| Topic Overview
What is seasonal affective disorder (SAD)?
If you are depressed during the shorter days of winter but feel
happier and more energetic in spring and summer, you may have seasonal
affective disorder (SAD). SAD is a type of depression that affects
you at the same time each year, usually in the fall or winter. But
as the days lengthen in spring and summer, the depression lifts.
What causes SAD?
Shorter days of winter and lack of light are considered one cause
of seasonal depression, especially for people who move to extreme
northern climates, where winter days are very short or seasonal
differences in the amount of daylight are extreme. 1, 2 However,
researchers are studying other possible causes, including disturbances
in the body's natural biological clock (circadian rhythms) or problems
with the regulation of a brain chemical (neurotransmitter) called
serotonin.
What are the symptoms?
Symptoms of SAD include irritability, sadness, anxiety, increased
appetite and a craving for carbohydrates, weight gain, decreased
activity and a need for more sleep, drowsiness during the daytime,
and problems with work and relationships.
Symptoms begin and end around the same time each year for each
person, usually starting in September or October and ending in April
or May.
How is SAD diagnosed?
A doctor will base his or her diagnosis of SAD on whether you have
been depressed in the winter and recovered in the spring or summer
for at least 2 years in a row. These dramatic mood swings in response
to changes in seasons are what differentiate SAD from nonseasonal
depression.
Although many of the symptoms for depression and SAD are the same,
your doctor will look for increased appetite (especially cravings
for carbohydrates), weight gain, and excessive sleeping as symptoms
that help diagnose whether you have seasonal depression. Your doctor
may also ask if a close relative—a parent or sibling—had
seasonal depression.
How is it treated?
Treatment for SAD includes light therapy, in which you sit at a
certain distance from artificial bright lights, usually in the morning.
Another form of light therapy called dawn simulation is also used.
With dawn simulation, lights in your bedroom are programmed to come
on gradually a few hours before you wake up in the morning.
Your doctor may also prescribe antidepressant medications, such
as fluoxetine (for example, Prozac). Fluoxetine is a selective serotonin
reuptake inhibitor (SSRI) that can improve the balance of certain
brain chemicals that regulate mood.
Who is affected by SAD?
You are more likely to develop seasonal affective disorder if you
are a female between the ages of 15 and 55. Between 60% and 90%
of people with SAD are women, and those who have a relative with
SAD are more likely to develop it. Older teens and young adults
are also at risk for SAD. People living farther away from the equator
develop SAD more often, but you can develop it no matter where you
live. 3 The risk of developing SAD for the first time decreases
as you age.
Symptoms
If you have seasonal affective disorder (SAD), you will usually
develop symptoms of depression during the winter when there is less
daylight (October through April). Symptoms of SAD include: 3
Difficulty concentrating.
Low energy and fatigue.
Reduced interest in daily activities, especially social activities.
Moodiness (depressed, sad, or unusually quiet).
Increased appetite.
Cravings for complex carbohydrates (such as pasta and bread).
Weight gain.
Increased sleep.
Loss of interest in sex.
Irritability.
People with SAD may either have symptoms of major depression or
minor depression. Those with minor depression are considered to
have subsyndromal SAD.
Exams and Tests
Before diagnosing you with seasonal affective disorder (SAD), a
health professional will ask about your medical history.
Your health professional may order blood tests to check for other
conditions, such as hypothyroidism, that could be causing your depression,
and he or she may ask you to complete a questionnaire regarding
changes in your sleep patterns, social activity, mood, weight, appetite,
and energy levels.
The questionnaire may ask the following:
Do you feel a dramatic reduction in energy when the days get shorter
and darker?
Do you have difficulty waking up in the morning?
Do you sleep more than you used to or sleep too much?
Are you eating more than you used to or more than you should?
Have you gained weight?
Your health professional may also do a mental health assessment,
which includes an evaluation of your emotional functioning and your
ability to think, reason, and remember (cognitive functioning).
The assessment may also include written or verbal tests and laboratory
tests (such as blood and urine tests). During the interview, your
health professional will assess your appearance, mood, behavior,
thinking, reasoning, memory, and ability to express yourself and
may ask about your personal relationships and family history of
SAD.
Treatment Overview
Treatment for seasonal affective disorder (SAD) doesn't cure the
seasonal depression, but it can help relieve your symptoms. Light
therapy is the main treatment for SAD, and research is continuing
to determine the most effective way to use it. Medications and counseling
are also used to treat SAD.
Light therapy
Research has shown that light therapy is an effective treatment
for SAD. 4, 5
There are two types of light therapy: bright light treatment, in
which you sit in front of a "light box" for a certain
amount of time (usually in the morning); and dawn simulation, which
is done while you sleep. For dawn simulation, a low-intensity light
is timed to go on at a certain time in the morning before you wake
up and gradually gets brighter.
Light boxes are available commercially and use fluorescent lights
that are brighter than indoor lights but not as bright as sunlight.
Ultraviolet light, full-spectrum light, tanning lamps, and heat
lamps should not be used. You place the light box at a specified
distance from you on a desk or in front of a chair and use it while
you read, eat breakfast, or work at a computer. Light therapy is
usually prescribed for 30 minutes to 2 hours, depending on the intensity
of the light used. 2
Some people find dawn simulation light therapy more convenient
because it works as they sleep. Light box therapy, which some studies
have shown to be most effective if done in the morning, may be less
convenient for people who have busy schedules. 6 Yet some studies
have found that dawn simulation therapy is not as effective as bright
light (light box) therapy. 2
It may take as little as 3 to 5 days or up to 2 weeks before you
respond to light therapy. Stopping light therapy will likely cause
you to relapse back into depression. 2
Light therapy may work by resetting your "biological clock"
(circadian rhythms), which controls sleeping and waking.
If you have eye problems or you take medications that make you
light-sensitive, ask your health professional about whether light
therapy is safe for you. Tell your health professional about any
conditions you have and medications you are taking before you start
treatment.
Light therapy will need to be continued for the entire time you
are depressed. People who discontinue treatment usually lapse back
into depression. 1
Antidepressants
Antidepressants effectively treat episodes of depression in people
with seasonal affective disorder. They can be used along with light
therapy or alone. 1 The most common antidepressants used to treat
people with seasonal affective disorder include the following:
Selective serotonin reuptake inhibitors (SSRIs). Examples include
bupropion (Wellbutrin or Zyban), citalopram (Celexa), fluoxetine
(such as Prozac), paroxetine (Paxil), or sertraline (Zoloft) .
Other antidepressants. Examples include desipramine (Norpramin),
tranylcypromine (Parnate), or venlafaxine (Effexor).
SSRIs usually are the first type of antidepressants given to treat
SAD. SSRIs often have less serious side effects than other antidepressants.
These medications may take at least 3 to 4 weeks to start working.
All antidepressant medications are started at low doses and increased
gradually. When stopped, they should be decreased gradually to avoid
side effects.
General side effects of antidepressant medications can include:
Nausea, loss of appetite, or diarrhea.
Anxiety or nervousness.
Difficulty sleeping or drowsiness.
Loss of sexual desire or ability.
Headaches.
Bupropion can cause dry mouth. Bupropion should not be taken if
you have seizures, severe problems with eating, or an eating disorder
because it can cause seizures.
For more information, see the topic Depression or see the Drug
Reference. (Drug Reference is not available in all systems.)
FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued
an advisory to patients, families, and health care providers to
closely monitor adults and children taking antidepressants for signs
of suicide. This is especially important at the beginning of treatment
or when doses are changed.
The FDA also advises that patients be observed for increases in
anxiety, panic attacks, agitation, irritability, insomnia, impulsivity,
hostility, and mania. It is most important to watch for these behaviors
in children, who may be less able to control their impulsivity as
much as adults and therefore may be at greater risk for suicidal
impulses. The FDA has not recommended that people stop using antidepressants,
but simply to monitor those taking the medications and, if concerns
arise, to contact a health professional.
Counseling
Counseling, such as interpersonal therapy and cognitive-behavioral
therapy, may help with your treatment for SAD. You may choose individual
counseling, participate in group counseling, or seek family therapy.
During counseling, you will learn about SAD, ways to handle the
symptoms, and how to help prevent future depressive episodes. If
you have had SAD for a long time, your family members may have developed
ways of coping with your symptoms and may also benefit from counseling.
Treatment Overview
Treatment for seasonal affective disorder (SAD) doesn't cure the
seasonal depression, but it can help relieve your symptoms. Light
therapy is the main treatment for SAD, and research is continuing
to determine the most effective way to use it. Medications and counseling
are also used to treat SAD.
Light therapy
Research has shown that light therapy is an effective treatment
for SAD. 4, 5
There are two types of light therapy: bright light treatment, in
which you sit in front of a "light box" for a certain
amount of time (usually in the morning); and dawn simulation, which
is done while you sleep. For dawn simulation, a low-intensity light
is timed to go on at a certain time in the morning before you wake
up and gradually gets brighter.
Light boxes are available commercially and use fluorescent lights
that are brighter than indoor lights but not as bright as sunlight.
Ultraviolet light, full-spectrum light, tanning lamps, and heat
lamps should not be used. You place the light box at a specified
distance from you on a desk or in front of a chair and use it while
you read, eat breakfast, or work at a computer. Light therapy is
usually prescribed for 30 minutes to 2 hours, depending on the intensity
of the light used. 2
Some people find dawn simulation light therapy more convenient
because it works as they sleep. Light box therapy, which some studies
have shown to be most effective if done in the morning, may be less
convenient for people who have busy schedules. 6 Yet some studies
have found that dawn simulation therapy is not as effective as bright
light (light box) therapy. 2
It may take as little as 3 to 5 days or up to 2 weeks before you
respond to light therapy. Stopping light therapy will likely cause
you to relapse back into depression. 2
Light therapy may work by resetting your "biological clock"
(circadian rhythms), which controls sleeping and waking.
If you have eye problems or you take medications that make you
light-sensitive, ask your health professional about whether light
therapy is safe for you. Tell your health professional about any
conditions you have and medications you are taking before you start
treatment.
Light therapy will need to be continued for the entire time you
are depressed. People who discontinue treatment usually lapse back
into depression. 1
Antidepressants
Antidepressants effectively treat episodes of depression in people
with seasonal affective disorder. They can be used along with light
therapy or alone. 1 The most common antidepressants used to treat
people with seasonal affective disorder include the following:
Selective serotonin reuptake inhibitors (SSRIs). Examples include
bupropion (Wellbutrin or Zyban), citalopram (Celexa), fluoxetine
(such as Prozac), paroxetine (Paxil), or sertraline (Zoloft) .
Other antidepressants. Examples include desipramine (Norpramin),
tranylcypromine (Parnate), or venlafaxine (Effexor).
SSRIs usually are the first type of antidepressants given to treat
SAD. SSRIs often have less serious side effects than other antidepressants.
These medications may take at least 3 to 4 weeks to start working.
All antidepressant medications are started at low doses and increased
gradually. When stopped, they should be decreased gradually to avoid
side effects.
General side effects of antidepressant medications can include:
Nausea, loss of appetite, or diarrhea.
Anxiety or nervousness.
Difficulty sleeping or drowsiness.
Loss of sexual desire or ability.
Headaches.
Bupropion can cause dry mouth. Bupropion should not be taken if
you have seizures, severe problems with eating, or an eating disorder
because it can cause seizures.
For more information, see the topic Depression or see the Drug
Reference. (Drug Reference is not available in all systems.)
FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued
an advisory to patients, families, and health care providers to
closely monitor adults and children taking antidepressants for signs
of suicide. This is especially important at the beginning of treatment
or when doses are changed.
The FDA also advises that patients be observed for increases in
anxiety, panic attacks, agitation, irritability, insomnia, impulsivity,
hostility, and mania. It is most important to watch for these behaviors
in children, who may be less able to control their impulsivity as
much as adults and therefore may be at greater risk for suicidal
impulses. The FDA has not recommended that people stop using antidepressants,
but simply to monitor those taking the medications and, if concerns
arise, to contact a health professional.
Counseling
Counseling, such as interpersonal therapy and cognitive-behavioral
therapy, may help with your treatment for SAD. You may choose individual
counseling, participate in group counseling, or seek family therapy.
During counseling, you will learn about SAD, ways to handle the
symptoms, and how to help prevent future depressive episodes. If
you have had SAD for a long time, your family members may have developed
ways of coping with your symptoms and may also benefit from counseling.
Other Places To Get Help
Organization
National Institute of Mental Health (NIMH), Office of Communications
6001 Executive Boulevard
Suite 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: (301) 443-4513
(866) 615-6464
Fax: (301) 443-4279
TDD: (301) 443-8431
E-mail: nimhinfo@nih.gov
Web Address: http://www.nimh.nih.gov
The National Institute of Mental Health (NIMH) provides information
to help people better understand mental health and mental disorders.
NIMH does not provide referrals to mental health professionals or
treatment for mental health problems.
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