For some of us, winter is the most wonderful time of the year. But winter can also be lonely and stressful, and the holidays often bring up complicated emotions. There are also clinical reasons many of us feel sad or depressed in winter. With short days and long nights the norm for the next few months, we’re missing the sunny days of summer. For some patients, the winter blues are more than just a passing mood: Seasonal Affective Disorder (SAD) is a common diagnosis with several treatment options.
How and Why Does Winter Affect My Mood?
Seasonal Affective Disorder happens when shifts in natural light cause our body’s natural rhythms to get out of whack. Winter in our region means shorter days and less sunlight. Decreased light can change your body’s circadian rhythms–the internal clock regulating our sleep/wake cycles. These changes can lead to changes in mood and behavior. Here are some of the reasons why:
- Decreased sunlight can lead to a drop in serotonin, an important neurotransmitter that elevates mood. According to the National Institute of Mental Health, sunlight plays a role in regulating serotonin production. Levels can get thrown off when the days get shorter.
- SAD can increase the production of melatonin, an important hormone affecting sleep patterns and mood.
- Studies also link SAD to low Vitamin D levels, which may be caused by lack of sunlight.
- Seasonal stress can also play a role in SAD.
How Long Does SAD Last?
For many patients, winter-onset SAD starts in the fall as days become shorter and lasts through the winter months. Symptoms often go away as spring rolls back around.
What Are The Symptoms of Seasonal Affective Disorder?
Many of us get a mild case of the winter blues or feel stressed during the holidays. But the symptoms of SAD tend to be more regular and long-lasting. While many of the symptoms are the same as ongoing major depression, SAD is more likely to wax and wane with seasonal changes. However, SAD and depression can coexist, and patients with underlying mental health challenges are often at greater risk for seasonal depression. According to NIMH, some of the symptoms are the same as major depression, while others are winter-onset 
specific.
- Feeling depressed most of the day, nearly every day
- Losing interest in activities you once enjoyed
- Changes in appetite or weight
- Sleep problems
- Feeling sluggish or agitated
- Low energy
- Feeling hopeless or worthless
- Difficulty concentrating
- Frequent thoughts of death or suicide
Additional symptoms specific to winter-onset SAD include:
- Oversleeping
- Overeating
- Weight gain
- Social withdrawal from family, friends, and activities
Who Is At Risk For SAD?
According to the American Psychiatric Association, Seasonal Affective Disorder affects up to five percent of American adults. Several factors can lead to increased risk for SAD.
- SAD is more common in women than in men.
- We generally see the onset of SAD in early adulthood, but it can also occur in teens.
- SAD is more common in people with major depression, bipolar disorder or other mental health challenges and those with a family history of depression.
- According to NIMH, SAD occurs more frequently in people living further away from the equator (further north in the Northern Hemisphere), where seasonal changes in natural light have a more significant impact.
Can I Prevent Seasonal Affective Disorder?
There are several ways we can boost physical and mental health during the winter months. Taking charge of our physical health can contribute to our mental well-being throughout the season.
- Spend time outside during daylight hours
- Get regular exercise, both indoors and outdoors
- Eat a healthy diet
- Avoid excessive alcohol use
What Are The Treatments for Seasonal Affective Disorder?
We often use effective treatments for major depression to address Seasonal Affective Disorder. Many patients also respond well to light therapy, which substitutes artificial light for sunlight and helps get hormone levels back in gear.
- Light therapy is a longtime lifesaver for patients with SAD. It makes up for the lack of sunlight by exposing patients to a high-intensity bright-light box for 30 to 45 minutes each day.
- Antidepressant medications can help regulate serotonin levels for SAD patients just as they do for those with depression. Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants are often effective with SAD symptoms.
- Psychotherapy: studies have shown that talk therapy, including Cognitive Behavioral Therapy or CBT), can effectively treat SAD. The CBT approach helps patients replace negative thoughts about winter with a more positive outlook.
- Vitamin D supplements: the results of studies on the relationship between Vitamin D and SAD are mixed, according to NIMH. SAD patients often have low levels of Vitamin D, so your provider may recommend supplements in addition to other treatments.
What Should I Do If I Think I Have SAD?
Patients who find their winter mental health challenges going beyond the winter blues often wonder where to start. You may also have questions about whether you have seasonal or major depression. Your primary care provider is the best first step in identifying and addressing SAD. Your primary care provider can run routine blood tests, including a check on Vitamin D levels. They can also prescribe light therapy and antidepressants as needed. If you decide on talk therapy, your primary care provider can refer you to a qualified therapist.
At Comprehensive Primary Care, our ongoing mission to address each patient as a whole individual. This approach means meeting both physical and mental health needs. If you’re having symptoms of SAD, make an appointment with your primary care provider. In most cases, we can start with a telemedicine visit and move on from there, the first big step in making winter joyful again.
