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Seasonal Affective Disorder (SAD) FACT SHEET NAMI • The National Alliance on Mental Illness • 1 (800) 950-NAMI • http://www.nami.org 3803 N. Fairfax Drive, Suite 100, Arlington, Va. 22203 1 What is seasonal affective disorder (SAD)? The symptoms of depression are very common. Some people experience these only at times of stress, while others may experience them regularly at certain times of the year. Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression, usually in late fall and winter, alternating with periods of normal or high mood the rest of the year. Whether SAD is a distinct mental illness or a specific type of major depressive disorder is a topic of debate in the scientific literature. Researchers at the National Institute of Mental Health (NIMH) first posited the condition as a response to decreased light, and pioneered the use of bright light to address the symptoms. It has been suggested that women are more likely to have this illness than men and that SAD is less likely in older individuals. SAD can also occur in children and adolescents. Scientists have identified that the neurotransmitter serotonin may not be working optimally in many patients with SAD. The role of hormones and sleep-wake cycles (called circadian rhythms) during the changing seasons is still being studied in people with SAD. Some studies have also shown that SAD is more common in people who live in northern latitudes. What are the patterns of SAD? In SAD, the seasonal variation in mood states is the key factor to understand. Symptoms of SAD usually begin in October or November and subside in March or April. Some patients begin to “slump” as early as August, while others remain well until January. Regardless of the time of onset, most patients don’t feel fully “back to normal” until early May. Depressions are usually mild to moderate, but they can be severe. Treatment planning needs to match the severity of the condition for the individual. Although some individuals do not necessarily show these symptoms, the classic characteristics of recurrent winter depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain. Additionally, many people may experience other features of depression including decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities and decreased socialization. In a minority of cases, symptoms occur in the summer rather than winter. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss and agitation or anxiety. In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each fall and spring, around the equinoxes. Many people with SAD also report that their depression worsens or reappears whenever there is “less light around.” Seasonal Affective Disorder (SAD) FACT SHEET NAMI • The National Alliance on Mental Illness • 1 (800) 950-NAMI • http://www.nami.org 3803 N. Fairfax Drive, Suite 100, Arlington, Va. 22203 2 Some people with bipolar disorder can also have seasonal changes in their mood and experience acute episodes in a recurrent fashion at different times of the year. How is SAD treated? Many people with SAD will find that their symptoms respond to a very specific treatment called light therapy. For people who are not severely depressed and are unable—or unwilling—to use antidepressant medications, light therapy may be the best initial treatment. Light therapy consists of regular, daily exposure to a “light box,” which artificially simulates high-intensity sunlight. Practically, this means that a person will spend approximately 30 minutes sitting in front of this device shortly after they awaken in the morning. Side effects of light therapy are uncommon and usually reversible when the intensity of light therapy is decreased. The most commonly experienced side effects include irritability, eyestrain, headaches, nausea and fatigue. Scientific studies have shown light therapy to be effective when compared to placebo and as effective as antidepressants in many cases of non-severe SAD. Light therapy may also work faster than antidepressants for some people, with notable effects beginning with in a few days of starting treatment. Other people may find that it takes a few weeks. Antidepressant medications have also been found to be useful in treating people with SAD. Some people may require treatment of their symptoms only for the period of the year in which they experience symptoms. Other people may elect for year-round treatment or prophylactic treatment that begins prior to the onset of the season in which their symptoms are most severe. This is yet another reason to discuss treatment options with one’s physicians. While not explicitly studied for the treatment of SAD, psychotherapy, such as cognitive behavioral therapy (CBT), is likely a useful additional option. What should I do if I think I have SAD? Any person experiencing significant symptoms of depression should feel comfortable discussing their concerns with their doctors. Some primary care doctors (e.g., pediatricians and general practitioners) may be experienced in treating SAD and will feel comfortable treating this illness. Other doctors may want to refer people with SAD to a psychiatrist for treatment of this illness. This is more common in people with complex psychiatric illnesses or more severe symptoms. Before starting any treatment for SAD, a person should make sure to meet with their doctor to discuss the benefits and risks of treatment. Friends and family members of people with SAD may be appropriately concerned for the well being of their loved one. Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., December 2012

Health Insurance and Mental Health Services

Q: How does the Affordable Care Act help people with mental health issues?

Answer: The Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges. These new protections build on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provisions to expand mental health and substance use disorder benefits and federal parity protections to an estimated 62 million Americans.

Because of the law, most health plans must now cover preventive services, like depression screening for adults and behavioral assessments for children, at no additional cost. And, as of 2014, most plans cannot deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.

Q: Does the Affordable Care Act require insurance plans to cover mental health benefits?

Answer: As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. Another is rehabilitative and habilitative services. Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in MHPAEA, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.

Q: How do I find out if my health insurance plan is supposed to be covering mental health or substance use disorder services in parity with medical and surgical benefits? What do I do if I think my plan is not meeting parity requirements?

Answer: In general, for those in large employer plans, if mental health or substance use disorder services are offered, they are subject to the parity protections required under MHPAEA. And, as of 2014, for most small employer and individual plans, mental health and substance use disorder services must meet MHPAEA requirements.

If you have questions about your insurance plan, we recommend you first look at your plan’s enrollment materials, or any other information you have on the plan, to see what the coverage levels are for all benefits. Because of the Affordable Care Act, health insurers are required to provide you with an easy-to-understand summary about your benefits including mental health benefits, which should make it easier to see what your coverage is. More information also may be available with your state Consumer Assistance Program (CAP).

Q: Does Medicaid cover mental health or substance use disorder services?

Answer: All state Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries, and Children’s Health Insurance Program (CHIP) beneficiaries receive a full service array. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. While states determine which of these services to cover for adults, Medicaid and CHIP requires that children enrolled in Medicaid receive a wide range of medically necessary services, including mental health services. In addition, coverage for the new Medicaid adult expansion populations is required to include essential health benefits, including mental health and substance use disorder benefits, and must meet mental health and substance abuse parity requirements under MHPAEA in the same manner as health plans. For additional information on Medicaid and mental health and substance use disorder services, visit:http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Mental-Health-Services.html

Q: Does Medicare cover mental health or substance use disorder services?

Answer: Yes, Medicare covers a wide range of mental health services.

Medicare Part A (Hospital Insurance) covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.

Medicare Part B (Medical Insurance) helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.

Medicare Part D (Prescription Drug ) helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs .

If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials or call the plan for details about how to get your mental health benefits.

If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit Medicare & Your Mental Health Benefits . To see if a particular test, item or service is covered, please visit the Medicare Coverage Database .

Q. What can I do if I think I need mental health or substance use disorder services for myself or family members?

Here are three steps you can take right now:

1. Learn more about how you, your friends, and your family can obtain health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting HealthCare.gov.
2. Share this infographic with your friends, family, and colleagues so more people know about the mental health benefits accessible under the Affordable Care Act.
3. Find out more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm

Q: What is the Health Insurance Marketplace?

The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. The Marketplace Can Help You:

• Look for and compare private health plans.
• Get answers to questions about your health coverage options.
• Get reduced costs, if you’re eligible.
• Enroll in a health plan that meets your needs.

How To Get Mental Health Help

If you or someone you know has a mental health problem, there are ways to get help. Studies show that most people with mental health problems get better and many recover completely.

Get Immediate Help

People often don’t get the mental health help they need because they don’t know where to start. Use these resources to find the help you, your friends, or family need.

Help for Veterans and Their Families

Current and former servicemembers may face different health issues than the general public and may be at risk for mental health problems.

Health Insurance and Mental Health Services

Mental health services may be available to you through your health insurance plan. Learn more about your coverage and options.

Participate in a Clinical Trial

The National Institute of Mental Health supports research studies on mental health and disorders. Find out more about participating in a clinical trial.