Here’s a common misconception about seasonal affective disorder (SAD): the idea that it only happens during the winter. While winter is the typical season for SAD, due to the lack of light and opportunity to go outdoors and keep your serotonin levels up, it can also be experienced in the spring or summer. Summer blues, anyone?
That said, we can’t deny that SAD feels particular harsh this year. This may be a result of the COVID-19 pandemic and the drag of ongoing isolation, augmenting depression symptoms. Research shows depression rates have more than tripled during the pandemic, and since pre-existing depression is one of the risk factors for SAD, there could be correlation.
What is seasonal affective disorder?
Seasonal affective disorder is a form of depression that comes and goes with the seasons. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this diagnosis is known as major depressive disorder with a seasonal pattern or clinical depression. SAD typically starts in the late fall or early winter, resolving in the late spring or summer, but it can also happen in the spring or summer.
Your likelihood for having seasonal affective disorder increases if you:
- are female: SAD is four times more prevalent in women than men
- live up north: studies show 1% of those in Florida experience SAD compared to 9% in Alaska
- are of a younger age, with onset between 18 and 30
- have a history of major depressive disorder or bipolar disorder
- have a family history of SAD
While SAD affects up to 15 million American adults, this condition can also affect anywhere from 1% to 10% of global population.
What causes SAD?
“There’s a strong interplay between exposure to light and certain chemicals in the brain that affect mood and sleep, such serotonin, dopamine, norepinephrine, and melatonin,” explains Dr. W. Chris Winter, a sleep medicine specialist and author of The Sleep Solution.
Researchers theorize that the lack of sunlight may cause SAD. Each of your retinas is packed with light-receptor cells that, when activated, trigger a cascade of chemical reactions designed to wake you up. Without sufficient light, your brain doesn’t get a clear message of when it’s day and when it’s night.
This also triggers regulation issues in the body, causing a series of events such as:
- Increased melatonin: lack of sunlight may cause an overproduction of melatonin, triggering longer periods of sleepiness and low energy.
- Decreased serotonin: serotonin is the neurotransmitter responsible for regulating mood. With less sunlight, serotonin activity falls.
- Circadian rhythm: changes in melatonin and serotonin can shift the circadian rhythm so that it’s harder for the body to adjust to seasonal changes.
- Vitamin D deficiency: with less sun exposure, your body produces less vitamin D, which aids with serotonin activity.
It might be tempting to just wait SAD out by letting winter (or your specific season of doldrums) pass by, but research shows that there are effective ways to improve symptoms. There’s no reason to suffer or let your self-care lapse, especially if you believe the symptoms will return next year. Read on to learn what symptoms you may experience and how to manage them.
What are the symptoms of SAD?
Symptoms of seasonal affective disorder can look a lot like symptoms of clinical depression. To distinguish between the two, a healthcare provider may send you a screening to fill out, such as the Seasonal Pattern Assessment Questionnaire. This questionnaire will ask about your symptoms and how long you’ve been experiencing them. SAD symptoms typically last about 40% of the year.
The symptoms can include:
- loss of pleasure or interest
- difficulty concentrating
- low or no energy
- thoughts of death or suicide
Additional winter symptoms for SAD
Anywhere from two-thirds to three-fourths of people with SAD experience hypersomnia, according to a BMC Medicine review. While extra sleep may sound like a good thing, it isn’t necessarily restorative and can upend your sleep schedule during the winter.
“Similar to chronic depression, SAD can result in increased sleepiness and fatigue during the day and can cause individuals suffering from it to sleep longer at night,” explains Nicole Avena, Ph.D., assistant professor of neuroscience at Mount Sinai School of Medicine in New York City and visiting professor of health psychology at Princeton University. SAD, like other forms of major depression, can also cause an increase in nightmares and fragmented sleep.
What’s worse, nights spent tossing and turning can dial up the condition’s other symptoms, creating a vicious cycle. “SAD can reduce quality of sleep, and low-quality sleep can worsen symptoms of SAD by increasing feelings of depression and anxiety,” says Avena.
Other winter symptoms for SAD may include:
- Decreased social activity: contributes to a drop in serotonin
- Loss of energy or increased fatigue: can decrease motivation, pleasure, or interest
- Increased appetite or preference for carbohydrates: may lead to overeating or weight gain
How to treat seasonal affective disorder
1. Bathe yourself in light (at the right time)
Light exposure is a key component of effective seasonal affective disorder treatment, says Winter. When it comes to setting the body’s circadian rhythms, research shows exposure to bright light acts on photoreceptors in the eyes, and is more effective than light exposure to the skin.
Light exposure can take the form of:
- opening the curtains first thing in the morning
- prioritizing outdoor time during the day’s brightest hours
- sitting in front of a dedicated light therapy box or SAD lamp
Most forms of light therapy require at least 20 minutes of exposure at a brightness that is 20x stronger than indoor lighting. Options can include something as simple as a pair of light therapy glasses, like Luminette Light Therapy Glasses, from Sleep Score Labs, though you’ll want to run any option by your doctor. The time you want to use your light box may also depend on your chronotype.
2. But avoid light before bed
In the evening, dim your household lights if possible, to help your body recognize that it’s time to get ready for sleep.
And, most importantly, in the hour or so before bedtime, avoid watching TV or using your computer, phone, or tablet. These devices all emit blue light, to which your eye’s photoreceptors are especially sensitive, Winter says.
3. Use up your energy during the day
Yes, you may feel fatigued, but you should try to move your body as much as possible when you’re awake. This is because you need to expend your energy stores during the day in order to actually sleep at night, says Winter.
Staying active can be hard to do since mood disorders can make you feel lethargic, so focus on setting small, attainable exercise goals for yourself such as taking a walk each day. In time, as your energy levels grow, you’ll be able to do more for additional benefits.
4. Try CBT therapy to help with depressive thoughts
Among the most popular, scientifically supported methods for addressing depression is cognitive behavioral therapy (CBT), a form of psychotherapy that centers on challenging unhealthy mental thought patterns and replacing them with healthy thought processes and actions.
CBT is also highly effective in the treatment of mental-health-related sleep troubles, and your psychologist or psychiatrist can refer you to a sleep medicine physician who specializes in cognitive behavioral therapy.
5. Reach out to your networks for support
It’s important to recognize seasonal affective disorder for what it is: a form of depression that merits support. If you suspect you have SAD, reach out to your doctor or a licensed psychologist, psychiatrist, or sleep medicine physician for professional help.
If you need help being kept accountable, try asking a family member or friend to check in with your regularly, or work with a behavioral therapist to come up with a strategy moving forward.
6. Ask your doctor about supplementation or medication
Reviews on supplementation for SAD are mixed, however some research does show positive effects for vitamin D and melatonin supplementation during your SAD episode. Studies have found that people with depression tend to be low in vitamin D levels, though more research is needed to help identify who would benefit the most from vitamin D supplementation. As for melatonin, long-term use is not recommended.
When it comes to medication, taking antidepressants on a temporary basis may also help with your symptoms. However, it can take multiple medications and dosages to find the right fit without too many side effects.
7. Practice good sleep hygiene
The everyday tips for good sleep can still apply whether you’re coping with SAD or not. Be sure to practice good sleep hygiene — including creating a relaxing bedtime routine to help you wind down, avoiding caffeine mid-day, sticking to a sleep schedule as best as possible, and keeping your bedroom at a cool, comfortable temperature at night.