SAD – how to cope with seasonal depression

What is seasonal affective disorder (SAD)?

“The most common type of SAD is winter depression, which starts in the fall or winter, as daylight hours become shorter and the skies turn gray. If left untreated, it doesn’t lift until the spring,” says Dr Ann. “It’s also possible – but much less common – to get summer depression, which starts in the spring and lifts in the fall.

• SAD affects about 3 in 100 people in the US and the UK
• around 10-20 out of every 100 people in the US get a milder type of seasonal low mood, sometimes called the ‘winter blues’

Women are about 3 times as likely as men to get SAD symptoms.

“If you notice a pattern of feeling depressed when the seasons change and it's affecting your life, see your doctor for assessment and treatment,” says Dr Ann.

“The good news is that there are effective self-care strategies and treatments available, so you don’t have to feel low all winter or summer with these feelings.”

Read on to learn what to look out for, and how to deal with seasonal depression.

Have I got the winter blues or SAD?

SAD is a type of depression. It’s different from other kinds of depression because it’s seasonal, returning each year in either autumn/winter or spring/summer.

“While a lot of us tend to get a bit of ‘winter blues’ during the darker months, and can feel down from time to time, seasonal depression is much more than that,” explains Dr Ann. “It has a big impact on your daily life.”

Seasonal affective disorder symptoms

“With SAD, you may have some of the common symptoms of depression – including wanting to sleep more, increased appetite, and weight gain – but the severity can vary,” says Dr Ann.

You may:

• find it difficult to wake up in the mornings
• lose interest in things you usually enjoy
• have less energy
• want to eat more carbohydrates, such as biscuits, bread, cakes or pizza
• gain weight
• find it hard to concentrate
• withdraw from friends and family – which may affect your relationships and work
• lose your sex drive (libido)
• have thoughts about hurting yourself, if you have severe depression (find out how to get help if you’re having suicidal thoughts)

Winter blues symptoms

“With the winter blues, although you’ll get some low mood symptoms, which come on with the change in season, they’re much milder,” says Dr Ann. “It’s a sort of ‘SAD-lite’ – it’s less serious, and much more common.”

You may get some of the symptoms above – such as decreased energy and increased appetite – but your day-to-day life won’t be as affected.

For example, research has found people with SAD say they sleep an average of 2.5 hours more in winter than summer, whereas people with winter blues say they sleep 1.7 hours more (for the general population, it’s 0.7 hours more).

Read more about how winter affects women's health with our complete guide.

Summer depression symptoms

“Summer SAD starts in the spring and lifts again in the fall/winter, and is much less common than winter SAD,” says Dr Ann.

With summer SAD, you may get symptoms of depression such as:

• loss of appetite
• trouble sleeping (insomnia)
• weight loss
• restlessness and agitation
• anxiety

What do women say SAD feels like?

“It was as if my body had just shut down and I’d want to hibernate,” explains Abigail, writing in a blog post for the mental health charity Rethink Mental Illness. “I was physically and mentally exhausted without having any reason to be. I’d cancel plans with friends as I couldn’t see the point of meeting up with people. I never thought anything was wrong as such. I just assumed that everyone else was feeling the same way.”

After several years of winter depression symptoms, Abigail realized her feelings weren’t normal, and has since developed self-care strategies for dealing with her feelings.

“I only felt alive half the year” and it felt like I had “fallen into a black hole in the darkness,” said women who took part in a study looking at light therapy for SAD.

“Lack of energy, overwhelming tiredness and inactivity” were symptoms other women from the study described. Others talked about “difficulties meeting expectations of normal life” and “problems with daily sleep rhythms”. Some reported distubed relationships with friends and family, and reduced work capacity.

Watch a video of founding SAD researcher Dr Norman Rosenthal talking about his own experiences of SAD.

What causes seasonal depression?

While we don’t know exactly what causes SAD, there are several theories. The most well-established is that it’s caused by reduced exposure to sunlight.

This is thought to affect your body in the following ways:

• your brain works differently. The part of your brain that helps control your mood, appetite and sleep (the hypothalamus) stops working properly
• your sleep patterns get changed. The brain changes may affect your ‘sleep’ hormone, melatonin, changing your sleep patterns so that you want to sleep more than normal
• you produce less ‘feel-good’ hormone, serotonin, which may cause low mood
• your internal 24-hour body clock may be disrupted (circadian rhythm), so you’re out of sync

“The theory that SAD is linked to light exposure might explain winter SAD, but this doesn’t explain why a few people get SAD in the summer,” adds Dr Ann. “This is something doctors are still researching.”

Who gets seasonal depression?

Women are about 3 times more likely to get SAD than men – though we don’t know why this is.

There are also some other things that may mean you’re more likely to be affected:

• symptoms usually start between the ages of 20 and 30 – SAD is less likely to happen as you get older
• it sometimes runs in families – it’s thought that genes may play a part, although this isn’t understood
• 1 theory is that you’re more likely to have SAD the further you live from the equator, and less likely to have it if you live close to the equator, where the hours of sunlight are more constant and bright throughout the year. For example, if you live in Alaska or New England, you may be more likely to get SAD than people who live in Florida. However other studies have found the distance from the equator doesn’t make a difference – and some people get SAD in the summer, too
• you’re more likely to get SAD if you have a major depressive disorder or bipolar disorder
• people with SAD are more likely to have other mental health conditions, such as attention deficit hyperactivity disorder (ADHD) or eating, panic, or anxiety disorders
• SAD is more common in people with relatives who have other mental health conditions, such as major depression or schizophrenia

It’s also worth noting that 1 study found that around 60% of people with SAD who joined research trials had never been treated for depression – possibly because they thought their feelings were normal.

How to work out if your feelings might be SAD

• keep a mood diary to track your feelings and whether they are seasonal
• speak to your doctor

Self-care for summer depression

If your seasonal blues hit in the summer months, there are a few different things that might help. Try:

• limiting your time in natural daylight – get no more than 13 hours a day, and keep out of the sun when it’s at its hottest
• staying cool, especially at night – loose clothing, fans or air conditioning can be helpful
• keeping hydrated – by drinking plenty of water
• planning social activities indoors – meet friends in a café or at the movies to stop yourself becoming isolated

When to see a doctor

“If you notice a pattern of getting some of the symptoms described above as the seasons change, and it’s affecting your daily life, you should see your doctor for an assessment and find out about treatment options,” says Dr Ann.

Your doctor may ask you about:

• your mood – do you feel depressed and down?
• changes in the way you think – do you have trouble concentrating?
• eating and sleeping – are you sleeping more than usual, or eating more and putting on weight?
• whether your symptoms stop you doing your daily activities – such as working, looking after children, exercising and socializing
• your intake of alcohol and other drugs
• your support network – in terms of family and friends
• stresses in your life – such as work stress
• whether you’ve thoughts of hurting yourself, or have suicidal thoughts

Confirming a SAD diagnosis

To diagnose SAD, your doctor will look to see if your depression has a seasonal pattern, starting at a similar time of year for at least 2 years in a row.

In the US, depression is usually assessed using a questionnaire called the PHQ-9. If you score more than 20, this is classed as severe depression. If you score below 20, this is classed as mild to moderate depression.

Treatments to combat seasonal depression

If you’re diagnosed with SAD, there are 3 main recommended treatments:

• light therapy and/or dawn simulation
• antidepressants
• talking therapy (psychotherapy)

You and your doctor will decide on the right treatment for you, based on how severe your symptoms are and how you’re coping with them.

You may need a combination of treatments, and it can take time to find what works for you. It’s also recommended that you try lifestyle changes, such as the self-care tips above.

Bright light therapy for winter depression

Bright light therapy can be used on its own or with antidepressants (see below). You use special lamps and light boxes to boost light exposure to the hypothalamus in your brain. The theory is that bright light helps rebalance the production of melatonin and serotonin, and reset your body clock.

Most people can use light therapy safely. But if you have an eye condition, are taking any light-sensitizing medication or aren’t sure, discuss it with your doctor to make sure it’s suitable for you.

What is bright light therapy?

It’s been used since the 1980s using special lamps and light boxes to boost light exposure to the hypothalamus in your brain.

How does bright light therapy work?

The theory is that bright light helps rebalance the production of melatonin and serotonin and resets your body clock.

Where can you get a SAD lamp and which ones are best?

Light boxes are available to buy or hire, or at some medical facilities.

Make sure you choose one with a UV filter and light dispersion to protect your eyes. Yale School of Medicine has more information on the best light boxes to try.

SAD light boxes are usually 20 times brighter than ordinary indoor light.
The best-studied devices give out 10,000 lux of light.

How to use a light box

• a review found that you should try it for at least 2 weeks to see if it’s having an effect
• try to use it every day at the same time, including weekends and vacations
• if early-morning light therapy isn’t helping after 2 weeks, some studies suggest trying a 30-minute evening session as well
• most people with winter depression start using light boxes in the 2 to 4 weeks before their symptoms start in the autumn, and stop in spring and summer

Does bright light therapy work?

Several high-quality trials have found it can reduce the severity of SAD symptoms, with improvement or remission in about 60% of people who try it.

Are there any side effects from bright light therapy?

Side effects are mild and reversible – the most common are eye strain and headaches, but they can also include anxiety, agitation, fatigue and insomnia (if used too late in the evening or too early in the morning).

These usually settle down if the dose (time in front of the light) is reduced – see your doctor if they persist.

Dawn simulation or sunrise alarm clocks for winter depression

Sometimes used as an alternative or add-on to bright light therapy, this involves using an alarm clock that wakes you up gradually with progressively brighter light in the morning.

How effective are sunrise alarm clocks?

It’s been shown to be effective at reducing SAD symptoms in several small research trials, with improvement or remission in about 65% of cases.

Antidepressants

Antidepressants are often recommended alongside light therapy:

• they’re thought to be most effective if taken before the start of winter, as they can take around 4 to 6 weeks to have an effect
• they should be slowly reduced at least 2 weeks after the end of the winter season
• they can include selective serotonin reuptake inhibitors (SSRIs), such as sertraline and fluoxetine
• if you don’t respond to SSRIs or can’t take them, bupropion may also be used. This increases a brain chemical called dopamine, which is involved in calming and pleasure sensations

Psychotherapy

Psychological treatments are also often recommended, either alone or in combination with other treatments:

• cognitive behavioral therapy (CBT) is based on the idea that how we think and behave affects the way we feel. It can teach you to challenge dysfunctional thoughts about winter, and change behaviors such as socially isolating (hibernating)
• CBT adapted for SAD has been shown in trials to be helpful, with remission expected in about 50% of cases
• counseling is another type of talking therapy that’s sometimes used, as is psychodynamic therapy – which involves seeing if anything in your past is affecting how you feel today

Treatment for summer depression

Summer depression is generally managed with the same treatments that are used for other types of depression. This can involve antidepressants, psychotherapy, or a combination (see above).

Getting urgent help

For many people mood changes with season changes can be normal but in rarer cases you might find that it has triggered your mood to feel very low. There is lot’s of help available. If you feel distressed or need urgent help, it’s best to get help immediately by going to the emergency department or calling for help.
Are you or someone you know in distress or thinking about hurting themselves?

In the US, you can contact the Suicide & Crisis Lifeline by calling 988 toll-free, or using the website’s Lifeline Chat. Or contact the Crisis Text Line by texting HOME to 741741.

In the UK, you can contact Samaritans for free from any phone by calling 116 123. Or check mental-health charity Mind’s list of crisis helplines.

Ones to watch: vitamin D and melatonin

You may be interested in trying supplements or herbal remedies for SAD or the winter blues. Unfortunately, there’s little evidence that they’re effective, so we can’t recommend them.

However, some might be ones to watch for the future. These include:

• vitamin D for seasonal depression – people with SAD are often found to have low levels of vitamin D in their blood, but the evidence for using it as a supplement is mixed. Some studies have suggested it may be as effective as light therapy, but others have found it to have no effect. Find out how much sunshine you need to make vitamin D

• melatonin – there’s some limited evidence that melatonin hormone supplements may improve sleep in some people with SAD. However, studies into its effectiveness have been very small (read more about melatonin). Supplements are available to buy from pharmacies in the US