Is SAD Real Depression or Just Winter Blues?

Summary: Yes, SAD is real depression. SAD stands for seasonal affective disorder, which is a subtype of clinical diagnosis for major depressive disorder (MDD).

Key Points:

• SAD is real depression, and more than just a case of the winter blues of blahs.
• SAD can affect anyone, but some people are more at risk than others.
• It’s most often associated with winter, but people can get SAD in the summer, too.
• Treatment for SAD is effective, and may include therapy, medication, and lifestyle changes

What Should You Know About Seasonal Affective Disorder?

The first thing you should know is that SAD is real depression. It’s not a made-up diagnosis, and it far exceeds what we typically call the winter blues. In fact, to receive a diagnosis for SAD, you must show the same types of symptoms – including frequency and duration – as major depressive disorder (MDD), and the symptoms must occur during a specific time of year.

In a new article published by the American Medical Association (AMA) called “What Doctors Wish Patients Knew About Seasonal Affective Disorder,” a pair of experienced mental health providers, Dr. Adrian Jaques H. Ambrose, MD, and Dr. Andrea DeSimone, DO, share the basic facts everyone should understand about SAD.

Here’s how Dr. Ambrose describes SAD:

“Technically [SAD is] not a real name, [but] seasonal affective disorder – or very appropriately initialized as SAD – is a subtype of major depressive disorder. It’s characterized by recurrent episodes of depression that happen in a seasonal pattern, so generally when there is a reduced exposure to natural sunlight. In the Northern hemisphere, it’s generally during the fall and winter months. People historically have called it the winter blues, [or] major depressive disorder and the subcategory is with seasonal pattern.”

Dr. DeSimone adds:

“To meet the criteria for seasonal affective disorder, you much first meet the criteria for major depressive disorder, which [means] having five of nine symptoms plus anhedonia, which is that loss of pleasure for at least two weeks. This cycle must occur for two years to meet criteria for the specific type of major depressive disorder.”

We should add that while SAD is most common in the winter, it can occur in the summertime, too – and summer SAD is as real as winter SAD, and both types of SAD are real depression, rather than short periods of low mood. Summer SAD is slightly different, and includes a greater proportion of symptoms such as poor appetite, anxiety, and insomnia.

Seasonal Affective Disorder was first identified by psychiatrist Norman Rosenthal in the 1980s, who indicated SAD can appear in two types: major SAD, with significant disruption, and minor SAD, which is less disruptive, but serious, nonetheless.

Seasonal Affective Disorder (SAD): Prevalence and Symptoms

Here’s what we know about how many people have SAD:

• Major SAD: 6% of adults in U.S.
• Minor SAD: 14% of adults in U.S.
• SAD varies by gender:
  • Female: 80% of SAD diagnoses
  • Male: 20% of SAD diagnoses
• Age of onset of SAD:
  • Between age 20-30
  • May occasionally appear during childhood or adolescence

These figures answer the question we pose in the title of this article: millions of people – and their mental health providers – can confirm that SAD is real depression. Symptoms of SAD include, but are not limited to:

• Low energy, lower than all other seasons/times of year
• Sleep problems, most often sleeping more than usual
• General feelings of sluggishness
• Sad/depressed/low mood every day for more than two weeks
• Weight problems: significant gain or loss
• Appetite changes: significant increase or decrease
• Difficulty concentrating/making decisions
• Persistent feelings of hopelessness and/or worthlessness
• Isolating from friends and family
• Decreased libido, declining interest in sexual contact

Winter SAD peaks in December, January, and February. The most common initial signs of winter SAD include:

• Uncharacteristic oversleeping
• Cravings for carbohydrate-heavy foods
• Weight gain
• Constant fatigue

In addition, people with SAD – winter or summer – may experience suicidal ideation, which means thinking about, talking about, or planning suicide. While this may seem counterintuitive, rates of depression-related suicide attempts are higher in summer than in winter. However, in any case of SAD, winter or summer, please note the following:

NEVER IGNORE TALK OF SUICIDE, NO MATTER THE SEASON. CONNECT LOVED ONES AT RISK TO SUPPORT via 988, THE NATIONAL SUICIDE HOTLINE. IF YOU OR SOMEONE YOU LOVE IS AT IMMINENT RISK OF HARM, CALL 911 OR GO TO THE EMERGENCY ROOM. DO NOT WAIT.

SAD: Risk Factors and Causes

We’ve established – via credible data from verified, reliable sources – that SAD is real depression.

It’s possible for anyone to develop SAD, but evidence shows that some factors increase risk of developing SAD, including:

• Geography: Proximity to the equator impacts risk: the greater your distance from the equator, the greater your risk.
• Age: Younger adults report SAD more often than older adults.
• Pre-existing conditions: If you have a clinical diagnosis of major depressive disorder (MDD) or bipolar disorder (BD), you have a greater risk of developing SAD, e.g. a significant escalation of symptom severity that follows a seasonal pattern
• Genetics: If you have family members with SAD, you have an increased risk of developing SAD.
• Gender: SAD is common among women and men. Women report higher rates of SAD, overall, and men report more intense/severe symptoms of SAD.

In addition, research identifies the following potential causes of SAD, derived from studies on the role of seasonality in major depressive disorder and bipolar disorder:

1. Variation in neurotransmitters associated with seasons
2. Variation in brain function and structure associated with seasons
3. Seasonal changes in the immune system
4. Seasonal changes in circadian rhythm

That’s most of what mental health professionals want you to know about SAD. We’ve covered what SAD is, the primary symptoms of SAD, who’s most at risk of developing SAD, and what we know about what causes SAD.

There are two more things mental health professionals want you to know about SAD:

1. It’s treatable with standard psychotherapy and psychiatric medication.
2. There are practical steps you can take to reduce or avoid SAD.

We’ll review the effective treatments for SAD, and lifestyle changes you can make to mitigate the impact of SAD, below.

SAD: Treatment and Proactive Steps

Research indicates the most effective treatment for SAD includes, but is not limited to:

• Cognitive behavioral therapy (CBT):
  • This is a standard therapeutic approach to depression modified for SAD.
• Light therapy:
  • Various types of light therapy can improve symptoms, augment the effectiveness of antidepressants, and improve sleep.
• Medication:
  • Selective serotonin reuptake inhibitors (SSRIs) may help reduce symptoms of SAD, with extended-release SSRIs showing specific effectiveness for SAD.

In addition, the psychiatrist who identified SAD as a subtype of depression, Dr. Norman Rosenthal, indicates you can improve, reduce, or possibly eliminate the symptoms of with several changes to lifestyle and behavior.

Five Lifestyle and Behavioral Changes That Help People with SAD

1. Let the Sun Shine In

Most experts agree that shorter winter days – read less sunlight – are a primary cause SAD. Therefore, light therapy is part of most treatment plans for SAD. But you don’t have to go to a therapist to get light. You can make sure you spend time in the sun every day. It doesn’t have to be hours and hours: even a few minutes, a couple of times a day, can make a difference. If you’re an office worker, try to position yourself so you can see out a window. Evidence shows that the more sunlight you see – however you can see it – can help reduce symptoms in people with SAD.

 

2. Daily Exercise and Activity

It’s tempting to take a cue from the bears and hibernate all winter. Or at least get home as soon as possible every day, get in your pajamas, and settle in on the couch under a blanket. We get it. We want to do that some days, too. But there’s a problem with that approach: it leads to a sedentary lifestyle, which is not only bad for your body, but doesn’t help stress reduction, which is an important part of managing the symptoms of SAD. To help manage your symptoms of SAD, we encourage you to get outside and exercise – or do something outdoors – every day for at least a hour. It’s good for your body, your mood, and your mind.

3. Get Out and See Your Friends

Being social and connecting with people helps people with all types of depression, including SAD. That’s another reason not to hibernate like a bear: to lift your mood, it helps to be around people you know and love who know and love you. Writer and thinker James Baldwin once said this:

“The longer I live, the more deeply I learn that love – whether we call it friendship or family or romance – is the work of mirroring and magnifying each other’s light.”

Granted, he wasn’t talking about treatment for SAD, literally, but his words work as treatment for SAD, figuratively. When we see our friends, this observation may be why they make us feel better: they amplify our own light, which sometimes dims so far we don’t see it. But they do, and they lift our spirits by reminding us of our inner light. And if you can get out and see your friends outdoors, even better. Try making plans to go on a lunchtime walk with a friend: we bet it will improve your day.

4. Get Outta Town

To help reduce symptoms of winter SAD, you can plan a trip, preferably to somewhere warm where the sun shines all day and there’s little chance of rain. We’re not talking about an extravagant trip to Bora Bora or Tahiti. In the U.S., options include Southern California and Florida for beaches, while people who don’t love the beach can travel to other states that are sunny year-round, such as Arizona or New Mexico – but fair warning, while the days are mostly bright and warm, winter nights in the desert can get chilly.

5. Move to A Sunny, Warm Place

Remember the risk factors we list above? The further from the equator you are, the more likely you are to develop SAD. For instance, if you live in a place like Upstate New York or St. Paul, Minnesota, and get SAD every winter, you may want to consider moving out West or possibly Down South. For example, San Diego is roughly 1,000 miles closer to the equator than Niagara Falls (in far Upstate New York), and Miami is roughly 1,200 miles closer to the equator than St. Paul. This is an extreme, long-term solution that may take time and planning to implement, but if you get serious or severe SAD every winter, this may be a more practical and realistic option than it first appears.

The Bottom Line: SAD is Real Depression, SAD is Treatable

Circling back to the article we cite above by Drs. Ambrose and DeSimone, a key part of managing SAD is knowing you have SAD. That means getting regular mental health screenings, and, if you know you experience low mood/sadness/depression every winter, then the best choice would be to receive a professional screening for depression.

An annual psychiatric assessment is an excellent idea. Here’s how Dr. Ambrose sees regular mental health screenings:

“As we begin to more proactively look at mental health as a medical condition with medical treatments, we can look at it in very similar ways as an annual physical. Having an annual psychiatric appointment in which you can address a lot of these longitudinal or recurrent symptoms or concerns with your psychiatrist in a way that we can more proactively or preemptively treat the symptoms before they become problematic.”

When you take this approach, your provider can identify potential problems before they become real problems. In addition, you can bring up things you think may be problems, if they don’t show up on standard mental health assessments or targeted assessments for disorders such as anxiety or depression.

In other words, you and your provider can collaborate on mental health topics the same way you collaborate on physical health topics: no stigma attached. You can talk about your symptoms, talk about treatment, and review your options, all before the symptoms become severe and disruptive. And for SAD, you may even get a prescription – well maybe not a prescription, but a referral – for sun and fun, right in the middle of December.