For some of us, the crackle of leaves underfoot and the first big storm of winter signal coziness. If you live where the days get shorter and the nights get longer, you may love bundling up, cooking favorite foods, and enjoying the great indoors. Or you may not.
Seasonal affective disorder, or SAD, is a specific form of depression affecting some of us.[i] The most common form, called winter depression, fall-onset SAD, or winter-pattern SAD, usually starts in the fall and lasts through the winter, going away in the spring. A less common type starts in the spring and goes away in fall. It is called spring-onset SAD, the summertime blues, and summer-pattern SAD.[ii]
Symptoms of seasonal affective disorder
Like general depression, symptoms of SAD include feeling sad or “down” most of the time for at least two weeks. Some people feel irritable instead of sad. Losing interest in things you normally enjoy is another important symptom.[iii]
How are fall and spring SAD different?
SAD that starts in the fall is the most common type. It tends to cause:[ii]
- Increased appetite, often with carb cravings.
- Weight gain because you’re eating more.
- Greater desire to sleep or just stay in bed.
Spring-onset SAD is much less common and tends to cause the opposite symptoms: eating less, losing interest in food, weight loss, and difficulty sleeping.[ii] This article focuses on fall-onset SAD—winter depression. But it’s important to be aware that another type exists so you can talk with your health-care provider if you notice symptoms.
More depression symptoms – and warning signs
Because SAD is a form of depression, it causes the typical symptoms of the disorder. No matter when your SAD starts, you may feel tired, low on energy, restless, unable to focus, or as if you are moving in slow motion.
You may also feel some dark emotions. These may include feeling guilty, worthless, or even that the world would be better off without you.[iii] It’s important to understand that these feelings reflect the depressive disorder, not reality. If you notice these feelings, take them as a signal to get help, even by texting a friend or family member about them. When you are depressed, reaching out can seem pointless, but it’s important to tell yourself that others do care and can help you feel better.
Treatment for SAD
An integrative approach, bringing conventional medical help together with non-drug approaches, such as exercise, counseling, and a gratitude practice, can be ideal for a disorder like SAD that strongly affects the mind, body, and spirit.
If you might hurt yourself or someone else
Call the National Suicide Prevention Lifeline at 1-800-273-8255 if you think you might hurt yourself or someone else. Or visit their website at www.suicidepreventionlifeline.org. You can also go to the nearest emergency room, call your health-care provider, or call 911.
Integrative approaches to help fall SAD
For fall SAD, doing things that boost energy and signal you to be active and alert can help. These include:
- Incorporating at least 30 minutes a day of movement into your schedule, if possible. (You may not feel like moving, but it can help.)[iv] Exercise helped more than relaxation therapy in one study.
- Using a device called a “dawn simulator.”[v] This is basically a light on a timer that gradually gets brighter over a period of several minutes to hours, imitating the increase in light that happens at sunrise.
- Exposing your body to natural light.[vi] Taking a walk outside has been shown to help.
- Practicing healthy sleep habits. This includes turning off blue-light devices at night so your brain can absorb the hormonal signals that it’s time to sleep.[v]
Being active outdoors exposes you to natural light, and even to sunshine if it’s sunny where you live. You don’t have to take up jogging (though you might enjoy the exercise boost). You can walk your pet, sweep the front step, or chat with a neighbor.
If you have spring-onset SAD, talk with your health-care provider about whether you need to reduce your exposure to natural light or make other changes.
A form of therapy called cognitive behavioral therapy, or CBT, can be helpful for SAD. In fact, a specific program has been developed to help people with winter depression. Learn more from the National Institute of Mental Health.
The benefits of supplements for people with SAD have not yet been extensively studied.[vii] While some people with depression have been found to have low vitamin D levels, it is not yet known if taking vitamin D supplements helps treat this condition. St. John’s wort is frequently recommended for depression. However, this herbal supplement can interact with many different medications. Small studies have been done on the benefits of ginkgo, melatonin, and vitamin B12, but more research is needed.
It can be tempting to purchase a supplement at your favorite natural foods store or from a favorite practitioner who recommends it. Similarly, taking what “works great” for a friend or family member can seem like the answer (plus, they’re always happy if you take their advice!).
However, just because a substance is natural doesn’t mean it is safe. A licensed and accredited health-care provider should be the first person you turn to before adding any vitamin, mineral, or herbal supplement to your daily regimen. Be sure to tell them about everything else you take, including special teas or nutritional drinks and over-the-counter medicines. You may want to share our free, downloadable Provider’s Pocket Guide to Supplements with them.
Medical treatments for fall SAD
Light therapy with a specific type of bright lighting can help. This should be done under a health-care provider’s supervision.
Antidepressant medications can help with both types of SAD (fall-onset and spring-onset), just as they often help other forms of depression. Experts currently recommend light therapy plus antidepressants as the first treatment if you have fall SAD, but you can also use either one alone.[viii]
Treatment may take a few days to a week or two to change SAD symptoms. Talk with your health-care provider if you don’t think your symptoms are changing. You may want to create a routine that helps your SAD, as many people who have SAD tend to get it every year.
Personalizing your treatment
Talk to your health-care provider if you think you might have SAD. Depression can be life-threatening, so don’t hesitate to keep asking or talk with a different provider if you do not get help right away.
Mind-body practices to add to medical treatments for depression can include:
- Movement, including yoga.
- Mindfulness meditation.
- Music therapy or art therapy.
For more information on mind-body practices for SAD and other forms of depression, check out the following resources:
- Depression Doesn’t Have to Cripple Your Life
- Depression Pocket Guide
- Music Therapy Pocket Guide
- Art Therapy Pocket Guide
[i] Thase ME. The multifactorial presentation of depression in acute care. J Clin Psychiatry. 2013;74 Suppl 2:3-8. doi:10.4088/JCP.12084su1c.01
[ii] Magnusson A, Partonen T. The diagnosis, symptomatology, and epidemiology of seasonal affective disorder. CNS Spectr. 2005;10(8):625-14. doi:10.1017/s1092852900019593
[iii] Avery D. Seasonal affective disorder: Epidemiology, clinical features, assessment, and diagnosis. UpToDate. Updated December 28, 2020. Literature review current through October 2021. Available at https://www.uptodate.com/contents/seasonal-affective-disorder-epidemiology-clinical-features-assessment-and-diagnosis?search=Seasonal%20affective%20disorder&topicRef=91774&source=see_link#H280788857Accessed November 23, 2021.
[iv] Pinchasov BB, Shurgaja AM, Grischin OV, Putilov AA. Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light. Psychiatry Res. 2000;94(1):29-42. doi:10.1016/s0165-1781(00)00138-4
[v] Avery D. Seasonal affective disorder: Treatment. UpToDate. Updated December 28, 2020. Literature review current through October 2021. Available at https://www.uptodate.com/contents/seasonal-affective-disorder-treatment?search=Seasonal%20affective%20disorder&topicRef=1705&source=related_link#H155707397. Accessed November 23, 2021.
[vi] Wirz-Justice A, Graw P, Kräuchi K, et al. ‘Natural’ light treatment of seasonal affective disorder. J Affect Disord. 1996;37(2-3):109-120. doi:10.1016/0165-0327(95)00081-x
[vii] National Center for Complementary and Alternative Medicine. Seasonal affective disorder. Available at https://www.nccih.nih.gov/health/seasonal-affective-disorder. Accessed December 20, 2021.
[viii] Kurlansik SL, Ibay AD. Seasonal affective disorder. Am Fam Physician. 2012;86(11):1037-1041.
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