Seasonal Affective Disorder (SAD) Awareness Month
What is Seasonal Affective Disorder?
Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons. In other words, seasonal affective disorder (SAD) begins and ends at about the same times every year.
Symptoms start in the fall and continue into the winter months. This can often sap a person’s energy and make them feel moody. These symptoms often resolve during the spring and summer months. Less often, SAD causes depression in the spring or early summer and resolves during the fall or winter months. Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.
Don’t brush off that yearly feeling as simply as a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.
The awareness color associated with SAD is green. Green typically is associated with mental health. Wear a green enamel awareness pin, fabric ribbon or green silicone wristband to highlight this condition.
What are the signs and symptoms of Seasonal Affective Disorder?
SAD is a type of depression. It is characterized by a recurrent seasonal pattern. These symptoms last about 4−5 months out of the year. The signs and symptoms of SAD are typically associated with depression as well as disorder-specific symptoms. Symptoms differ for winter-pattern versus summer-pattern SAD.
Remembering that symptoms are different for everyone, depression can include:
- Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
- Feelings of hopelessness or pessimism
- Feelings of irritability, frustration, or restlessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, or feeling slowed down
- Difficulty concentrating, remembering, or making decisions
- Changes in sleep or appetite or unplanned weight changes
- Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
- Thoughts of death or suicide or suicide attempts
For winter-pattern SAD, additional symptoms can include:
- Oversleeping
- Overeating, particularly with a craving for carbohydrates, leading to weight gain
- Social withdrawal (feeling like “hibernating”)
For summer-pattern SAD, additional symptoms can include:
- Trouble sleeping
- Poor appetite, leading to weight loss
- Restlessness and agitation
- Anxiety
- Violent or aggressive behavior
Winter-pattern SAD should not be confused with the “holiday blues.” “Holiday blues” are feelings of sadness or anxiety brought on by stresses at certain times of the year. The depression associated with SAD is related to changes in daylight hours, not the calendar, Stresses associated with the holidays or predictable seasonal changes in work or school schedules, family visits, and so forth are not the same as SAD.
How is SAD diagnosed?
If you or someone you know is showing symptoms of SAD, talk to a health care provider or a mental health specialist about your concerns. They may have you fill out a questionnaire to determine if symptoms meet the SAD criteria.
To be diagnosed with SAD, a person must meet the following criteria:
- They have the symptoms of depression, or the more specific symptoms of winter- or summer-pattern SAD listed above.
- Their depressive episodes occur during specific seasons (winter or summer) for at least 2 consecutive years. However, not all people with SAD experience symptoms every year.
- Their depressive episodes during the specific season are more frequent than depressive episodes experienced at other times of the year.
Who develops SAD?
Millions of Americans experience SAD. However, many may not know they have this common disorder. In most cases, SAD begins in young adulthood.
SAD occurs much more often in women than in men. Winter-pattern SAD also occurs more often than summer-pattern SAD. Therefore, SAD is more common in people living farther north, where there are shorter daylight hours in the winter.
SAD is more common in people with depression or bipolar disorder, especially bipolar II disorder, which involves repeated depressive episodes and hypomanic episodes (less severe than the typical manic episodes of bipolar I disorder). Additionally, people with SAD tend to have other mental disorders, such as attention-deficit/hyperactivity disorder, eating disorder, anxiety disorder, or panic disorder. In addition, SAD sometimes runs in families and may be more common in people who have relatives with other mental illnesses, such as depression or schizophrenia.
What causes Seasonal Affective Disorder?
Researchers are still determining what causes SAD. Most research to date has investigated potential causes of winter-pattern SAD because it is more common and easier to study. As a result, less is known about summer-pattern SAD.
Studies indicate that people with SAD, especially winter-pattern SAD, have reduced levels of the brain chemical serotonin, which helps regulate mood. Research also suggests that sunlight affects levels of molecules that help maintain normal serotonin levels. Shorter daylight hours may prevent these molecules from functioning properly, contributing to decreased serotonin levels in the winter.
Vitamin D Deficiency, Melatonin Levels and Serotonin
Vitamin D deficiency may exacerbate these problems in people with winter-pattern SAD. This is because vitamin D may promote serotonin activity. In addition to vitamin D consumed in food, the body produces vitamin D when exposed to sunlight on the skin. With less daylight in the winter, people with SAD may have lower vitamin D levels, further reducing serotonin activity.
Other studies suggest that both forms of SAD relate to altered levels of melatonin. Melatonin is a hormone important for maintaining the normal sleep−wake cycle. People with winter-pattern SAD produce too much melatonin, which can increase sleepiness and lead to oversleeping.
In contrast, people with summer-pattern SAD may have reduced melatonin levels, consistent with long, hot days worsening sleep quality and leading to depression symptoms. Longer daylight hours, shorter nights, and high temperatures can also cause sleep disruptions.
Both serotonin and melatonin help maintain the body’s daily rhythm tied to the seasonal night−day cycle. In people with SAD, changes in serotonin and melatonin disrupt normal daily rhythms. As a result, they can no longer adjust to seasonal changes in day length, leading to sleep, mood, and behavior changes.
Negative thoughts and feelings about the winter or summer and its associated limitations and stresses are also common among people with SAD (as well as others). It is unclear, however, whether these thoughts are causes or effects of the mood disorder, but they can be a useful focus of treatment.
How is SAD treated?
Treatments are available to help people with SAD. They fall into four main categories.
These treatments may be used alone or in combination:
- Light therapy
- Psychotherapy
- Antidepressant medication
- Vitamin D
Light therapy and vitamin D are treatments for winter-pattern SAD, whereas psychotherapy and antidepressants are used to treat depression in general, including winter- and summer-pattern SAD. There are no treatments specific to summer-pattern SAD.
Can SAD be prevented?
Because the onset of SAD is so predictable, people with a history of the disorder might benefit from starting the treatments mentioned above before the fall (for winter-pattern SAD) or spring (for summer-pattern SAD) to help prevent or reduce depression symptoms. It is unclear whether SAD can be prevented.
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