Are you SAD? What to know about seasonal affective disorder, treatments as sunlight fades

For most people, losing daylight is not a part of the holiday season we look forward to.

Following the time reset courtesy of daylight saving time ending, many of us working a traditional 9-5 end our days with an already-dark commute home, the sun having set half an hour before clocking out.

The shorter days combined with longer, darker and often colder nights understandably put a damper on the moods of many, leaving us feeling tired and yearning for the milder days of spring and summer.

While feeling more bummed out is certainly not uncommon during these times of sparser sunlight, the shift in mood goes much further for about 5% of the U.S. population who suffer from seasonal affective disorder, also known as SAD.

While this condition is fairly prevalent, it comes with a variety of pretty serious symptoms, many of which can result in disruption to a person's relationships, work life and ability to function on a daily basis. Those who may suspect or know they are suffering from SAD are encouraged to reach out for professional help, as this disorder has both life-altering consequences and many courses of treatment to help alleviate symptoms.

Here are a few things to keep in mind about SAD.

What is seasonal affective disorder (SAD)?

According to Kimberly E Kleinman, Senior Psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center, seasonal affective disorder, or SAD, is a type of depression with a seasonal pattern. Most often associated with winter and fall, SAD generally occurs and ends around the same time every year for those affected.

"Most notably, people with SAD typically experience mood changes and symptoms similar to depression around the fall and winter months when there is less sunlight, and usually improves by the spring," Kleinman told USA TODAY. "It is important to note that it is possible to also have SAD in the summer, but it is far less common."

It is believed shorter days and less sunlight cause chemical changes in the brain, including increased production of the sleep hormone melatonin, which has been linked to symptoms of depression.

SAD is a subcategory of depression disorders, meaning symptoms of seasonal depression generally align with those under the broader depression umbrella. The disorder is more than just the "winter blues," however, and is a persistent and consistent form of clinical depression that occurs yearly for the duration of the season.

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Who experiences SAD and what causes it?

There is no universally agreed upon definitive cause of SAD. However, it is estimated 10 million Americans are affected by SAD annually, and women are four times more likely than men to receive a formal SAD diagnosis. Younger people, generally between 20 and 30 years of age, are also more likely to be recognized as having SAD.

"Although it isn’t fully understood what causes SAD, less sunlight and shorter days are thought to be connected with chemical changes in the brain, most notable serotonin and melatonin," said Kleinman. "Research indicates that people with SAD may have reduced activity of serotonin which helps regulate mood. It also may be caused by too much melatonin, which causes sleepiness. The body naturally makes more melatonin when it’s dark - when the days are shorter and darker, more melatonin is made."

While there is no full-proof answer, there are thought to be some common contributing factors, including:

• Low vitamin D can occur when someone is not getting enough of the vitamin through their diet or exposure to sunlight. Vitamin D is a factor in the production of serotonin, one of the brain's "happy" chemicals.
• Pre-existing mental health conditions such as major depression, bipolar disorder or other mood disorders. These can be exasperated by SAD-related factors.
• Family history and genetic factors can play a part. Like with many other mental health disorders, having family members who also suffer from depression and/or SAD may indicate you are more likely to experience these and similar conditions as well.
• Environmental factors such as living further from the equator where sunlight is dramatically decreased in winter may increase occurrences of SAD.
• Age and gender are relevant to rates of diagnosis. Women and young adults are more likely to be recognized as having SAD.
• Chemical levels within our bodies help determine our moods. Too much or too little melatonin (the sleep chemical) and serotonin (a mood chemical) can have dramatic impacts on how we feel. In the winter, a lack of sunlight can impact the production of both of these.
• Disturbances to your biological clock or your circadian rhythm, which regulates sleep, can cause feelings of tiredness and low mood. Because our bodies take cues from our environment to dictate our sleep and wake cycles, the amount of sunlight we are exposed to has an impact on our internal clock.

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Symptoms of SAD

The symptoms of SAD overlap with other forms of depression and a number of other mental health conditions, meaning professional diagnosis is necessary to definitively determine if a person is suffering seasonal depression.

The most common symptoms come back and then improve at about the same times each year.

According to the Mayo Clinic and John Hopkins Medicine, the most prevalent symptoms include:

• Feeling sluggish, fatigued or low on energy during the day.
• Increased need for sleep or sleeping longer and more often than usual.
• Feeling sad or down most days.
• Loss of interest and pleasure in activities you usually enjoy.
• Social withdrawal and isolating, increased irritability and anxiety.
• Feelings of guilt, worthlessness and hopelessness.
• Decreased sex drive.
• Decreased ability to focus or concentrate, trouble thinking clearly.
• Increased appetite, especially for sweets and carbohydrates.
• Weight gain.
• Headaches, aches and pains and other physical symptoms.
• In the case of spring or summer depression, symptoms may reverse in the form of insomnia, decreased appetite and weight loss.

Depression can impact many facets of a person's life, leading to consequences like social withdrawal and strained relationships, issues functioning at school or work, suicidal thoughts or behaviors, impulsive decision making, self-medication through substance abuse and the onset or worsening of other mental health issues.

"Similar to all forms of depression, SAD can be associated with more serious symptoms like frequent (nearly every day) thoughts of worthlessness, guilt and depressed mood," said Kleinman. "Depression can also be associated with recurring thoughts of death, suicide or self-harm."

If you are experiencing any of these symptoms, urged Kleinman, reach out immediately to a healthcare provider, visit your local emergency room or call 988 Lifeline for 24/7, free and confidential support and crisis resources. 

Treatments for seasonal depression

Like with other forms of depression, there is no one definitive "cure" or treatment for SAD. Getting help for any mental health concern generally includes consulting with a care team to determine which combination of treatments and supportive solutions are best for you.

"If someone suspects they may be impacted by SAD, I recommend reaching out to a healthcare provider to be evaluated," said Kleinman. "A provider will be able to understand a patient’s medical history and personalize a treatment plan to best treat an individual's needs...it’s important to note that typically a combination of treatments is most effective."

Symptom management will look different from individual to individual, but there are a few interventions commonly used for the treatment of SAD patients:

• Psychotherapy including oft-used forms of "talk therapy" like cognitive-behavioral therapy (CBT) can help people better understand and manage their seasonal depression. Therapists can guide patients in identifying stressors, developing coping skills and navigating their symptoms.
• Medication is a common way to treat symptoms related to chemical imbalances. Antidepressants can help to elevate mood, lessen anxiety and correct biology-related causes of depression.
• Light therapy is commonly used because increased exposure to light is a natural treatment for SAD. Exposure to sunlight provides necessary vitamins and cues our bodies use to determine things like sleep and wake cycles. When a natural source of life isn't enough, lamps made specifically for the treatment of SAD are often introduced. These light lamps or boxes are designed to provide access to bright light while limiting UV exposure.

"SAD is more than the ‘winter blues,’ it is technically a diagnosis of depression with a seasonal pattern," Kleinman advised. "It can be distressing and overwhelming and interfere with daily function for patients. If you are experiencing SAD, you don't have to suffer through the winter seasons without support. "

Tips for combatting SAD

• Take in that sunlight as much as possible. While the shorter winter days can leave limited time outside work and school hours to enjoy the outdoors, it is important to take every opportunity to get out there and take in the real stuff. Whether this is achieved through a daily walk, winter sports or even sitting next to a window, mere exposure to sunshine can help.
• Keep an eye on your diet, especially during the cold months when our bodies are tempted to load up on carbs and other heavy foods. A healthy, well-balanced and proportionally appropriate diet plays an important role in overall energy and well-being.
• Stay active and try not to stay cooped up inside all winter. Regular exercise has long-since been acknowledged as an effective means of reducing depression symptoms. Moving your body outside of your home is associated with several mental health benefits.
• Stay engaged and avoid temptations to self-isolate. Stay in close touch and spend time with family and friends, sign up for activities in your community, get out of the house and around other people. Staying involved and socially engaged helps with feelings of loneliness and despair.
• Avoid complicating factors such as drugs and alcohol. While it is common for people to turn toward self-medicating, the use of such substances has been shown to worsen depression and potentially cause further issues.
• Be aware of your mental health and know that you do not have to ignore or suffer through feelings of depression. If you are struggling, don't simply write it off. If you have already begun treatment, recognize that feeling better is a process.