It's not out of the norm to feel down in winter months when the skies are gray and decidedly gloomy and the weather seems to be working against you. But if your blues are manifesting as something more serious—a significant decrease in energy, loss of interest in activities you once enjoyed, withdrawal from family and friends, or even physical manifestations like weight gain—it's worth getting evaluated by a professional to see if you might have seasonal affective disorder.
Seasonal affective disorder, or SAD, is a psychological disorder that tends to occur in winter months. "One theory suggests that SAD may be directly related to the decrease in exposure to sunlight during winter months," notes psychologist Marc J. Romano, PsyD, director of medical services at Delphi Behavioral Health, whom we asked to share his expertise on the subject. He explains that SAD is listed in the Diagnostic and Statistical Manual of Mental Disorders and is listed under the diagnosis of "Other Specified Depressive Disorders With Seasonal Patterns."
"Several causes have been put forth to explain winter SAD, including decreased exposure to sunlight, disruption to serotonin, and changes in circadian rhythms," says Romano. Below, he explains how to determine whether you might have SAD and lists the top-recommended treatments.
HOW DOES ONE KNOW IF THEY HAVE SEASONAL AFFECTIVE DISORDER?
"The symptoms of SAD often mimic symptoms of depression," says Romano. "People who experience SAD usually start to experience symptoms in the late autumn or early winter, and these symptoms tend to subside in early spring." January and February are typically the months where symptoms of SAD tend to become the most severe, due to the significant decrease in sunlight. Of the most common symptoms of SAD, Romano lists feelings of sadness, decreased activity, increased sleep, weight gain, irritability, loss of interest in previously enjoyed activities, changes in libido, increased anxiety, and withdrawal from family and friends.
SAD is frequently diagnosed as a major depressive disorder, yet Romano makes it clear that there is a distinction due to the cyclical nature of SAD. He distinguishes that those with a major depressive disorder may experience symptoms of depression at any time of the year, whereas individuals with SAD typically see their depressive symptoms "begin to subside in early spring or early summer with full remission." Romano notes that SAD occurs more frequently among women and tends to occur more often in younger individuals—typically, onset occurs between ages 18 and 30—though individuals of any age may experience it. Because of its correlation with weather and lack of sunlight, "SAD has also been found to have higher rates in northern regions of the United States and lower rates in southern areas," says Romano.
SUGGESTED WAYS TO TREAT SAD
"One of the most common approaches to treating SAD is light therapy," notes Romano. "Light therapy, also known as phototherapy, involves exposure to a bright light first thing in the morning which triggers changes in the brain that influence mood."
"Medication is another treatment option for individuals suffering from SAD," says Romano. "It is recommended that individuals begin taking the medication prior to the start of fall to ensure that the medication is in the person's system before symptoms of SAD appear."
Studies have found that melatonin can help to improve mood during and relieve the symptoms of SAD. A study led by Alfred Lewy, MD, Ph.D., at Oregon Health and Science University found that similar to jet lag, circadian misalignment is a significant part of SAD. Taking low-dose melatonin either in the morning or in the afternoon or evening, depending on the direction of the patient's misalignment, helped to alleviate the symptoms of depression. While more research is needed, Lewy notes that melatonin could be a promising accompaniment to bright-light exposure.
"Psychotherapy can be used to help individuals learn ways to cope with SAD by identifying thoughts and behaviors that may be," describes Romano. "The presence of a seasonal depressive disorder—whether it occurs in the winter or in the summer—can be debilitating for individuals, so if you feel your mood changes during a particular time of the year, it could mean you have a SAD and should seek out a professional to discuss treatment options."