[3 min read]
- For a lot of us, the Big Dark comes with additional feelings of sadness and physical changes that are related to a lack of sunshine and the heavy cloud cover of winter months.
- Symptoms of the condition can range from just feeling a little "off" to debilitationg depression.
- You can manage Seasonal Affective Disorder with spacial lights, medication an dother therapies.
- A Providence Swedish behavioral health expert is here with guidance to help you move through the cloudy winter months without letting SAD get the best of you.
As the seasons change, many of us notice shifts in our mood, energy levels, and overall sense of well-being. A lot of us in the Pacific Northwest are used to the Big Dark and take the sun's annual vacation from the region in stride, but for others winter cloud cover comes with pronounced mood changes that are associated with a condition known as Seasonal Affective Disorder (SAD).
SAD affects millions worldwide and comes with a host of symptoms. It typically emerges in the fall and winter months when daylight hours shorten. This blog explores the intricacies of SAD, shedding light on its symptoms, causes, and effective management strategies. From understanding the science behind light therapy to discovering lifestyle adjustments that can make a difference, we aim to empower you with knowledge and tools to navigate seasonal transitions with resilience and positivity. To learn more about the condition and how to manage it we spoke with Janarthan Sivaratnam, Ph.D., a Providence Swedish behavioral health expert at Providence Swedish South Lake Union Primary Care.
What is SAD, clinically speaking?
Seasonal affective disorder (SAD) is a type of depression that comes and goes with the seasons. Most people with SAD experience depression during the fall and winter months, then feel better when spring and summer arrive. To be diagnosed with SAD, these seasonal patterns need to happen for at least two years in a row. The exact cause isn't fully understood, but lack of sunlight during shorter winter days plays a major role. When there's less sunlight, your body's internal clock (which controls sleep, mood, and energy) can get disrupted. This may affect brain chemicals like serotonin, which helps regulate mood.
How do I know if my symptoms are SAD or depression?
It’s important to know that SAD is a form of depression. However, if you are curious if you have SAD as opposed to the more well known “major depressive disorder,” here are some of the key differences:
- For SAD, the episode must begin and end at around the same times every year, full remissions (getting better) must occur seasonally, and over the person's lifetime, and the seasonal mood symptoms must outnumber any nonseasonal episodes (like in major depression).
- SAD can also have unique symptoms including sleeping a lot, increased appetite with carbohydrate cravings, and weight gain, whereas nonseasonal depression more commonly involves insomnia, decreased appetite, and weight loss.
- On average, SAD patients typically show less occupational and cognitive impairment and require less psychiatric intervention than those with nonseasonal depression
What are some treatments for SAD? Do the lights really work?
Some of the most common/frontline treatments include bright light therapy, antidepressants, and cognitive behavioral therapy. Typical light therapy protocols involve 2,500 to 10,000 lux for 30 to 60 minutes daily, preferably in the morning, using commercial light boxes, with many patients noticing improvement within a few weeks (though treatment should continue ideally throughout the winter season until remission occurs). Antidepressants can work well and CBT adapted for SAD has been shown to also have similar treatment benefits to light therapy.
I’m on medications but still have SAD symptoms. What should I do?
I would recommend light therapy (see above for additional contexts) and speak with your physician on to what extent it could be beneficial for you. CBT for SAD could also be helpful and has shown similar benefits compared with light therapy. Other behavioral changes such as increasing exercise and exposure to natural light are recommended interventions that can provide additional therapeutic benefit. However, recent studies have shown inconclusive evidence as to how effective increasing vitamin d supplementation can have on treating SAD specifically.
How is SAD different from the winter blues?
“Winter blues” are essentially SAD that do not meet diagnostic criteria. The main differences lie in severity and functional impairment (how much do the symptoms practically impact your life). SAD requires meeting full criteria for major depressive disorder or bipolar disorder with the episodes happening again occurring at specific times of year (typically fall/winter) and complete remission during the opposite season, occurring for at least two consecutive years.
Can someone have SAD in other climates? If someplace is hot and sunny, might they experience something similar?
Yes, seasonal affective disorder (SAD) can occur in hot, sunny climates, but people there typically experience depression during summer months rather than winter. Heat and humidity appear to trigger summer SAD rather than lack of sunlight. For example, in tropical northern Australia and northern Thailand, researchers found that excessive heat and humidity were the two most influential environmental factors affecting mood and behavior. Temperature strongly correlated with when people "feel worst" in these hot climates. Symptoms can also look differently – unlike winter SAD where people typically sleep more, eat more (especially carbohydrates), and gain weight, people with summer SAD in tropical regions often experience decreased appetite and trouble sleeping instead.
What should I say to a friend who I think is struggling with SAD?
Expressing concern in a supportive, non-judgmental way is the most helpful approach. The conversation should focus on specific observations rather than diagnostic labels. For example, mention concrete changes you’ve noticed, such as "I've noticed you seem more tired lately and haven't been joining us for activities you usually enjoy" or "You've mentioned feeling down every winter for the past couple of years." This approach can be less confrontational than suggesting a diagnosis and shows genuine attention to their well-being. Also encourage them to talk with their doctor or a mental health professional, emphasizing that seasonal patterns of depression are common and treatable. Mention that healthcare providers can help determine what's going on and discuss treatment options. You also can offer practical support: Ask "How can I help?" or offer specific assistance like accompanying them to an appointment, helping them research treatment options, or simply being available to talk. Encouraging outdoor activities during daylight hours or exercise together can provide both social support and potential symptom relief!
What should I avoid if I think I may be struggling with SAD?
It might sound self-serving from someone working in the medical field, but avoid delaying care as SAD can resemble other mood disorders and requires careful assessment for accurate diagnosis and appropriate treatment. Related to that, collaborate with your doctor to identify a treatment plan and stick with it in a manner you both identify, while exploring evidence based treatments (such as what was previously shared above) and minimizing unproven treatments/therapies.
Learn more and find a physician or advanced practice clinician (APC)
If you are looking for help managing holiday stress or learning to deal with holiday stress, support is available at Providence Providence Swedish Behavioral Health. Whether you require an in-person visit or want to consult a doctor virtually, you have options. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
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Bridging the gaps: rethinking how we communicate can help men and boys thrive
Choosing a therapist: identifying your mental health goals and what to keep in mind
This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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