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Seasonal Affective Disorder (SAD)
Topic Overview
What is seasonal affective disorder (SAD)?
Seasonal affective disorder, or SAD, is a type of
depression that affects a person during the same
season each year. If you get depressed in the winter but feel much better in
spring and summer, you may have SAD.
Anyone can get SAD, but it
is more common in:
- People who live in areas where winter days
are very short or there are big changes in the amount of daylight in different
seasons.
- Women.
- People between the ages of 15 and 55.
The risk of getting SAD for the first time goes down as you age.
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People who have a close relative with SAD.
What causes SAD?
Experts are not sure what causes
SAD, but they think it may be caused by a lack of sunlight. Lack of light may
upset your sleep-wake cycle and other
circadian rhythms. And it may cause problems with a
brain chemical called serotonin that affects
mood.
What are the symptoms?
If you have SAD, you
may:
- Feel sad, grumpy, moody, or
anxious.
- Lose interest in your usual activities.
- Eat
more and crave
carbohydrates, such as bread and pasta.
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Gain weight.
- Sleep more and feel drowsy during the daytime.
Symptoms come and go at about the same time each year.
For most people with SAD, symptoms start in September or October and end in
April or May.
How is SAD diagnosed?
It can sometimes be hard to
tell the difference between nonseasonal depression and SAD, because many of the
symptoms are the same. To diagnose SAD, your doctor will want to know
if:
- You have been depressed during the same
season and have gotten better when the seasons changed for at least 2 years in
a row.
- You have symptoms that often occur with SAD, such as being
very hungry (especially craving carbohydrates), gaining weight, and sleeping
more than usual.
- A close relative—a parent, brother, or sister—has
had SAD.
How is it treated?
Doctors often prescribe
light therapy to treat SAD. There are two types of
light therapy:
- Bright light treatment. For this treatment,
you sit in front of a "light box" for half an hour or longer, usually in the
morning.
- Dawn simulation. For this treatment, a dim light goes on
in the morning while you sleep, and it gets brighter over time, like a sunrise.
Light therapy works well for most people who have SAD, and it
is easy to use. You may start to feel better within a week or so after you
start light therapy. But you need to stay with it and use it every day until
the season changes. If you don't, your depression could come back.
Other treatments that may help include:
- Antidepressants. These medicines can improve
the balance of brain chemicals that affect mood.
- Counseling. Some
types of counseling, such as
cognitive-behavioral therapy, can help you learn more
about SAD and how to manage your symptoms.
If your doctor prescribes antidepressants, be sure you
take them the way you are told to. Do not stop taking them just because you
feel better. This could cause side effects or make your depression worse. When
you are ready to stop, your doctor can help you slowly reduce the dose to
prevent problems.
You may feel better if you get regular exercise.
Being active during the daytime, especially first thing in the morning, may
help you have more energy and feel less depressed.
Moderate exercise such as walking, riding a stationary
bike, or swimming is a good way to get started.
Frequently Asked Questions
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Learning about seasonal affective disorder (SAD):
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Being diagnosed:
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Getting treatment:
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Living with SAD:
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Symptoms
If you have
seasonal affective disorder (SAD), you will usually
have symptoms of
depression during the winter when there is less
daylight (October through April). Symptoms of SAD include:
- Difficulty concentrating.
- Low
energy and fatigue.
- Reduced interest in daily activities,
especially social activities.
- Moodiness (depressed, sad, or
unusually quiet).
- Increased appetite.
- Cravings for
complex carbohydrates (such as pasta and bread).
- Weight
gain.
- Increased sleep.
- Loss of interest in
sex.
- Irritability.
Exams and Tests
Before diagnosing you with
seasonal affective disorder (SAD), a doctor will ask
about your medical history.
Your doctor may order blood tests to
check for other conditions, such as
hypothyroidism, that could be causing your depression.
He or she also may ask you to complete a questionnaire regarding changes in
your sleep patterns, social activity, mood, weight, appetite, and energy
levels.
The questionnaire may ask the following:
- Do you feel a dramatic reduction in energy when
the days get shorter?
- Do you have difficulty waking up in the morning?
- Do
you sleep more than you used to or sleep too much?
- Are you eating
more than you used to or more than you should?
- Have you gained
weight?
Your doctor may also do a
mental health assessment, which includes an evaluation
of your emotional functioning and your ability to think, reason, and remember
(cognitive functioning). The assessment may also include written or verbal
tests and lab tests (such as blood and urine tests). During the interview, your
doctor will assess your appearance, mood, behavior, thinking, reasoning,
memory, and ability to express yourself and may ask about your personal
relationships and family history of SAD.
Treatment Overview
Treatment for
seasonal affective disorder (SAD) doesn't cure the
seasonal depression, but it can help relieve your symptoms. Your symptoms may improve if you get more natural sunlight during the daytime. Light therapy is
the main treatment for SAD, and research is continuing to determine the most
effective way to use it. Medicines and counseling may also be used to treat
SAD.
Light therapy
There are two types of light therapy. One type is bright light treatment, in which
you sit in front of a "light box" for a certain amount of time (usually in the
morning). The other type is dawn simulation, which is done while you sleep. For dawn
simulation, a low-intensity light is timed to go on at a certain time in the
morning before you wake up, and it gradually gets brighter.
Light
boxes use fluorescent lights that are brighter
than indoor lights but not as bright as sunlight.
Ultraviolet light, full-spectrum light, tanning lamps,
and heat lamps should not be used. You place the light box at a specified
distance from you on a desk or in front of a chair and use it while you read,
eat breakfast, or work at a computer. Light therapy is usually prescribed for
30 minutes to 2 hours, depending on the intensity of the light used and on
whether you are starting out or are using it to maintain a response.
It
may take as little as 3 to 5 days or up to 2 weeks before you respond to light
therapy. Stopping light therapy might cause you to relapse back into
depression.
Light therapy may work by
resetting your "biological clock" (circadian rhythms), which controls sleeping and waking.
If you have
eye problems or you take medicines that make you light-sensitive, ask your
doctor about whether light therapy is safe for you. Before you start treatment,
tell your doctor about any other conditions you have and about the medicines
you are taking.
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Seasonal Affective Disorder: Using Light Therapy
Antidepressants
Antidepressants
effectively treat episodes of depression in people who have seasonal affective
disorder. You may start to feel better within 1 to 3 weeks of taking
antidepressant medicine. But it can take as many as 6 to 8 weeks to see more
improvement. If you have questions or concerns about your medicines, or if you
do not notice any improvement by 3 weeks, talk to your doctor. Antidepressants
can be used along with light therapy or alone. The
most common antidepressants used to treat people with seasonal affective
disorder include:
SSRIs are usually the first type of antidepressants
given to treat SAD. SSRIs often have less serious side effects than other
antidepressants. All antidepressant medicines are started at low doses and
increased gradually. When stopped, they should be decreased gradually to avoid
side effects.
General side effects of antidepressant medicines
can include:
- Nausea, loss of appetite, or
diarrhea.
- Anxiety or nervousness.
- Difficulty sleeping
or drowsiness.
- Loss of sexual desire or
ability.
- Headaches.
Bupropion can cause dry mouth. Bupropion should not be
taken if you have seizures, severe problems with eating, or an
eating disorder, because it can cause seizures.
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Depression: Dealing With Medicine Side Effects
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Depression: Taking Antidepressants Safely
Counseling
Counseling, such as
interpersonal therapy and
cognitive-behavioral therapy, may help with your
treatment for SAD. You may choose individual counseling, participate in group
counseling, or seek
family therapy. During
counseling, you will learn about SAD, ways to handle
the symptoms, and how to help prevent future depressive episodes. If you have
had SAD for a long time, your family members may also benefit from
counseling.
Home Treatment
Home treatment is very important in
the treatment of
seasonal affective disorder (SAD). Home treatment for
an episode of depression may include a combination of the following:
Physical activity
Being physically active during
the daytime, especially first thing in the morning during winter, may help
improve your energy level and relieve
depression. Moderate exercises like walking,
stationary cycling, and swimming are a good way to start an exercise
routine.
Experts say to do either of these things to get and stay
healthy:1
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Moderate activity
for at least 2½ hours
a week. One way to do this is to be active 30 minutes a day, at least 5 days a
week. Moderate activity means things like brisk walking, brisk cycling, or
shooting baskets. But any activities—including daily chores—that raise your
heart rate can be included. You notice your heart
beating faster with this kind of activity.
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Vigorous activity
for at least 1¼ hours a week. One way to do this is to be
active 25 minutes a day, at least 3 days a week. Vigorous activity means things
like jogging, cycling fast, or cross-country skiing. You breathe rapidly and
your heart beats much faster with this kind of activity.
It's fine to be active in blocks of 10 minutes or more
throughout your day and week. You can choose to do one or both types of
activity.
Moderate activity is safe for most people, but it's
always a good idea to talk to your doctor before you start an exercise
program.
Also try to do
exercises to strengthen muscles at least 2 times
each week. Examples include weight training or stair climbing on 2 or more
days that are not in a row. For best results, use a resistance (weight) that
gives you muscle fatigue after 8 to 12 repetitions of each exercise.
Healthy diet
Eating a healthy,
balanced diet is helpful for any type of depression and may help relieve some of
the symptoms of SAD.
Complementary treatment
The following complementary
treatments may be helpful in treating symptoms of SAD, although there currently
is not enough scientific evidence to prove their usefulness.
- An herb called
St. John's wort may help ease depression symptoms.
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Melatonin is a hormone that may help regulate your
biological clock (circadian rhythms). But you need to take a very low
dose at a specific time of the day.
Be sure to check with your doctor before you try these
complementary therapies, because they may interact with other medicines you are
taking.
You should not take St. John's wort if you are taking other antidepressants. Also, St.
John's wort may cause light sensitivity. If you are using light therapy, you
may want to discuss with your doctor whether St. John's wort is right for you
in the treatment of SAD.
Research on the effectiveness of other
SAD treatments is ongoing.
Advice for caregivers
Sometimes family members and
friends are not sure how to help someone who has seasonal affective disorder.
It may help to:
- Spend time with your loved one even though he
or she may be withdrawn or quiet.
- Offer to help with daily tasks
that temporarily may be too difficult to do alone. But it is important that you
do not enable the person to remain depressed by taking over all of his or her
daily responsibilities.
- Take a walk or do some other type of
exercise activity together. Getting out first thing in the morning for a walk
may be helpful.
- Help the person to stay with the prescribed
treatment plan.
For more information on helping someone with SAD or
depression, see:
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Depression: Helping Someone Get Treatment.
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Depression: Supporting Someone Who Is Depressed.
Unfortunately, many people don't seek treatment for
mental health problems. You may not seek treatment because you think the
symptoms are not bad enough or that you can work things out on your own. But
getting treatment is important.
If you need help deciding whether
to see your doctor, see
some reasons why people don't get help and how to overcome them.
Other Places To Get Help
Organizations
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Healthy Minds. Healthy Lives.American Psychiatric Association
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| 1000 |
| Wilson Boulevard |
| 1825 |
| Arlington, VA 22209 |
| Phone: |
1-888-35-PSYCH
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| Email: |
apa@psych.org |
| Web Address: |
www.healthyminds.org |
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This online resource is provided by the American Psychiatric Association for anyone seeking mental health information. It includes information on many common mental health concerns, including warning signs of mental disorders, treatment options, and preventive measures.
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KidsHealth for Parents, Children, and
Teens
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| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: |
(904) 697-4100 |
| Fax: |
(904) 697-4220 |
| Web Address: |
www.kidshealth.org |
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This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
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Mental Health America
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| 2000 North Beauregard Street, 6th Floor |
| Alexandria, VA 22311 |
| Phone: |
1-800-969-NMHA (1-800-969-6642) referral service for help with depression
(703) 684-7722 |
| Fax: |
(703) 684-5968 |
| TDD: |
1-800-969-6642 |
| Web Address: |
www.mentalhealthamerica.net |
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Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its Web site has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
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National Alliance on Mental Illness
(NAMI)
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| 3803 North Fairfax Drive |
| Suite 100 |
| Arlington, VA 22203 |
| Phone: |
1-800-950-NAMI (1-800-950-6264) hotline for help with depression
(703) 524-7600 |
| Fax: |
(703) 524-9094 |
| Email: |
info@nami.org |
| Web Address: |
www.nami.org |
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The National Alliance on Mental Illness is a national
self-help and family advocacy organization dedicated solely to improving the
lives of people who have severe mental illnesses such as schizophrenia, bipolar
disorder (manic depression), major depression, obsessive-compulsive disorder,
and panic disorder. NAMI focuses on support, education, advocacy, and research.
The mission of the organization is to "eradicate mental illness and improve the
quality of life of those affected by these diseases."
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References
Citations
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U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/guidelines/default.aspxf.
Other Works Consulted
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American Psychiatric Association (2010). Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd ed. Available online: http://psychiatryonline.org/guidelines.aspx.
- Byrne B, Brainard GC (2008). Seasonal affective disorder and light therapy. Sleep Medicine Clinics, 3: 307–315.
- Melatonin (2009). Review of Natural Products. St. Louis: Wolters Kluwer Health.
- Provencio I (2009). Chronobiology. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 198–210. Philadelphia: Lippincott Williams and Wilkins.
- Sadock BJ, Sadock VA (2007). Mood disorders. In
Kaplan and Sadock's Synopsis of Psychiatry, 10th ed.,
pp. 527–562. Philadelphia: Lippincott Williams and Wilkins.
- Shirani A, St Louis EK (2009). Illuminating rationale and uses for light therapy. Journal of Clinical Sleep Medicine, 5(2): 155–163.
- U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/guidelines/default.aspxf.
- Westrin A, Lam RW (2007). Seasonal affective disorder: A clinical update. Annals of Clinical Psychiatry, 19(4): 239–246.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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Kathleen Romito, MD - Family Medicine |
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Specialist Medical Reviewer
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Alfred Lewy, MD, PhD - Psychiatry |
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Last Revised
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June 20, 2012 |
Last Revised:
June 20, 2012
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/guidelines/default.aspxf.
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