SAD 101: What is Seasonal Affective Disorder?

Seasonal Affective Disorder is one of the most widespread manifestations of depression symptoms, with millions of people affected each year in the United States (National Institute of Mental Health, 2023). Even so, SAD, as it is abbreviated, is often written off as "winter blues" or sadness around the holidays. Seasonal Affective Disorder is serious, common, and treatable. Why is it so misunderstood?

In this blog, we'll explore the definition of SAD, how it differs from other similar depressive episodes, and end with common pathways for clinical treatment.

What is Seasonal Affective Disorder (SAD)?

Seasonal Affective Disorder is a pattern of depressive symptoms lasting more days than not, affecting your ability to function day-to-day, for an extended duration that matches up with the change of the seasons. In the DSM-V-TR, it is recognized as "Major Depression with Seasonal Pattern" (2022).

While this most commonly occurs with the change from fall to winter, the seasonal pattern can refer to the warmer months as well. Some people experience mood changes with the onset of spring or summer. A major contributing factor to SAD is the change in daylight hours and how they shift neurotransmitter production. Your brain receives information from the outside world through your sense organs — eyes, ears, nose, mouth, and skin. In the winter, these messages tell us that it's dark and cold, in turn telling your brain to produce more melatonin, the chemical that helps you feel sleepy (Johns Hopkins Medicine, 2024). In most cases, these symptoms start to improve or resolve within 4 to 5 months with the change of seasons again: more sunlight equals less melatonin production, and your body starts to regulate itself (National Institute of Mental Health, 2023).

What are the Symptoms of SAD?

Physiologically, more melatonin means more fatigue, and psychologically, we interpret this as a feeling of malaise or lack of motivation. That apathy can lead to behavior changes like social isolation or lower productivity. Are these effects starting to sound familiar yet, clinicians? You got it — seasonal depression is a perfect example of how the symptoms of a condition can span biological, psychological, and social realms of functioning.

While symptomology can look different for everyone, there are a few standout signs that clinicians should be aware of when assessing for depression with a seasonal pattern:

• Mood changes occurring most of the day, nearly every day
• Including sadness, emptiness, or profound anxiety
• Lasting for a period of greater than 2 weeks
• Symptom onset is around the change in daylight hours, and improve with the change back to the previous seasonal pattern of daylight (National Institute of Mental Health, 2023)

In terms of depression symptoms that tie in specifically with SAD, this condition often presents with the typical profile of depression symptoms, and the "tell" that it has a seasonal pattern is around the context of onset and resolution. Clinicians should be on the lookout for hopelessness, worthlessness, helplessness, and suicidality specifically, as these are part of assessing risk of harm to self or others in the treatment of depression. Just because winter-pattern SAD often improves with the return to increased daylight in spring does not mean that we should encourage clients to white-knuckle through the cold months.

Isn't That Just the Winter Blues?

Our culture often writes off depressive episodes as "the blues." If you have mood changes after giving birth, it's the "baby blues." If this occurs after adopting a puppy, it's "puppy blues," a cutely termed similar phenomenon. And depression with a seasonal pattern is coined "winter blues" or "holiday blues," passing the buck back to the individual. Just get through to the new year, and you'll be fine, we say. This minimizes the seriousness of depression and keeps people from seeking treatment when it is needed.

While feeling "the blues" periodically is normal and common, that does not mean we should dismiss it. During the winter holiday season, clients might notice mental health effects caused by temporary situational stressors. Increased workloads, schedule disruptions, parenting stress, grief and loss, loneliness, financial strain — all of these factors can spring up around certain special occasions. Coupled with the societal narrative that we must always be grateful, cheerful, and bright at this time of year, and it is no wonder that we feel burned out, guilty, ashamed, and sad when those factors start to affect us.

The difference here is that "holiday blues" tend to improve when the stressor has passed. After the last Hanukkah candle is lit, or the Christmas ornaments are safely packed away, our focus shifts to the new year ahead. Though our stress may not melt away instantly, for most people, the blues fade and we return to baseline as life gets back to a normal routine.

Treatment Options

For folks who are experiencing seasonal depression that does not lift on its own, clinical treatment options tend to fall into three main categories: light therapy, pharmacotherapy, and psychotherapy.

The first, light therapy, consists of replacing the lost sunlight in the winter months with simulated sunlight via a UV lamp, or "light box" (Mayo Clinic, 2016). Research is promising, but limited, and claims about the utility of light boxes in reversing depressive symptoms completely are dubious (or perhaps a placebo effect). While light boxes are commercially available, they may retail for over $100, and are not regulated by the FDA, which raises an eyebrow about both efficacy and quality control. In short: use your own discretion. While the risks to trying may be low, ineffective treatment can frustrate patients and prolong the healing process.

Second, many people opt for a low-dose antidepressant in the winter months to replace another lost neurotransmitter (serotonin). Among other reasons, the brain produces less serotonin in the winter months due to the same changes in circadian rhythms that cause an increase in melatonin. Particularly in winter, we tend to be more isolated and sedentary, meaning that we generate less serotonin from socialization and physical activity, which would normally supplement us. As such, many people take a temporary antidepressant to counteract the low level of serotonin once they know how winter months impact their mental health.

Lastly, the option I am most familiar with: therapy! Many new clients initiate psychotherapy in the winter months to cope with the physical, mental, and social changes that are initiated with colder weather. While every client's journey through therapy looks different, treatment for seasonal depression in a general sense includes processing past experiences with depression, identifying patterns, and making plans to cope ahead of time. We might also sprinkle in new self-care practices and increase health-promoting behaviors like sleep and exercise, learning to have more mental flexibility in working around the barriers that winter creates.

In short, there is no one-size-fits-all approach to treating SAD. No one option is best. An individual may benefit from one option, or a combination of two or three. Just as every person's symptom presentation is unique, so is their treatment plan.

Takeaways

If there is one thing you leave this blog with, I hope it is the knowledge that seasonal depression is both common and treatable. Many people are dismissed or misdiagnosed when they talk about their symptoms, which can lead to greater suffering long-term. Just because it is common does not mean you should not ask for help. You deserve to enjoy your life during all seasons of the year.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Johns Hopkins Medicine. (2024). Seasonal Affective Disorder. Www.hopkinsmedicine.org; Johns Hopkins University. https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-affective-disorder

Mayo Clinic. (2016). Seasonal affective disorder treatment: Choosing a light therapy box. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298

National Institute of Mental Health. (2023). Seasonal Affective Disorder. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

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