Changing seasons are inevitable, but does winter have you down? For some people, the change in weather can usher in a lower mood, while others ride through the cooler months of the year with mental ease. Seasonal Affective Disorder (SAD) is not an uncommon event. It’s estimated that millions of Americans experience SAD every year, though many may not even know it. According to the American Psychiatric Association, SAD is considered a Major Depressive Disorder (MDD) and impacts five percent of adults in the United States.

What is SAD?

Though first listed as a health condition in the 1980s, scientists are still actively trying to find its cause. From what we know so far, SAD seems to be hormone-related. People who are affected by SAD have trouble stabilizing serotonin, a mood-regulating hormone, and melatonin, a hormone needed for sleep. These hormones play an important role in managing the body’s internal rhythms and changes in them can really make someone feel out of balance.

As the days get shorter, your circadian rhythm, or "internal clock" adjusts. For those who are affected by SAD, this change in regulation does not happen as easily. Generally, people affected by SAD experience symptoms similar to depression including:

• Depressed most days for 4-5 months
• Loss of interest in activities they once enjoyed
• Low energy
• Sleep difficulties
• Hopeless or depressive thoughts
• Considering their own death or suicide

SAD is typically experienced in the winter months, but it is not uncommon for some people to experience periods of altered mood in the summer. During the winter, oversleeping, overeating, weight gain, and a preference for being alone can be included. In the summer, trouble sleeping, appetite problems leading to weight loss, anxiety, and being more agitated/violent can occur. In either case, symptoms can also begin mildly and become more severe as the season progresses.

Who is Most Affected?

Research has found women are at a higher risk of developing SAD than men. Additionally, people who are already diagnosed with major depressive disorder or bipolar disorder, or those who have a relative diagnosed with a mental disease are also at high risk. We also know low vitamin D levels can contribute to a depressed mood. As SAD is more common in northern latitudes where the sun is not as bright/present during the winter months, vitamin D levels may be a major contributor.

First-Line Therapy Options

Once a doctor has diagnosed someone with SAD, there are a variety of treatment options. Some of the treatment options available include medications. One of the more common classes of antidepressant medication is called selective serotonin reuptake inhibitors (SSRIs). Outside of medications, there are many available therapies. Those diagnosed with SAD may find some relief through counseling or talk therapy. Research shows cognitive behavioral therapy (CBT) can help people learn better coping mechanisms. CBT can be done one-on-one or in group sessions with a licensed health professional.

More Natural Therapy Options

Alternatively, there are other options that can be used alone or in conjunction with medications and counseling sessions.

Exercise. Exercise in general is supportive of a healthy mental state. Research has found working out two-three times a week can be helpful in lowering depression. Any kind of movement has been found to have some benefit over no exercise at all.

Light Therapy. Light boxes can be used in the comfort of your own home. In the morning, you can sit in front of a light box with 10,000 lux of cool-white fluorescent light. It’s recommended to do this for 20-60 minutes each day. This is generally well-tolerated though side effects such as eyestrain, headaches, irritability, etc., may occur.

Vitamin D. As mentioned above, research has shown low levels of vitamin D are associated with depression. During the winter months, especially in the northern latitudes, there isn’t enough sunlight to produce adequate amounts of vitamin D. Supplementation through food or capsules can be helpful.

Herbal Therapy. Many herbs have been evaluated for their ability to help lift a depressed mood. St. John’s Wort, green tea, kava kava, and others have been evaluated for help with depression. More research is needed, but herbs generally tend to have fewer side effects for most people. Always consider seeing a qualified holistic doctor for recommendations specific to you and your symptoms.

Where to Start

If you experience any of the above symptoms for over two weeks, you should speak with your healthcare provider right away as depression can be a very serious disease. Taking care of yourself is more than taking care of your body, it is taking care of your mind too. If you or a loved one are having suicidal thoughts and are located in the United States, dialing or texting 988 will connect you to Suicide & Crisis Lifeline. You can also call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night.

Resources:

1. Gihyun Lee, Hyunsu Bae, (2017). "Therapeutic Effects of Phytochemicals and Medicinal Herbs on Depression", BioMed Research International, vol. 2017, Article ID 6596241. https://doi.org/10.1155/2017/6596241
2. Melrose S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression research and treatment, 178564. https://doi.org/10.1155/2015/178564
3. National Institute of Mental Health. "Seasonal Affective Disorder.” Accessed 02/16/2023. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
4. "Seasonal Affective Disorder (SAD).” 2020. American Psychiatric Association. https://www.psychiatry.org/patients-families/seasonal-affective-disorder
5. "Seasonal Affective Disorder (SAD).” N.D. Mayo Clinic. Mayo Foundation for Medical Education ad=nd Research (MFMER). Accessed Feb. 20, 2023. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
6. Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (2006). Exercise Interventions for Mental Health: A Quantitative and Qualitative Review. Clinical Psychology: Science and Practice, 13(2); 179–193. doi:10.1111/j.1468-2850.2006.00021.x
7. Szegedi, A., Kohnen, R., Dienel, A., & Kieser, M. (2005). Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomized controlled double-blind non-inferiority trial versus paroxetine. BMJ (Clinical research ed.), 330(7490); 503. https://doi.org/10.1136/bmj.38356.655266.82