Seasonal Affective Disorder (SAD): Signs, Symptoms, & Treatments

How Common Is SAD?

About 5% of the population experiences SAD, with symptoms that last about 40% of the year.^1,4 Also, about 10% of people diagnosed with major depressive disorder note a seasonal pattern. Fortunately, SAD may not last, as only 27% of people with a prior SAD diagnosis still had the condition 12 years later.

Winter Vs. Summer Seasonal Affective Disorder

With SAD, the winter commonly means periods of depression with the summer months involving periods of no symptoms or manic episodes, depending on the individual and their condition. Some people will not fit into this pattern, though, and will note mania in the winter and depression in the summer, often referred to as “summer-onset SAD.”

Seasonal Affective Disorder Symptoms

People with both bipolar disorder and depression who have the “with seasonal pattern” label will experience depressive symptoms and episodes during the fall and winter. The symptoms will present most of the day for more days than not over the last few weeks.

The most common symptoms associated with seasonal affective disorder include:²

• Low mood or increased irritability
• Low energy
• Low motivation to engage in pleasurable activities
• Changes in eating and sleeping habits
• Feeling slowed down or sped up behaviorally
• Increased feelings of guilt and worthlessness
• Poor attention, concentration, and decision-making skills
• Thoughts of death, dying, and suicide

Spring & Summer SAD Symptoms

SAD that develops in the spring and summer may have slightly different symptoms from SAD which presents in fall or winter.⁵ Summer-onset SAD, also sometimes referred to as summer depression, is less common than fall-onset SAD.⁵

Some signs and symptoms of summer-onset SAD include:⁵

• Insomnia, or trouble falling or staying asleep
• Difficulties with hunger cues
• Unintended weight loss
• Irritability, moodiness, or anxiety

Seasonal Changes & Bipolar Disorder

Individuals with a pre-existing diagnosis of bipolar disorder are at increased vulnerability of developing SAD.⁵ Bipolar disorder mania is sometimes triggered by the start or end of seasons.⁵ For example, summer sometimes triggers symptoms of moodiness and irritability, hypo-mania, or full-blown manic episodes in people with bipolar disorder.⁵ In the winter months, depressive episodes and suicidal ideation may present in those with bipolar disorder.⁵

In any case, seasonal changes can exacerbate pre-existing diagnoses of either bipolar disorder or a depressive disorder. Individuals already diagnosed with bipolar may want to speak with their doctor about any concerns regarding SAD symptoms, as available treatments may vary.

Signs of Seasonal Affective Disorder

SAD creates a pattern where the weather and seasons dictate the person’s mental health, physical health, and overall well-being. A person with SAD will show predictable and consistent mood changes caused by a change in season. Seasonal affective disorder may emerge at any age. Most cases do not begin until adulthood, so children with the condition will be rare.¹

People who have depression with seasonal patterns will often present as mentally healthy during the summer months. Perhaps they will be more physically active, more social, more energetic, and display signs of happiness. They will thrive during these periods.

Someone who has bipolar disorder with seasonal patterns will have a different experience in the summer. During warmer weather, these people will be more likely to display signs of mania, including increased energy, decreased need for sleep, and reckless behaviors.²

In the fall and winter, though, the effects of the spring and summer will give way to low mood, worthlessness, low energy, and other unwanted symptoms of depression. During these depressive episodes, the people with the condition will barely resemble the other versions of themselves.

During the colder months, the person may be unable to work, go to school, and maintain responsibilities at home. Their relationships will struggle, and their disposition will be less desirable. They may feel the urge to stay in bed most of the day and hibernate through the season.

What Causes Seasonal Affective Disorder?

A combination of risk factors, causes, and triggers of seasonal affective disorder put some people at greater risk of the condition. With enough risk factors for SAD, the condition will most certainly present and bring with it drastic changes to mood, energy, motivation, and sleep.

Causes of seasonal affective disorder include:³

• The person’s biological clock: Levels of sunlight influence each person’s circadian rhythm. As daylight changes, the rhythms change as well.
• Serotonin changes: Serotonin is a brain chemical linked to mood and depression. Serotonin tends to drop during the winter months.
• Melatonin changes: Melatonin is an important chemical associated with sleep and mood. Like serotonin, seasons influence the amounts of melatonin in the body.

Who Is at a Higher Risk for Developing SAD?

Some of the most significant risk factors of seasonal affective disorder include:³

• Family history of depression or bipolar disorders
• Having major depressive episodes or manic episodes
• Living far from the equator. Due to the impact of seasons and weather on SAD, people who live closer to the poles report increased incidents of SAD

Complications of Living With SAD

Once you recognize any signs or symptoms of SAD, it is important to reach out to your doctor and discuss treatment options. When left untreated, SAD can result in long-term negative effects on your quality of life.⁵

Complications from untreated SAD may include:

• Increased and sustained social withdrawal or relational conflicts
• Issues in workplace or school, such as frequent absences or decreased productivity
• Co-occurring substance abuse
• Development or worsening of other mental health conditions, such as anxiety or eating disorders
• Suicidal ideation or behaviors

How Is Seasonal Affective Disorder Diagnosed?

Only a mental health professional can diagnose seasonal affective disorder or a seasonal pattern related to a depressive or bipolar disorder. Rather than using tests or measurements, clinicians will complete a thorough interview to gather information and record their findings. If depression or bipolar disorder is present, the professional will inspect the existence of the seasonal pattern. To do this, the clinician will ask about recent mood episodes to track their presentation. If the episodes mostly fit the seasonal changes, a seasonal pattern applied to their depression or bipolar disorder could be the proper diagnosis.

Experienced clinicians will also check to see if other issues or situations for the symptoms exist. Someone who experiences extra stress or sadness in the winter because of grief and loss issues, lack of money associated with seasonal work, or increased substance use would not qualify as having a seasonal pattern, and instead may have a form of situational depression.²

Seasonal Affective Disorder Treatments

The type of treatment for seasonal affective disorder will depend on if there is an underlying diagnosis of depression or bipolar disorder. In either case, a combination of therapy and psychiatric medications will be offered by a team of mental health professionals to create the desired reduction of symptoms. Treatment for depression and treatment for bipolar disorder are different, so understanding your diagnosis is important for getting proper care.

“The best treatment for someone with SAD (winter depression type) is exposure to bright light of 10,000 lux intensity for at least 30 minutes before 8 a.m. every day of the week. Many research studies support this therapy. Individuals with depression should always work with a professional qualified to treat depression and should never treat themselves.

SAD is not caused by Vitamin D deficiency, so taking extra vitamin D will not help most people. Individuals who want light therapy should obtain a proper device (see Yale School of Medicine’s list of recommended light boxes); most lights sold on the internet are too dim and too small to work well,” says Paul Desan, MD, PhD, associate professor of psychiatry at Yale University.

Therapy for Seasonal Affective Disorder

People may need ongoing therapy to address the behavioral patterns that emerge with changing seasons, or they could utilize a few sessions at certain times of the year to regulate symptoms. As always, people should consult with their therapist, rather than making any impulsive decisions alone.

Experts utilize and recommend several therapy styles for SAD, including:^{6, 7}

• Cognitive behavioral therapy (CBT): CBT is one of the most effective therapy styles for seasonal affective disorder. CBT helps people understand the link between their thoughts, feelings, and behaviors, so they can adjust their patterns to produce more desirable results.
• Acceptance and commitment therapy (ACT): ACT teaches people to accept their current status while also making the decision to commit to change. With this combined technique, people can cope with unwanted thoughts, clarify their values, and shift their perspective.
• Dialectical behavioral therapy (DBT): As a blend of CBT and meditative techniques, DBT works to build mindfulness, communication skills, distress tolerance, and emotional regulation in specific blocks of treatment.
• Interpersonal therapy (IPT): For adolescents and adults dealing with depression linked to SAD, IPT is a way to address symptoms by focusing on communication skills and relationships.

Seasonal Affective Disorder Medication

Because much of SAD is regulated by changing chemicals in the body, medication for depression may be an essential aspect of treatment. Psychiatrists, nurse practitioners, and primary care physicians (PCPs) can offer trials of medications to see which options best meet the individual’s needs.

Some of the most popular medications prescribed for seasonal affective disorder are selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac). As a class of medications, SSRIs help to increase the amount of serotonin available in the brain and include.^{3, 6}

Aside from SSRIs, another type of antidepressant medication called bupropion (Wellbutrin) may be used to prevent and manage the depressive symptoms connected to SAD. The prescriber may recommend taking medication all year or only in the months leading up to season changes.³

Light Therapy for SAD

Light therapy has been a standard treatment for SAD due to its high efficacy rates.⁸ Some research supports efficacy rates for light therapy treatment of SAD as high as 60-80%.⁸ It is important to get a verified light therapy unit as certain types of light and sizes of units may be more effective than others. Most people can find relief from 30-90 minutes of light therapy treatment, which equates to around 10,000 lux.⁸ Some may find relief from symptoms in as little as 2 to 4 days.⁸

How to Get Help for Seasonal Affective Disorder

To get help for seasonal affective disorder, people should seek treatment from whatever sources are accessible and available. People can contact their primary care doctor, insurance company, school psychologist, or the local mental health facility to inquire about SAD treatment.

How people can get help for seasonal affective disorder is important, but it may not be as important as when they get help. If someone waits until they are deep into the season before seeking treatment, it could prove more challenging to address the condition.

How to Cope With Seasonal Affective Disorder

Living with seasonal affective disorder is a challenge for anyone, but by using positive coping skills and avoiding unhelpful impulses, a person can live a happy and fulfilling life.

Here are seven ways to manage seasonal affective disorder symptoms:

1. Plan Ahead & Stick With Your Treatment Plan

Many people experience seasonal symptoms during the same months or even weeks each year. With this information, a person would be wise to begin consulting with mental health professionals and adjusting their treatment in the time before the season changes. With SAD, prevention is invaluable.

2. Be Open About Your Seasonal Affective Disorder

There is no need to live with shame related to SAD or any mental health disorder. Rather than keeping your condition private, tell the important people in your life what is coming. Together, you can prepare for the road ahead.

3. Monitor Your Alcohol & Substance Use

As the weather changes and influences your brain, you may be more tempted to seek out the comfort of alcohol and other drugs to help regulate the chemistry. This behavior is always negative, though, as it uniformly results in more problems and stress in the future.

4. Create Consistency with Schedules & Routines

SAD creates frustrations and inconsistencies in your life. You can fall victim to the flux, or you can create a program focused on consistency. By setting schedules, following routines, and encouraging others to keep you accountable, you can keep SAD well-managed. Using your light therapy, taking your medication, and engaging in psychotherapy regularly will help along the way.

5. Focus on Physical Self-Care

Physical self-care is an important component of managing SAD symptoms. Physical self-care can encompass exercise, healthy hygiene practices, staying hydrated, eating a balanced diet, taking medications routinely, and even sleep hygiene. Making a list of your desired physical self-care routine can help keep you grounded in the practices you want to prioritize.

6. Don’t Isolate Yourself

Some people diagnosed with SAD can struggle with the temptation to isolate. Isolation can seem like an effective coping mechanism when your energy levels are low or you are feeling blue, but a potential danger is that it can increase feelings of loneliness and disconnection. Especially if one of your symptoms is struggling with suicidal ideation, it can be stabilizing to seek comfort and validation from your support system. If you don’t have the energy to meet with loved ones in person, consider sending a text, doing a virtual meeting, or even scheduling a long phone call.

7. Be Patient & Kind to Yourself

Even the best coping skills may not be enough to erase all symptoms of SAD, so if complete relief is what you are expecting, you could feel quite let down. Give yourself some kindness and patience by allowing yourself some “bad days.” Just work to keep them as limited as possible.

Positive coping skills are never very exciting or glamorous, but the benefit they can offer people with SAD is invaluable. Be patient and take your time to find the best possible results.

Is SAD Preventable?

Unfortunately, the development of SAD is not preventable. However, once diagnosed, this gives you the insight and opportunity to look into available treatments and figure out a recovery plan. Some people find it helpful to begin treatment before they know their symptoms will present. For example, if you are diagnosed with fall or winter SAD, it may be helpful to begin treatments in the summer or spring. Others find that continuous treatments are better suited for the management of their symptoms.

What’s the Outlook for People With Seasonal Affective Disorder?

Although SAD is not a preventable disorder, the outlook with treatment is positive. Research supports the idea of different treatments even being equally effective for the management of SAD symptoms.⁹ For example, a direct comparison of people receiving light therapy and those receiving cognitive behavioral therapy for SAD symptoms showed equally effective improvements.⁹ Other research supports light therapy as holding a 60-80% efficacy rate for those diagnosed with SAD.⁸

Will SAD Come Back Every Year?

Researchers cannot come to a consensus as to why, but SAD may not occur for diagnosed individuals every year.⁹ Development of SAD appears to be a complex interaction between genetic and environmental influences, which may affect the recurrence of the disorder. For example, available serotonin levels, production of melatonin, varying levels of sunlight, vitamin D levels, and negative cognitions about winter, are all variables which may change and affect presentation of the disorder.⁹

How to Get Help for a Loved One

If a loved one seems to be struggling with seasonal affective disorder, depression, or bipolar disorder, the best choice is to kindly and gently address the situation from a stance of love and understanding. Never blame, name call, or address your concerns during periods of anger. Always take steps to maintain and preserve open communication, so the relationship can survive.