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Symptoms
Causes
Diagnosis
Treatment
Coping
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It is not uncommon for people to experience seasonal fluctuation in moods. You may have noticed how a gray, rainy day makes you feel gloomy and tired, while a sunny day can leave you feeling cheerful and energized.
The longer, sunnier days of summer are often associated with better moods, while the shorter, darker days that begin in late fall often align with an increase in SAD symptoms.
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The symptoms of SAD occur cyclically with a return of symptoms each year during the winter months. Symptoms can include:
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When it’s dark, the pineal gland produces a substance called melatonin which is responsible for the drowsiness we feel each day after dusk. Light entering the eyes at dawn shuts off the production of melatonin.
Insufficient exposure to sunlight has been associated with low levels of melatonin and serotonin, carbohydrate craving, weight gain, and sleep disturbance.
During the shorter days of winter, when people may rise before dawn or not leave their offices until after sunset, these normal rhythms may become disrupted, producing the symptoms of SAD.
The DSM-5 does not consider SAD to be a separate disorder. Instead, it is a “specifier” of a major depressive episode diagnosis. In order to be diagnosed with SAD a person must, first of all, meet the criteria for amajor depressive episode.
At least five of the symptoms listed below must be present most of the time during a two-week period. Further, at least one of the person’s symptoms must be one of the first two items listed.
A depressed mood that is due to a medical condition or that is related to the content of a delusion or hallucination that the person is experiencing would not count.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see ourNational Helpline Database.
If these criteria fit, the following criteria would also need to be met to obtain a seasonal pattern specifier:
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Seasonal affective therapy responds well to treatment. The most commonly used treatments for SAD include light therapy, medication, and psychotherapy.
Light Therapy
Light therapy using a device that gives off bright, white light is considered the best form of treatment for SAD at this time. In fall 1998, a group of 13 Canadian specialists issued a set of professional consensus guidelines for the treatment of SAD.
Among their conclusions:
Drugs should be brought in as adjuvants only if light therapy is insufficient.
Optimum dosing of light is crucial since if done wrong it can produce no improvement, partial improvement, or even worsening of symptoms.
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In a study published in theArchives of General Psychiatryresearchers exposed participants with SAD to bright lights that were 10 to 20 times brighter than normal indoor electrical lights.
One group was exposed to these lights for approximately one and a half hours in the morning, while a second group was exposed in the evening. The third group received a placebo treatment.
The participants who were exposed to the morning bright light treatments experienced full or near-full relief from depression.
Newer research published in theJournal of Nervous and Mental Diseasehas found that even a single, one-hour light session can rapidly improve symptoms of depression in people with SAD.And morning therapy, specifically, can help to correct any sleep-wake cycle issues contributing to the symptoms.
Medications
On June 12, 2006,Wellbutrin XL(bupropion hydrochloride) became the first drug approved specifically for SAD in the United States.
The effectiveness of Wellbutrin XL for the prevention of SAD episodes was established in three double-blind, placebo-controlled trials in adults with a history of major depressive disorder in fall and winter.
Treatment began in the September through November timeframe, prior to the onset of symptoms. Treatment ended the first week of spring.
In these trials, the percentage of patients who were depression-free at the end of treatment was significantly higher for those on Wellbutrin XL than for those on placebo.
For all three studies combined, the overall rate of patients depression-free at the end of treatment was 84% for those on Wellbutrin XL, compared to 72% for those on placebo.
Wellbutrin XL is chemically unrelated to other common antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). In fact, there is no conclusive evidence from randomized trials to support the use of SSRIs in the treatment of SAD.
Psychotherapy
Cognitive-behavioral therapy (CBT) can also be an effective treatment for SAD, particularly if it is used in conjunction with light therapy and medication. CBT involves identifying negative thought patterns that contribute to symptoms and then replacing these thoughts with more positive ones.
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Healthy habits and lifestyle choices can also help reduce SAD symptoms. Things that you can do include:
Vitamin D
Research has found that people with SAD often have low vitamin D levels.Because of this, people with the condition are often encouraged to increase their intake of this vitamin either through diet, exposure to sunshine, or vitamin supplementation.
However, research on effectiveness has been mixed. Some studies have suggested that it may be as effective as light therapy, whileother studieshave found no positive effect of vitamin D on SAD symptoms.
Always talk to your doctor before taking any medication, supplement, or herbal remedy to treat seasonal affective disorder.
Monitor Your Symptoms
Recognizing your tendency to experience seasonal depression can be helpful in aiding your treatment and coping. By knowing the signs, you’ll be able to reach out to your doctor and make lifestyle changes that may help you cope more effectively sooner.
The Center for Environmental Therapeutics (CET), a non-profit organization that provides educational materials about SAD, offers free, downloadableself-assessment questionnaires, as well as interpretation guides, to help you determine if you should seek professional advice.
Among the quizzes available are the AutoPIDS and AutoMEQ. Used together, the AutoPIDS helps you determine whether you have the symptoms of SAD and what your natural bedtime is, and the AutoSIGH tracks your current state of depression.
While helpful resources, these tests should not be taken as a firm diagnosis, so be sure to discuss your results with your primary care physician or mental health professional prior to beginning any treatment.
A Word From Verywell
Seasonal mood shifts are common, but sometimes seasonal depression may represent a serious condition that can impact your well-being and ability to function normally. If you suspect that what you are feeling might be seasonal affective disorder (SAD), talk to your doctor to explore treatment options that will work for you.
10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Melrose S.Seasonal affective disorder: An overview of assessment and treatment approaches.Depress Res Treat. 2015;2015:178564. doi:10.1155/2015/178564
National Institute of Mental Health.Seasonal Affective Disorder.
Gupta A, Sharma PK, Garg VK, Singh AK, Mondal SC.Role of serotonin in seasonal affective disorder. Eur Rev Med Pharmacol Sci. 2013;17(1):49-55. PMID: 23329523.
Lam, R.W., and A.J. Levitt.Canadian consensus guidelines for the treatment of seasonal affective disorder: A summary of the report of the Canadian Consensus Group on SAD.Canadian Journal of Diagnosis.1998;15 Suppl.: S1-S15.
Terman M, Terman JS.Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS spectrums. 2005 Aug;10(8):647-63.
Eastman CI, Young MA, Fogg LF, Liu L, Meaden PM.Bright light treatment of winter depression: a placebo-controlled trial. Arch Gen Psychiatry. 1998;55(10):883-9. doi:10.1001/archpsyc.55.10.883
Reeves GM, Nijjar GV, Langenberg P, et al.Improvement in depression scores after 1 hour of light therapy treatment in patients with seasonal affective disorder. J Nerv Ment Dis. 2012;200(1):51-5. PMID: 22210362
Melrose S.Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564.
Frandsen TB, Pareek M, Hansen JP, Nielsen CT.Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: a double-blind randomised placebo-controlled trial. BMC research notes. 2014 Dec;7(1):528. doi: 10.1186/1756-0500-7-528
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed., 2000. Washington, DC.Eastman Ch I, Young MA, Fogg LF, Liu L, Meaden PM.Bright light treatment of winter depression: A placebo-controlled trial.Archives of General Psychiatry. 1998 Oct;55(10):883-9. doi:10.1001/archpsyc.55.10.883Frandsen, TB, Pareek, M, Hansen, JP, and Nielsen, CT.Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: A double-blind randomized placebo-controlled trial.BMC Res Notes.2014; 14(7): 528. doi:10.1186/1756-0500-7-528. doi:10.1186/1756-0500-7-528Lam, R.W., and A.J. Levitt.Canadian consensus guidelines for the treatment of seasonal affective disorder: A summary of the report of the Canadian Consensus Group on SAD.Canadian Journal of Diagnosis.1998;15 Suppl.: S1-S15.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed., 2000. Washington, DC.
Eastman Ch I, Young MA, Fogg LF, Liu L, Meaden PM.Bright light treatment of winter depression: A placebo-controlled trial.Archives of General Psychiatry. 1998 Oct;55(10):883-9. doi:10.1001/archpsyc.55.10.883
Frandsen, TB, Pareek, M, Hansen, JP, and Nielsen, CT.Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: A double-blind randomized placebo-controlled trial.BMC Res Notes.2014; 14(7): 528. doi:10.1186/1756-0500-7-528. doi:10.1186/1756-0500-7-528
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