The Winter Blues: Seasonal Affective Disorder (SAD)

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In this video, we’re going to learn about Seasonal Affective Disorder, what it means, what the symptoms are, and how we can treat it.

First off, Seasonal Affective Disorder (SAD) is a type of depression that usually starts in the fall or early winter and continues until the spring or early summer. The technical term from the DSM (Diagnostic Manual of the American Psychiatric Association) is Major Depressive Disorder with Seasonal Pattern, but it’s usually just referred to as Seasonal Affective Disorder. It can also be present with bipolar disorder in which the depressive episodes follow a seasonal pattern.

The seasonal pattern could also involve the onset of depression in the summer, but that’s not nearly as common as Seasonal Affective Disorder during the fall and winter.

The symptoms of Seasonal Affective Disorder are the same as for depression – five or more of the following, including at least one of depressed mood most of the day, nearly every day or loss of interest or pleasure in all or almost all activities most of the day, nearly every day. The other symptoms are significant weight loss or weight gain or increase or decrease in appetite, insomnia or hypersomnia, feeling agitated and restless or slowed down and lethargic, feelings of worthlessness or guilt, diminished ability to think or concentrate or indecisiveness, recurrent thoughts of death or suicidal ideation or a plan to commit suicide or a suicide attempt.

Seasonal Affective Disorder is often characterized by loss of energy, hypersomnia, overeating, weight gain, and craving carbohydrates. Many people who don’t meet the full criteria for depression still experience some level of seasonal mood change with many of these symptoms, and about two to five percent of the population experience Seasonal Affective Disorder, and 10 to 15 experience at least some level of seasonal mood change.

So how do we treat Seasonal Affective Disorder? The three main treatments are bright light therapy, psychotherapy (generally cognitive-behavioral therapy), and antidepressant medications.

In general, there’s very limited evidence to support the effectiveness of any specific treatments for SAD. Some research has found that light therapy and CBT may be effective, but there’s really not enough evidence to draw any overall conclusions regarding the effectiveness of light therapy or CBT or antidepressant medications for treating SAD.

The most common way to treat Seasonal Affective Disorder is with bright light therapy. In the winter, we’re exposed to less sunlight, and this lack of sunlight can affect our bodies in ways that contribute to depression and can lead to Seasonal Affective Disorder. Bright light therapy is a way of making up for our lack of exposure to sunlight and as a result, can help alleviate symptoms of SAD and seasonal mood change.

Light therapy involves spending about half an hour as soon as you wake up in front of a light therapy box or lamp with a UV-free full spectrum light with a brightness of 10,000 lux. They’re really easy to use – make sure to follow the manufacturer’s instructions, but the lights usually set up in such a way that you can have breakfast or be on your computer while using it, so it’s not like you have to set aside time every day just to be exposed to the light.

One of the advantages of bright light therapy is that it’s relatively inexpensive, and you can get a light therapy box starting at around twenty to thirty dollars online. Another advantage is that side effects are uncommon, and if there are side effects, they’re generally pretty mild – headaches, dizziness, nausea, or eye strain. But if you have an eye condition that makes your eyes particularly sensitive to light or are taking medication that increases your sensitivity to light.

Another advantage is that side effects are uncommon, and if there are side effects, they’re generally pretty mild, such as headaches, dizziness, nausea, or eye strain. However, if you have an eye condition that makes your eyes particularly sensitive to light or are taking medication that increases your sensitivity to light, you should consult your doctor before starting bright light therapy. In general, you should always consult your doctor if you’re unsure about the suitability of a particular product and not start a treatment just because you heard about it from someone on YouTube.

So what about psychotherapy for seasonal affective disorder? There’s not much research available, so this is just my own opinion, but CBT is the most common psychological treatment for depression in general. And there’s one aspect of CBT for depression that I think is particularly relevant to treating seasonal affective disorder, and that’s behavioral activation.

Behavioral activation involves becoming more active and making sure we’re not spending too much time just sitting or lying around when we’re feeling depressed and not doing much of anything. And this is an effective treatment for non-seasonal depression, and I think it’s particularly well-suited to treating seasonal depression because with SAD, there can be such a sense of hibernation, of having very little energy or motivation to do anything, and just wanting to lie around and sleep most of the day.

And if we let ourselves go along with how we’re feeling and start limiting how much we do, this creates a vicious cycle in which when we’re depressed, we lose our motivation to do things. But the less we do, the more depressed we tend to feel, which just leaves us even less motivated to do things, which feeds back into our depression.

And behavioral activation is a way of reversing this cycle, and as we start to become a little more active, we start to feel a little bit better, which increases our levels of energy and motivation to continue being more active, which helps make us less depressed.

And getting any sort of exercise is one activity that can help improve our moods and increase our energy levels, and just going for a walk is a great place to start, especially if we can get out during the day where we get the added benefit of some exposure to sunlight. And I have a whole video about behavioral activation if you’d like to learn more about how it works.

And I think bright light therapy works well in the context of behavioral activation because it helps us develop a routine of getting up and doing something first thing in the morning instead of just lying around in bed for as long as possible.

And what about antidepressant medications? Seasonal affective disorder is commonly treated with the same medications used to treat non-seasonal depression, such as SSRIs like Prozac, Paxil, Zoloft, Lexapro, or Celexa, or bupropion, also known as Wellbutrin. And their effectiveness in treating SAD is unclear due to the lack of high-quality research. And if you want to explore medication for SAD, that’s something your doctor can help with.

And vitamin D deficiency may contribute to seasonal affective disorder, so if you are vitamin D deficient, a supplement may help alleviate symptoms of SAD. But not everyone with SAD is vitamin D deficient, and you shouldn’t start taking a supplement without consulting your doctor.