What is seasonal affective disorder (SAD)?

Seasonal affective disorder (SAD) is a form of depression that occurs at the same time each year, usually in winter. Otherwise known as seasonal depression, SAD can affect your mood, sleep, appetite, and energy levels, taking a toll on all aspects of your life from your relationships and social life to work, school, and your sense of self-worth. You may feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. While a less common form of the disorder causes depression during the summer months, SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring or early summer.

SAD affects about 1% to 2% of the population, particularly women and young people, while a milder form of winter blues may affect as many 10 to 20 percent of people. Since the amount of winter daylight you receive changes the farther you are from the equator, SAD is most common in people who live at least 30 degrees latitude north or south (north of places such as Jacksonville, Florida, Austin, Texas, Cairo, Egypt, and Hangzhou, China, or south of Perth, Australia, Durban, South Africa, and Cordoba, Argentina). No matter where you live, though, or how dark and cold the winters, the good news is that, like other forms of depression, SAD is treatable. The more you understand about seasonal depression, the better equipped you’ll be to manage or even prevent the condition.

Signs and symptoms of seasonal affective disorder

The signs and symptoms of seasonal affective disorder are the same as those for major depression. SAD is distinguished from depression by the remission of symptoms in the spring and summer months (or winter and fall in the case of summer SAD).

Common symptoms of seasonal depression include:

• Depressed mood, low self-esteem
• Loss of interest or pleasure in activities you used to enjoy
• Feelings of sadness, hopelessness, and despair
• Feeling angry, irritable, stressed, or anxious
• Unexplained aches and pains
• Changes in sleeping pattern
• Appetite and weight changes
• Difficulty concentrating
• Fatigue and lack of energy; reduced sex drive
• Use of drugs or alcohol for comfort

As with depression, the severity of SAD symptoms can vary from person to person—often depending on genetic vulnerability and geographic location. For many, the symptoms usually begin mildly at the start of fall and get progressively worse through the darkest days of winter. Then, by spring or early summer, the symptoms lift until you’re in remission and feel normal and healthy again.

To be clinically diagnosed with seasonal affective disorder, you need to have experienced these cyclical symptoms for two or more consecutive years. Regardless of the timing or persistence of your symptoms, if your depression feels overwhelming and is adversely affecting your life, it’s time to seek help.

Seasonal changes in bipolar disorder

The changes in seasons can trigger mood changes in some people with bipolar disorder. Spring and summer may trigger symptoms of mania or hypomania, while the onset of fall and winter can bring on symptoms of depression. While the depression symptoms of SAD and bipolar disorder can look alike, there are significant differences, especially when it comes to treatment. To learn more about bipolar disorder, see Bipolar Disorder Signs and Symptoms.

Causes of seasonal affective disorder

While the exact causes of seasonal affective disorder are unclear, most theories attribute the disorder to the reduction of daylight hours in winter. The shorter days and reduced exposure to sunlight that occurs in winter are thought to affect the body by disrupting:

• Circadian rhythms. Your body’s internal clock or sleep-wake cycle responds to changes between light and dark to regulate your sleep, mood, and appetite. The longer nights and shorter days of winter can disrupt your internal clock—leaving you feeling groggy, disoriented, and sleepy at inconvenient times.
• Production of melatonin. When it’s dark, your brain produces the hormone melatonin to help you sleep and then sunlight during the day triggers the brain to stop melatonin production so you feel awake and alert. During the short days and long nights of winter, however, your body may produce too much melatonin, leaving you feeling drowsy and low on energy.
• Production of serotonin. The reduced sunlight of winter can lower your body’s production of serotonin, a neurotransmitter that helps to regulate mood. A deficit may lead to depression and adversely affect your sleep, appetite, memory, and sexual desire.

As with any form of depression, there can be many different causes and contributing factors for seasonal affective disorder. Always consult your doctor for an accurate diagnosis and see the lifestyle changes outlined below for help to boost your mood and manage your depression symptoms.

Risk factors

Seasonal affective disorder can affect anyone but is most common in people who live far north or south of the equator. This means you’ll experience less sunlight in the winter months and longer days during the summer. Other risk factors include:

• Your gender. While 3 out of 4 sufferers of SAD are women, men often experience more severe symptoms.
• Your age. In most cases, winter SAD is first diagnosed in people aged 18 to 30 and is less likely to occur as you get older.
• Your family history. Having relatives who’ve experienced SAD or another type of depression puts you at greater risk.

Self-help tips for seasonal affective disorder

Seasonal depression can make it hard to motivate yourself to make changes, but there are plenty of steps you can take to help yourself feel better. Recovery takes time but you’ll likely feel a little better each day. By adopting healthy habits and scheduling fun and relaxation into your day, you can help lift the cloud of seasonal affective disorder and keep it from coming back.

Tip #1: Get as much natural sunlight as possible—it’s free!

Whenever possible, get outside during daylight hours and expose yourself to the sun without wearing sunglasses (but never stare directly at the sun).

• Take a short walk outdoors, have your coffee outside if you can stay warm enough.
• Increase the amount of natural light in your home and workplace by opening blinds and drapes and sitting near windows.
• Some people find that painting walls in lighter colors or using daylight simulation bulbs also helps combat winter SAD.

Tip #2: Exercise regularly—it can be as effective as medication

Regular exercise is a powerful way to fight seasonal depression, especially if you’re able to exercise outside in natural daylight.

• Regular exercise can boost serotonin, endorphins, and other feel-good brain chemicals. In fact, exercise can treat mild to moderate depression as effectively as antidepressant medication.
• Exercise can also help to improve your sleep and boost your self-esteem.
• Aim for 30 to 60 minutes of activity on most days. Even something as simple as walking a dog, for example, can be good exercise for you and the animal, as well as a great way to get outdoors and interact with other people.

Tip #3: Reach out to family and friends—and let them help

Close relationships are vital in reducing isolation and helping you manage SAD. Participate in social activities, even if you don’t feel like it. It may feel more comfortable to retreat into your shell, but being around other people will boost your mood. Even if you’ve retreated from relationships that were once important to you, make the effort to reconnect or start new relationships.

• Call or email an old friend to meet for coffee. Or reach out to someone new—a work colleague or neighbor, for example. Most of us feel awkward about reaching out, but be the one to break the ice.
• Join a support group for depression. Sometimes, just talking about what you’re going through can help you feel better. Being with others who are facing the same problems can help reduce your sense of isolation and provide inspiration to make positive changes.
• Meet new people with a common interest by taking a class, joining a club, or enrolling in a special interest group that meets on a regular basis. Whatever you choose, make sure it’s something that’s fun for you.
• Volunteer your time. Helping others is one of the best ways to feel better about yourself, expand your social network, and overcome SAD.

Tip #4: Eat the right diet

Eating small, well-balanced meals throughout the day, with plenty of fresh fruit and vegetables, will help you keep your energy up and minimize mood swings.

• While the symptoms of SAD can make you crave sugary foods and simple carbohydrates, such as pasta and white bread, complex carbohydrates are a better choice. Foods such as oatmeal, whole grain bread, brown rice, and bananas can boost your feel-good serotonin levels without the subsequent sugar crash.
• Foods rich in certain omega-3 fats—such as oily fish, walnuts, soybeans, and flaxseeds—can also improve your mood and may even boost the effectiveness of antidepressant medication.

Tip #5: Take steps to deal with stress—by making time for fun

Whatever the time of year, too much stress can exacerbate or even trigger depression. Figure out the things in your life that stress you out, such as work overload or unsupportive relationships, and make a plan to avoid them or minimize their impact.

• Practicing daily relaxation techniques can help you manage stress, reduce negative emotions such as anger and fear, and boost feelings of joy and well-being. Try yoga, meditation, or progressive muscle relaxation.
• Do something you enjoy every day. Having fun is a great stress buster, so make time for leisure activities that bring you joy, whether it be painting, playing the piano, working on your car, or simply hanging out with friends.

Treatment for seasonal affective disorder

While your doctor may also suggest treatment such as medication or psychotherapy, the mainstay of winter SAD treatment is light therapy, otherwise known as phototherapy. Light therapy aims to replace the missing daylight of winter by exposing you to bright light that mimics natural outdoor light. Daily exposure can suppress the brain’s secretion of melatonin to help you feel more awake and alert, less drowsy and melancholy.

Light therapy has been shown to be effective in up to 85 percent of SAD cases. However, the timing and length of exposure needed can vary according to your symptoms and circadian rhythm, so you’ll need guidance from your doctor or mental health professional to find the right dosage. Your doctor or therapist can also help you choose a light therapy product that’s both effective and safe.

Light therapy has to be continued daily throughout the winter months to be effective. Starting light therapy before the onset of symptoms in the fall may even help prevent seasonal affective disorder.

There are two different ways of administering light therapy.

• A light box delivers light that with up to ten times the intensity of normal domestic lighting. In most cases, you simply sit about 12 inches in front of a 10,000 lux light box for 15 to 30 minutes each morning. The light box emits a controlled amount of white light, with harmful ultraviolet (UV) rays filtered out. While the light needs to enter the eyes, you shouldn’t stare directly at the light box, but rather continue your morning routine, such as eating breakfast, reading the newspaper or working at the computer. Most people notice an improvement in their SAD symptoms after a few days and experience the full antidepressant effect in about two weeks.
• A dawn simulator is a device that gradually increases the amount of light in your bedroom in the morning to simulate the rising sun and wake you up. The light gradually increases, just as natural sunlight does, over a period of 30 to 45 minutes. Instead of waking in darkness, you wake to what looks like a sunny morning. This can help reset your circadian rhythm and improve your mood. While light boxes may trigger hypomania or mania in those with bipolar disorder, there is no such risk with a dawn simulator.

While tanning beds generate sufficient light, they should never be used to treat SAD as the UV rays they produce can be harmful to the skin and eyes.

Medication and psychotherapy for seasonal affective disorder

While light therapy is often a highly effective treatment for SAD or the winter blues, it doesn’t work for everyone. If that’s the case, don’t despair, there are other effective treatment options available and plenty of self-help techniques to help you feel better.

• Cognitive behavioral therapy (CBT) can be highly beneficial for people with seasonal depression.The right therapist can help you curb negative thoughts, attitudes, and behaviors that make the disorder worse and help you learn how to manage symptoms and deal with stress in healthy ways. For many people, CBT can be as effective at treating seasonal affective disorder as light therapy or antidepressants, but without any risky side-effects.
• Medication. If light therapy doesn’t work for you, your doctor may suggest antidepressant medication. SSRI antidepressants work by acting on serotonin levels in the brain to reduce SAD symptoms. In the U.S., the FDA has specifically approved the drug bupropion (Wellbutrin) to treat seasonal affective disorder. However, as with all antidepressants, there may be adverse side effects, including a number of safety concerns specific to children and young adults. It’s important to weigh the benefits against the risks before starting on medication.

Whatever treatment plan you settle on, it’s important to combine it with self-help techniques to help manage your depression symptoms and even help prevent seasonal affective disorder returning next year.

Do antidepressants cure a chemical imbalance in the brain?

You’ve seen it in television ads, read it in newspaper articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the brain that medication can correct. The truth is that there is very little—if any—research to support this theory. It’s a triumph of pharmaceutical marketing over science.

While antidepressant drugs increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but that doesn’t mean headaches are caused by an aspirin deficiency.

When it comes to depression, serotonin is just one small part of the story

Mental health researchers agree that the causes of depression are much more complex than the chemical imbalance theory suggests. A growing body of research points to other physiological factors, including inflammation, elevated stress hormones, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells. And these are just the biological causes of depression. Social and psychological factors⎯such as loneliness, lack of exercise, poor diet, and low self-esteem⎯also play an enormous role.

How effective are antidepressants?

So now we know that depression isn’t simply a matter of having too little serotonin. But that doesn’t mean that antidepressants don’t work. Going back to our aspirin analogy, even though headaches aren’t caused by an aspirin deficiency, they still go away when you pop a couple of pills. Is the same true with antidepressant and depression? Again, the evidence may surprise you.

When depression is severe, medication may be helpful—even lifesaving. However, research shows that very few people become symptom-free on antidepressants, and some become worse. Furthermore, many who respond initially to medication soon slip back into depression, despite sticking with drug treatment.

Other studies show that the benefits of antidepressants have been exaggerated, with a growing number of researchers concluding that—when it comes to mild to moderate depression—antidepressants are no more effective than placebos.

I’m depressed and need relief. Where does this leave me?

Medication may be right for you if depression is interfering with your ability to function in an important part of your life—work, school, or in your relationships, for example. However, many people use antidepressants when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects. Even if you decide to take medication, it’s a good idea to pursue therapy and lifestyle changes that can help you get to the bottom of your underlying issues and develop the tools to beat depression for good.

What are the side effects of antidepressant medication?

There are many different types of drugs used in the treatment of depression, including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Side effects are common in all antidepressants. For many people, the side effects are serious enough to make them stop taking the medication..

Side effects of SSRIs (selective serotonin reuptake inhibitors)

The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs). The SSRIs include drugs such as Prozac, Zoloft, and Paxil.

The SSRIs act on a chemical in the brain called serotonin. Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects.

Common SSRI side effects include:

The SSRIs can also cause serious withdrawal symptoms, especially if you stop taking them abruptly.

Side effects of atypical antidepressants

There are a variety of newer depression drugs, called atypical antidepressants, which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine. The atypical antidepressants include:

The side effects vary according to the specific drug. However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision.

Side effects of older depression drugs

Tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors) are older classes of antidepressants. Their side effects are more severe than those of the newer antidepressants, so they are only prescribed as a last resort after other treatments and medications have failed.

Antidepressants and suicide risk

There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the U.S. Food and Drug Administration requires that all depression medications include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month to two months of treatment.

Anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.

What are the risk factors of antidepressants?

Anyone who takes antidepressants can experience side effects, but certain individuals are at a higher risk:

• People over 65. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults.
• Pregnant women. The use of SSRIs late in pregnancy may lead to short-term withdrawal symptoms in newborns after delivery. Typical symptoms include tremor, restlessness, mild respiratory problems, and weak cry.
• Teens and young adults. The U.S. Food and Drug Administration requires all depression medications to include a warning label about the increased risk of suicide in children and young adults.
• People who may have bipolar disorder. Antidepressants can actually make bipolar disorder worse or trigger a manic episode; there are other treatments available for those with bipolar disorder.

Is depression medication right for you?

If you’re considering antidepressants as a treatment option, the following questions may help you make your decision.

Questions to ask yourself and a mental health professional

• Is my depression adversely affecting my life enough to require drug treatment?
• Is medication the best option for treating my depression?
• Am I willing to tolerate unwanted side effects?
• What non-drug treatments might help my depression?
• Do I have the time and motivation to pursue other treatments such as therapy and exercise?
• What self-help strategies might reduce my depression?
• If I decide to take medication, should I pursue therapy as well?

Questions to ask your doctor

• How much mental health care training have you had?
• Are there any medical conditions that could be causing my depression?
• What are the side effects and risks of the antidepressant you are recommending?
• Are there any foods or other substances I will need to avoid?
• How will this drug interact with other prescriptions I’m taking?
• How long will I have to take this medication?
• Will withdrawing from the drug be difficult?
• Will my depression return when I stop taking medication?

Guidelines for taking antidepressants

The more you know about your antidepressant, the better equipped you’ll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.

Some suggestions:

• See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you may need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor’s expertise, so it’s important to choose the most qualified physician.
• Follow instructions. Be sure to take your antidepressant according to the doctor’s instructions. Don’t skip or alter your dose, and don’t stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates and can cause serious withdrawal symptoms.
• Beware of drug interactions. You should avoid drinking alcohol when taking SSRIs since it can lessen the effects of the medication. Dangerous drug interactions can occur when SSRIs are taken with antihistamines, found in many over-the-counter cold and allergy medicines and sleep aids, or with prescription painkillers. Always talk to your doctor or pharmacist before combining medications.
• Monitor side effects. Keep track of any physical and emotional changes you’re experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression worsens or you experience an increase in suicidal thoughts. See your doctor on a regular basis.
• Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately four to six weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.

Antidepressant withdrawal

Once you’ve started taking antidepressants, stopping can be tough. Many people have severe withdrawal symptoms that make it difficult to get off of the medication. If you decide to stop taking antidepressants, it’s essential to consult a doctor and taper off slowly.

Antidepressant withdrawal symptoms

When you stop taking antidepressants, you may experience a number of unpleasant—even disabling—withdrawal symptoms, including:

Tips for stopping your antidepressants safely

• Reduce your dose gradually. In order to minimize antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually step down your dose, allowing for at least one to two weeks between each dosage reduction.
• Don’t rush the process. The antidepressant tapering process may take up to several months, and should only be attempted under a doctor’s supervision. Be patient. If, at any time, you experience difficulties, consider spending more time at your current dose before attempting any further reductions.
• Choose a time to stop that isn’t too stressful. Withdrawing from antidepressants can be difficult, so it’s best to start when you’re not under a lot of stress. If you’re currently going through any major life changes or significantly stressful circumstances, you may want to wait until you’re in a more stable place.