Understanding Seasonal Affective Disorder (SAD)

woman holding a cup staring out of the window

Winter blues — or something more?

As winter approaches, most of us look forward to nesting, nurturing indoor hobbies and enjoying festive holiday celebrations. For many, though, shorter days and longer nights can trigger a form of depression that’s often misunderstood and, if left untreated, can be debilitating.

Seasonal Affective Disorder, also known as SAD, is more than just a bout of “winter blues.” It’s a type of depression that occurs during seasonal transitions, most commonly when we shift from fall to winter. It’s estimated that millions of American adults suffer from SAD, and many may not even realize it. According to the American Psychiatric Association, about 5 percent of adults in the U.S. experience SAD, and symptoms can last about 40 percent of the year.

How can you know whether a seasonal mood shift is something more serious? To help shed light on SAD, we reached out to Mena Mirhom, MD, FAPA, Medical Director of Behavioral Health Services at Clara Maass Medical Center (CMMC).

What is SAD?

SAD is a subtype of depression that has a seasonal pattern. It typically occurs around the end of fall or the start of winter, especially in geographical locations such as the Northeast. Unlike major depressive disorder (MDD), SAD symptoms usually subside during the spring and summer.

What are the most common symptoms of SAD?

Symptoms include losing interest in things you typically enjoy, feeling down or sad most days, sleeping too much, overeating, weight gain and, in some cases, thoughts of self-harm or suicide. Unlike other forms of depression, SAD is diagnosed when depressive episodes occur during specific seasons for at least two consecutive years.

What causes SAD?

While the exact cause is unknown, several theories point to genetics and neurotransmitters like serotonin, a brain chemical that helps regulate mood. Some studies suggest that people with SAD have a higher level of a certain transporter called SERT, which decreases their serotonin levels in winter. There is also evidence that people with SAD produce too much melatonin, the hormone the body releases in response to darkness to facilitate sleep.

Who’s most at risk for SAD?

Women are more likely than men to suffer from SAD, which generally begins in young adulthood. It’s also more common in people with MDD or bipolar disorder and other mental disorders like Attention Deficit Hyperactivity Disorder (ADHD) or anxiety disorders. SAD is more common in those living farther north, where there are shorter daylight hours in the winter.

Is this condition physiological, psychological or both?

While there are physiological components related to serotonin and melatonin, there is also a psychological component where many of our coping mechanisms or connections can be restricted during winter. Social isolation, lack of movement and connection with the community play a role in SAD as in MDD.

How is SAD treated, and how well does treatment work?

The primary treatment for SAD is light therapy, which works by safely simulating sunlight. Patients sit in front of a very bright (10,000 lux) light for about 30 minutes daily. (Light-therapy lamps are widely available online and range in price from about $30 to $1,500 or more.) Biologically, this therapy inhibits melatonin, the hormone that contributes to oversleeping and an overall sluggish feeling. Other treatment options include psychotherapy, antidepressant medications and vitamin D, which can be used alone or in combination with light therapy.

What is the biggest misconception about SAD?

The biggest misconception about SAD is that it is something we must endure and that there’s nothing we can do about it. There are painful experiences in life that are unavoidable, but this condition is preventable and treatable. Recognizing this pattern and getting ahead of it can save patients a lot of grief.

When to Get Help

As with most mental health struggles, a good first question is, “Has this been getting in the way of my function?” If you’re still unsure, Dr. Mirhom says the four D’s can help people recognize when it’s time to seek professional support:

  • Duration: Are symptoms lasting for more than two weeks?
  • Depth: If I rate my mood from 1 to 10,1 being the lowest, do I often feel closer to 1?
  • Daily: Am I experiencing these feelings consistently and frequently?
  • Duty: Are these feelings making it harder for me to work or function?

To connect to the Department of Behavioral Health at Clara Maass Medical Center, call 973-844-4357; to reach the RWJBH Behavioral Health Access Center for 24/7 mental health support, call 800-300-0628.