correlate to SAD, and it is critical to know that it is a common affliction. Even more important, you can do something about it to prepare yourself. Though SAD can significantly impact your ability to manage your daily responsibilities, there are tools and strategies to cope with the affliction and live a healthy life effectively.
