How to Spot the Difference and Boost Your Mood

Seasonal affective disorder (SAD) is sometimes called the “winter blues” because it causes sadness during the fall and winter months. However, the winter blues and SAD are not the same condition.

SAD is a type of depression that needs treatment. It limits normal function and motivation, whereas the winter blues can affect you for shorter periods, such as a day or two once or twice a month. Some research reports suggest that the winter blues are a mild form of SAD called subsyndromal seasonal affective disorder.

Seasonal affective disorder (SAD) is a form of recurrent major depressive disorder (MMD) where depressive episodes occur during the same season each year. SAD is believed to be related to reduced daylight hours in the winter months. While much rarer, SAD can also occur in the warmer weather months.

SAD also has a genetic component and a more prevalent pattern. In addition, it is linked to low serotonin levels and melatonin imbalances. Treatment is available for SAD and may include medications, counseling, and light therapy. 

SAD Has a Genetic Component

SAD affects up to 3% of the general population. It affects 10% to 20% of people with major depressive disorder and 25% of people with bipolar disorder.

SAD tends to run in families. About 15% of people with SAD have a first-degree relative (parent or sibling with the condition). It may also occur in people who have a family history of other mood disorders. 

SAD tends to affect people born assigned female at birth more often than it does people assigned male at birth. It also occurs more frequently in younger adults compared to older adults. 

Other potential factors related to SAD include:

• Changes to circadian rhythm (biological clock): The reduced sunlight in the fall and winter months may lead to a winter onset of SAD. It affects the body’s internal clock, leading to depressive feelings.
• Serotonin levels: Serotonin is a brain chemical that affects mood. The reduced sunlight can lead to serotonin drops, which may trigger depression. 
• Melatonin levels: Melatonin is a hormone that affects the body’s mood and sleep patterns. Seasonal changes may affect melatonin levels, leading to depressive symptoms.
• A personal or family history of major depression or bipolar disorder: Symptoms of these conditions may worsen seasonally. You are also more likely to have SAD if you have a family history of major depression or bipolar disease.
• Living far from the equator: SAD is more common in people who live far north or south of the equator. This is likely due to decreased sunlight during winter or longer summer days.
• Low vitamin D: You can get vitamin D from eating vitamin D-rich foods. Some vitamin D is produced when the skin is exposed to sunlight. Vitamin D can boost serotonin. Less sunlight and insufficient vitamin D from food or supplements can lead to low levels of vitamin D and SAD.
• Stressors: Stressors and negative thoughts and feelings in the winter or summer months can also lead to SAD.

SAD Has a Pattern

SAD is a major depressive disorder with a seasonal pattern. A diagnosis of SAD can be made for someone who meets the criteria for major depressive disorder that occurs within specific seasons for at least two consecutive years. SAD is characterized by recurrent depressive episodes that occur in later fall and winter, with periods of normal mood during the rest of the year.

SAD has specific prevalence patterns that vary by latitude, age, and sex. For example:

• SAD is more common in people living in higher /northern altitudes.
• Young adults are more likely to be affected by SAD.
• People assigned female at birth are at a higher risk for the condition.

Winter Blues or SAD?

Feeling down or sad during the winter months could signify the winter blues. But if you find yourself experiencing symptoms that affect your ability to function, your depressive symptoms could be something more serious. 

SAD is a complex disorder, and it is more than just sadness. It causes symptoms like those often seen in major depressive disorder, including sleep troubles, energy level fluctuations, and appetite and weight changes. It may lead to isolation and an inability to enjoy things that previously brought you happiness or pleasure (anhedonia). 

If symptoms of SAD become severe, they lead to self-medication with alcohol or drugs or ideas of self-harm or suicidal ideation. 

If you are experiencing symptoms of SAD, feel depressed for two or more weeks, or are thinking about self-harm or suicide, it is crucial to seek out mental healthcare immediately. 

When Symptoms Get Better

Symptoms of SAD typically occur during the fall and winter months when there is less sunlight. Symptoms will improve with the arrival of spring. 

The most challenging months for people with SAD in the United States are January and February.

Some people will experience a rarer form of SAD that occurs in warmer weather called summer-pattern SAD. It starts in late spring or early summer and ends in the fall. 

The winter blues can also cause a mildly depressed mood over a shorter period or that occurs sporadically and improves in a day or two. But SAD generally lasts for the entire season and causes symptoms seen in other types of depression—a persistently sad mood, fatigue, loss of interest, sleep troubles, and changes in sleep patterns.

Signs and Symptoms of SAD

Symptoms of SAD will last four to five months out of the year. Symptoms may vary by season, and not every person with SAD will have the same symptoms. 

Symptoms of SAD may include:

• Feeling persistently sad or anxious, or feeling empty or numb on most days, nearly every day for at least two weeks
• Feeling hopeless or helpless 
• Feeling irritable, frustrated, or restless
• Loss of interest in activities you used to enjoy
• Fatigue, reduced energy, and lack of motivation 
• Difficulty with concentration, memory, and decision-making 
• Changes to sleep patterns or trouble sleeping 
• Appetite loss and unexplained weight changes 
• Physical aches and pains, headaches, and digestive troubles without clear causes that do not improve with treatment 

Winter-pattern SAD may also cause:

• Hypersomnia (oversleeping) 
• Overeating 
• Social withdrawal

Summer-pattern SAD may also cause:

• Insomnia (trouble sleeping)
• Poor appetite
• Restlessness and feeling agitated 
• Anxiety 
• Aggressive or even violent behavior 

When to Contact a Healthcare Provider

It is not unusual to have days when you feel down or sad. However, if you feel down for days and cannot get motivated to do the activities you typically enjoy, see a healthcare provider. 

It is essential to get medical help if you are also:

• Experiencing sleep pattern changes 
• Experiencing appetite and weight changes 
• Feeling hopeless or helpless
• Turning to alcohol or drugs for comfort or relaxation 
• Thinking about death or suicide
  

A healthcare professional can screen for SAD. Screening usually involves a questionnaire or verbal assessment.

Your primary care provider or your child’s provider can screen for SAD and offer recommendations, including treatment options or a referral to a therapist or psychiatrist.

Treatment Options for SAD

SAD is treatable and manageable. Treatment for SAD falls into four categories that can be used alone or in combination.

These categories are:

Light Therapy

Light therapy has been the mainstay treatment for SAD since the 1980s. It exposes a person with SAD to bright light to make up for the reduced natural sunlight in the winter months. It works by affecting the brain chemicals linked to mood.

Psychotherapy 

Psychotherapy, also called talk therapy, utilizes cognitive behavioral therapy (CBT) to manage SAD. CBT can help you learn ways to cope better, manage stress, identify negative thoughts and behaviors that make you feel worse, and develop healthy behaviors to manage symptoms, such as exercise and improving sleep hygiene (activities and environment surrounding bedtime).

Research on CBT and light therapy has found both therapies effective in improving symptoms, but CBT might offer slightly faster results.

Medications 

Antidepressant medicines work by changing how the brain produces or uses chemicals involved in mood processes. They can be used alone or with talk therapy. 

It may take a few weeks before you notice symptom improvement, or you may need to try more than one medication before you find one that works for you and has the fewest side effects. 

The Food and Drug Administration (FDA) has approved Wellbutrin (bupropion) to treat SAD. It is an extended-release antidepressant. It has been found to prevent recurrences of SAD episodes when taken from fall to early spring.

Your healthcare provider may recommend starting treatment before your symptoms typically begin each year and continuing treatment beyond when your symptoms usually dissipate.

Vitamin D Supplementation

Because winter-pattern SAD is sometimes linked to vitamin D deficiency, vitamin D supplements may help to reduce symptoms.

Talk to your healthcare provider before using vitamin D to treat your SAD. They will assess you and ask about other health conditions and medications you take to determine if vitamin D is a safe and effective option for you.

Tips to Feel Better

SAD is not preventable, but there are some things you can do to manage symptoms to keep them from getting worse.

If you have a history of SAD, your healthcare provider can start you on treatment before the fall for winter-pattern SAD or in the spring for summer-pattern SAD. Starting treatment early may help to prevent or reduce symptoms. 

Some healthy lifestyle and self-care habits may help you manage and prevent symptoms from returning. 

• Get as much natural sunlight as possible: Get outside during daylight hours and expose your skin to the sun. Sunlight can boost serotonin to improve mood. If you cannot get outdoors, increase the amount of sunlight that gets into your home and workplace by opening blinds and curtains and sitting near windows. 
• Get regular exercise: Exercise can be a powerful, all-natural way to ease SAD. It can boost serotonin, endorphins, and other feel-good brain chemicals. It can also improve sleep and self-esteem. Aim to get at least 30 to 60 minutes of activity daily. 
• Reach out to loved ones: Friendships and family relationships are vital for reducing isolation and managing SAD. Try to participate in social activities, such as meeting a friend for coffee, volunteering somewhere, taking a class, or asking a family member to visit you at home. You may even consider joining a depression support group. Sometimes, just talking to others who understand what you are feeling may help improve your mood. 
• Eat a nutritious and balanced diet: Eating a healthy, balanced diet, with plenty of fruits and vegetables, can help you keep your energy up and your mood managed. Foods that contain omega-3 fatty acids (i.e., oily fish, walnuts, seeds, and soybeans) may improve your mood and even boost the effectiveness of antidepressant treatments.
• Manage stress: Too much stress can worsen and trigger depression regardless of the season. Determine what stresses you out and do what you can to avoid or minimize its effects. Practice daily relaxation techniques like yoga and meditation to reduce negative emotions and promote a positive mood.
• Enjoyable activities: You should also try to do something you enjoy every day. Simple leisure activities like reading, painting, gardening, or spending time with friends can help reduce and manage stress and mood. 

Summary  

Seasonal affective disorder is a type of depression that occurs at the same time each year, usually in the winter months. While winter blues may last for a day or two once or twice a month, SAD affects people for longer periods in a seasonal pattern each year.

Symptoms of SAD can affect your mood, energy, sleep, and appetite. SAD is believed to be related to genetics, a personal or family history of depression, living further away from the equator, and vitamin D deficiency. If you have previously been diagnosed with SAD or have major depression or bipolar disorder, you are more prone to SAD or SAD recurrences. 

Treatment is available for SAD and includes medications, vitamin D supplements, talk therapy, and light therapy. If you suspect you may be depressed, reach out to your healthcare provider. This is especially important if you find you are unable to function, have lost interest in activities you enjoyed doing, are using drugs or alcohol to cope, or have suicidal thoughts. 

SAD is typically not preventable. However, your healthcare provider can prescribe an antidepressant treatment before symptoms start each year. You can manage symptoms of SAD by getting natural sunlight exposure, staying active, eating healthy, staying connected with friends and family, and managing stressors.