Seasonal Affective Disorder (SAD) Means Annual Challenges for Millions

What is Seasonal Affective Disorder and How is it Different from the Winter Blues?

By Mary Zamost, quality care coordinator at Network Health
Originally published on 12/7/2020 at 1:30 p.m. CST.
Updated on 12/14/2021 at 9:30 a.m. CST

Here in the cold and snowy Midwest, winter is a somber season. Gone are the long, bright days of summer and even the brisk and colorful days of fall. Instead, we move into a season of coldness and darkness. It can be easy to be affected by this change, even after decades of going through it.

If the winter months get you down more than you might feel they should, however, it may not just be the winter blues. You may have a condition called Seasonal Affective Disorder, or SAD. Luckily, you’re not alone and there are plenty of ways to help stave off the mood-lowering effects.

What is Seasonal Affective Disorder (SAD)?

Also called seasonal depression, SAD is a form of depression that follows a seasonal pattern, meaning it tends to appear and disappear at the same time each year.

For most, it resurfaces in the fall or winter and carries through until the spring or summer. Being a form of depression, the symptoms of SAD are similar to those of clinical depression.

What distinguishes it from clinical depression or chronic depression is the annual ebb and flow that takes place. Diagnosis requires at least two or more years in a row of this ebb and flow.

Like other forms of depression, the symptoms of SAD can be mild, severe or anywhere in between. Milder symptoms are ones that only minimally interfere with someone's ability to participate in everyday activities, while more severe symptoms can interfere much more.

Like other mental illnesses, symptoms vary. Symptoms of which you may want to be aware include the following.

• Feeling depressed most of the day, almost every day
• Feelings of worthlessness, helplessness and/or hopelessness
• Low energy and fatigue
• Low mood
• Loss of interest in previously enjoyable activities
• Difficulty sleeping or sleeping too much
• Overeating and weight gain

SAD can become long-term depression.

What causes Seasonal Affective Disorder (SAD)?

One of the prevailing theories about SAD is that it’s triggered by the reduced exposure to sunlight, common in Wisconsin and the northern United States. How and why this happens isn't yet fully understood. These theories focus on the role of sunlight in the brain’s production of mood-, sleep- and energy-regulating chemicals, or hormones.

Two such hormones that occur naturally in the body are the center of these theories.

Melatonin

Melatonin is a mood-regulating chemical that is produced in greater volumes when days are shorter and darker. An abundance of melatonin can result in sleepiness and lethargy.

Serotonin

The sun to melatonin’s moon, serotonin is a hormone that stabilizes our moods, increases feelings of happiness, encourages communication between organ systems and can even help with sleeping and digestion. Serotonin production increases with exposure to sunlight and decreases with the reduced sunlight of the fall/winter months.

Shorter days and longer hours of darkness in fall and winter can increase melatonin levels and decrease serotonin levels. These two movements can cause an imbalance that, over time, leads to the symptoms of depression.

Medical experts recommend both prevention and treatment of seasonal depression for individuals who live with the condition.

How to prevent seasonal depression

Get out

Spending time outdoors, even in the colder weather, has proven effects on your mood. Mind the dangerous cold, but otherwise, try and stand in the sun for at least 15-30 minutes of sunlight (even when it's cloudy). Doing this early in the morning can help regulate your internal clock.

Maximize light in your home

Get the most out of the limited daylight hours by opening shades and curtains to let that light into your home. Try and spend time in rooms with natural light.

Consider a lightbox

Lightboxes use full-spectrum and blue-light technology to deliver similar light as authentic sunlight. During the winter months where sunlight can be scarce, these lights allow you to soak in some serotonin-encouraging rays in the comfort of your own. If you own one, using it as early as late summer/early fall before symptoms of SAD show up will help keep you ahead of the winter blues.

Practice wellness 

Winter and starchy comfort food go hand-in-hand. Unfortunately, this relationship can have negative consequences in your journey to minimize seasonal depression. Instead, eat a well-balanced diet, making sure to consume plenty of leafy green vegetables, healthy fruits and your favorite proteins. You’ll wind up with more energy and will have an easier time feeling well, despite the reduced opportunities for outdoor activity.

Also, limit or eliminate alcohol consumption to further prevent depression symptoms, including the most severe.

Exercise for 30 minutes a day, five days a week

Exercise opportunities are tough to come by when you can no longer take a warm stroll around the neighborhood or take the kayak out to the river. Finding ways to exercise indoors or during the milder hours of the day, however, will keep you feeling healthy and well.

Using a fitness tracker, like a Fitbit, Apple Watch or Garmin device, may help you ensure movement by tracking how much you are moving and how many calories you’re burning.

We recently published an article on some great activities you can do in your own home during the winter, you can read it here.

Participate in some winter hobbies.

Hobbies give you an outlet for your time, with most including some form of progression and self-improvement, two aspects that help your body produce dopamine, a good surrogate for the reduced serotonin.

The chilly weather and pandemic safety measures may freeze your weekend outdoor plans, but this diversion can also make free time the best time to do any of the following.

• Catch up on your reading list.
• Tackle a new project in the house.
• Learn a new skill using a free online course.
• Adjust your leisure activities to fit the seasons.
• Stay involved and connected with your family, friends and social circle. We’re all finding new ways to stay in touch. Virtual contact works - Social support is very important.

How is SAD diagnosed?

There is no test for SAD. Your health care provider can make a diagnosis by asking about your symptoms and their history. Your personal doctor may perform a physical exam and blood tests to rule out other disorders that have similar symptoms to SAD.

When should I call my doctor?

SAD is common and usually disappears with the changing of the seasons.

If you feel depressed, fatigued, and irritable the same time each year, and these feelings seem to be seasonal in nature, SAD is a likely explanation.

While SAD is common, it doesn’t mean you should just endure the symptoms, especially if they are interfering with your everyday life and the above prevention steps are not successful at intervention. Talk openly with your personal doctor about your feelings.

Follow medical recommendations for treatment, prevention and next steps. Your personal doctor will know best a treatment that works for your unique lifestyle and case, so don’t hesitate to bring it up. It may not be just the winter blues, after all.

What treatment options are there for Seasonal Depression/SAD?

If you are diagnosed with seasonal depression or SAD, you have options for treatment you’re your personal doctor may recommend/prescribe. These treatment prescriptions/recommendations will vary based on the type of seasonal depression, the severity and other medical considerations your personal doctor will be factors when creating a treatment plan for you.

Some of these recommendations may include the following.

• More natural light by spending time outdoors
• Phototherapy (light therapy)
• Antidepressant medications
• Talk therapy (Psychotherapy)

Depending on the severity of your seasonal depression, your personal doctor may recommend a combination of these treatments to help get you feeling better as soon as possible.

Talking with your personal doctor or a professional therapist can be helpful in both identifying negative thought patterns and recommending a plan to learn coping strategies to improve self-care.

In addition to working with a personal doctor or therapist, mental health experts frequently recommend mitigation strategies such as 

Is talk therapy good for Seasonal Depression?

Yes. Talking with a doctor or professional therapist can be helpful in both identifying negative thought patterns and recommending a plan to learn coping strategies and ways to improve self-care. With COVID-19 still being a factor, many people are understandably not comfortable with the classic talk therapy setup of being in a doctor’s office physically.

Talk therapy is still available through virtual visits, telehealth and teletherapy. All of these provide the benefit of a traditional talk therapy session, without the risk of viral spread.

In addition to a professional/medical plan, individuals struggling with SAD are encouraged to seek out ways to help manage symptoms at home by setting and maintaining a daily routine, eating healthy foods and getting regular exercise.

Self-care looks different for everyone, so having a plan that is uniquely tailored to your own needs and self-communication is crucial to wellbeing.

As the weather grows colder and the days, shorter, taking care of our mental health is more important than any other time during the year.

Coronavirus and COVID-19 Pandemic Add Complication to Seasonal Depression

Many help combat the seasonal mood plunge of fall/winter by scheduling more indoor activities with friends. Bowling leagues pick up, church groups meet more frequently and even cafes and bars experience spikes in business as people are looking to spend time with others.

Unfortunately, with safety advice from experts at the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) unanimously recommending limiting gatherings, especially indoor gatherings, many of these will be off the table in the winter of 2020/2021.

This winter is likely to be a potential convergence of negative mental health triggers including the isolation we’ve been feeling for almost a year in the wake of the virus/illness, the shorter/colder days and the general anxiety about the disease. We’ll also be dealing with the winter flu that could further stress our healthcare systems. The flu shot, it turns out, is nearly as important as the upcoming COVID-19 vaccine immunizations.

All of these things can make this season feel overwhelming for those who deal with anxiety, stress or depression during the holiday season.

One strategy experts are recommending is to plan holiday events within your bubble. Your bubble is the people with whom you live in a household. Whether it’s a Hanukkah lighting, a Christmas dinner, a New Year’s party or even a Groundhog’s Day bash (seriously, have fun with it), treating these momentous occasions with the flare you would in a typical year, just with a smaller group, can help you feel good and have dates and times to anticipate.

You can make your celebrations even bigger by bringing in people outside your bubble via video chat apps like FaceTime, Google Duo, Zoom, Skype and more. Have dinner and set your computer or iPad up at the table so you can see and speak with people with whom you cannot physically meet.

Even just spending more time calling and checking in on friends, family members and loved ones is a great way to make this time feel just as connected as it normally does, maybe more so even as you won’t have to factor in time stuck in traffic as you drive to their homes.

You Don’t Have to Wait for Spring to Feel Better

With abundant treatment and prevention options, SAD doesn’t have to be a condition that takes you out of the game until the longer and warmer days of spring return.

As always, however, not everybody is the same. If your seasonal depression symptoms are interfering with your daily life, it may require escalated treatment recommended and/or prescribed by your personal doctor.

For that reason, discussing your emotional and mental state with your personal doctor is important to the ends of feeling your best year-round.

At Network Health, we’re building healthy and strong Wisconsin communities every day. This means helping our friends, family members and neighbors in Wisconsin be as prepared as possible for the mood-altering effects of our long, dark and cold winters.

If you have questions about ways to feel better in the winter and beyond or would like to learn how your health plan can assist with you getting the most out of every season, contact us today.

Here are some other important mental health resources.

• The Connection - E.W. Mental Health, North East Wisconsin
• National Alliance on Mental Illness (NAMI) – Fox Cities, Milwaukee, National
• National Institute of Mental Health (NIMH)