December 6, 2024

Understanding Seasonal Affective Disorder (SAD): Symptoms, Causes, and Treatment Options 

Published: December 6, 2024
By: Grit Psychology

Understanding Seasonal Affective Disorder (SAD): Symptoms, Causes, and Treatment Options 

As the days grow shorter and temperatures drop, many people experience shifts in mood and energy. For some, these seasonal changes bring more than just the "winter blues." Seasonal Affective Disorder (SAD) is a form of depression that occurs in a predictable pattern, usually during the fall and winter months, and can significantly impact an individual’s quality of life (Galima et al., 2020). In this blog, Grit Psychology explores the key aspects of SAD, its causes, risk factors, and effective treatment options.

What Is Seasonal Affective Disorder (SAD)?

SAD is a subtype of depression that typically emerges during the colder months when daylight hours are reduced (Galima et al., 2020). Unlike other forms of depression, SAD is directly linked to changes in seasons. The symptoms often remit during spring and summer, making it distinct from major depressive disorder (MDD), which may persist year-round. Some individuals also experience "summer SAD," a less common form that occurs during the warmer months.

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Differences in Brain Chemistry

The biological underpinnings of SAD differ from other depressive disorders (Fonte & Coutinho, 2021). SAD is often associated with disruptions in circadian rhythms (the body’s internal clock) and dysregulation of neurotransmitters like serotonin and melatonin. While major depression typically involves more generalized serotonin dysregulation, SAD may be triggered by reduced light exposure, which can disrupt the production and balance of these critical brain chemicals.

SAD as a Spectrum Disturbance

SAD is often described as part of a “spectrum disturbance,” meaning it exists on a continuum of mood disorders rather than as a standalone condition (Fonte & Coutinho, 2021). This concept emphasizes that SAD symptoms can range from mild to severe and may overlap with other psychiatric conditions like generalized anxiety disorder, bipolar disorder, or dysthymia. Understanding SAD as a spectrum helps clinicians tailor treatment based on symptom severity and co-occurring conditions.

Risk Factors for SAD

Certain individuals are more susceptible to SAD than others. Roecklein & Wong (2021) share some primary risk factors: 

  1. Living in Northern Latitudes: People who live farther from the equator, where daylight hours are significantly reduced during winter, have a higher risk of developing SAD.
  2. Family History: Genetics play a role, and individuals with a family history of SAD or other mood disorders are more likely to experience it.
  3. Biological Sex: Women are more frequently diagnosed with SAD than men, though men often experience more severe symptoms when affected (Fellinger et al., 2022; Dang et al., 2023).
  4. Age: Younger adults, particularly those in their 20s and 30s, are more vulnerable to SAD, though children and older adults can also be affected (Fellinger et al., 2022).

Biological Theories: Circadian Rhythm and Serotonin Dysregulation

Two prominent theories behind the biological causes of SAD are:

  • Circadian Rhythm Disruption: Reduced exposure to natural light in the winter months can disrupt the body’s internal clock, leading to sleep disturbances, fatigue, and mood changes. This disruption can make it difficult for individuals to maintain regular sleep-wake cycles.
  • Serotonin Dysregulation: Serotonin, a neurotransmitter that influences mood, is often dysregulated in individuals with SAD. Reduced light exposure may decrease serotonin levels, contributing to depressive symptoms and lethargy.

Diagnostic Criteria for SAD

SAD is diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-TR-5) (American Psychiatric Association, 2022). It is categorized as a specifier of either major depressive disorder or bipolar disorder, with a seasonal pattern. Key criteria include:

  1. A regular pattern of depressive episodes during a specific season for at least two consecutive years.
  2. Full remission of symptoms during other seasons.
  3. Symptoms such as low energy, hypersomnia, overeating (particularly carbohydrate cravings), social withdrawal, and feelings of hopelessness.

Differentiating SAD from general seasonal mood changes is crucial. While many people feel a slight dip in mood during winter, SAD involves clinically significant symptoms that interfere with daily functioning.

The Disruptive Impact of SAD

The most disruptive aspect of SAD is its impact on daily life. Individuals often experience a profound loss of energy and motivation, making it difficult to perform everyday tasks, maintain relationships, or succeed at work or school (Galima et al., 2020). Social withdrawal and increased isolation can exacerbate feelings of loneliness and hopelessness, creating a vicious cycle that further deepens the depression.

Treatment Options for SAD

Effective treatment for SAD often involves a combination of therapies:

Cognitive Behavioral Therapy (CBT) 

CBT is a highly effective treatment for SAD (Chen et al., 2024). It focuses on identifying and changing negative thought patterns and behaviors that contribute to depressive symptoms. For SAD, CBT often incorporates behavioral activation strategies, encouraging patients to engage in activities that provide a sense of accomplishment and enjoyment, even when motivation is low.

Light Therapy

 Light therapy, or phototherapy, is a frontline treatment for SAD (Pjrek et al., 2019). It involves exposure to a bright light box that mimics natural sunlight. Daily sessions of 20-30 minutes in the morning can help regulate circadian rhythms and boost serotonin production. Research supports its efficacy, particularly when combined with CBT (Galima et al., 2020).

Vitamin D Supplementation

Low levels of vitamin D have been linked to depressive symptoms. Supplementing with vitamin D, particularly during the winter months, may alleviate some symptoms of SAD (Petric, 2021). However, it is often most effective when combined with other treatments like light therapy or CBT.

Lifestyle Changes

Exercise, structured routines, and spending time outdoors can significantly reduce SAD symptoms (Yang et al., 2020). Physical activity boosts endorphins and serotonin, while consistent routines help stabilize circadian rhythms. For individuals hesitant to seek traditional treatments, lifestyle changes can be a crucial first step in managing SAD.

The Importance of Social Support

Opening up to friends and family about SAD can be a vital part of the healing process. Supportive conversations can lead to greater understanding, reduced isolation, and the encouragement needed to seek professional help. Social support networks can also help individuals stay accountable to treatment plans and lifestyle changes.

Long-Term Management and Final Advice

Long-term management of SAD often involves a combination of treatments tailored to the individual. If you’re unsure whether your winter blues are SAD or another mental health concern, it’s essential to consult a mental health professional. Early intervention can prevent symptoms from worsening and improve overall well-being.

At Grit Psychology, we understand the profound impact SAD can have on your life. If you or someone you know is struggling, reach out for support. There is hope, and with the right tools, you can reclaim the joy and energy of life—even during the darkest months of the year.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787 

Chen, Z.-W., Zhang, X.-F., & Tu, Z.-M. (2024). Treatment measures for seasonal affective disorder: A network meta-analysis. Journal of Affective Disorders, 350, 531–536. https://doi.org/10.1016/j.jad.2024.01.028 

Dang, T., Russel, W. A., Saad, T., Dhawka, L., Ay, A., & Ingram, K. K. (2023). Risk for seasonal affective disorder (SAD) linked to circadian clock gene variants. Biology, 12(12), 1532. https://doi.org/10.3390/biology12121532 

Fellinger, M., Waldhör, T., Serretti, A., Hinterbuchinger, B., Pruckner, N., König, D., Gmeiner, A., Vyssoki, S., Vyssoki, B., & Fugger, G. (2022). Seasonality in major depressive disorder: Effect of sex and age. Journal of Affective Disorders, 296, 111–116. https://doi.org/10.1016/j.jad.2021.09.051 

Fonte, A., & Coutinho, B. (2021). Seasonal sensitivity and psychiatric morbidity: Study about seasonal affective disorder. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03313-z 

Galima, S. V., Vogel, S. R., & Kowalski, A. W. (2020). Seasonal Affective Disorder : Common questions and answers. American Family Physician, 102(11), 668-672. 

Petric, D. (2021). The importance of vitamin D in seasonal affective disorder and other depressive disorders. International Journal of Medical Reviews and Case Reports, 5(13), 1-48. https://d1wqtxts1xzle7.cloudfront.net/77954527/Final_article_Petric_SAD-libre.pdf?1641229166=&response-content-disposition=inline%3B+filename%3DCLINICAL_MEDICINE_SCIENCES_MINI_REVIEW_T.pdf&Expires=1733440892&Signature=X61KCELHD35r-wpY9Zd0J0BQP~QFYdXVc8NkeNbqhSrTK713jfp2Fcm2R-dXAY~CBvia9k7haCbGED8P4Cz~9cZTMpM5TXut1Gq8EYZ8pCYq9g4HUxUbphsBnXQhnzIhdlzO6l~Q6fgsuutiHv0mgT5XckcFLNYagyMXqhXuEBBkt3hOeW2TH~gmx4pGDBU5KtGRsDupySVAwSvhwvP6LN7wuy6UzhMtiT264dMX5-Gvhs55RedL4K1JrUcRynwfoLPO0i7Y48NRR6lAZAuZb7Mebhlxzn9qvYlKRKTyrXr47itYtKqSar6zWS7tlDn5Lb0TmP3gZgFuv9lJVLv5yQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA 

Pjrek, E., Friedrich, M.-E., Cambioli, L., Dold, M., Jäger, F., Komorowski, A., Lanzenberger, R., Kasper, S., & Winkler, D. (2019). The efficacy of light therapy in the treatment of seasonal affective disorder: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 89(1), 17–24. https://doi.org/10.1159/000502891 

Roecklein, K. A., & Wong, P. M. (2020). Seasonal affective disorder. Encyclopedia of Behavioral Medicine, 1964-1966. https://doi.org/10.1007/978-3-030-39903-0_836 

Yang, Y., Zhang, S., Zhang, X., Xu, Y., Cheng, J., & Yang, X. (2020). The role of diet, eating behavior, and nutrition intervention in Seasonal affective disorder: A systematic review. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01451

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