Winter Blues or Seasonal Affective Disorder (SAD)?

The winter blues is a term for short periods of feeling sad or down that occur when the days get shorter in the fall and winter. However, seasonal affective disorder (SAD) is a more serious condition that can affect how a person feels, thinks, and behaves. SAD is a type of depression that's associated with seasonal changes and can be debilitating.

Winter blues

Symptoms - Feeling sad or wanting to stay home, but still able to function.

Pattern - Typically happens every now and then during the colder months.

Who’s more likely to experience it? - About 14% of Americans experience the winter blues

Seasonal affective disorder (SAD)

Symptoms

• Sadness, feeling depressed most of the day, almost every day

• Anxiety

• Carbohydrate cravings and weight gain

• Extreme fatigue and lack of energy

• Feelings of hopelessness or worthlessness

• Trouble concentrating

• Feeling irritated or agitated

• Limbs (arms and legs) that feel heavy

• Loss of interest in usually pleasurable activities, including withdrawing from social activities

• Sleeping problems (usually oversleeping)

• Thoughts of death or suicide

Pattern - Follows a cyclical pattern, with symptoms up to five months per year.

Who’s more likely to experience it? - About 14% of Americans experience SAD.

 As the days get shorter, many people find themselves feeling sad. You might feel blue around the winter holidays or get into a slump after the fun and festivities have ended. Some people have more serious mood changes year after year, lasting throughout the fall and winter when there’s less natural sunlight. What is it about the darkening days that can leave us down in the dumps?

Shorter days seem to be a main trigger for SAD. Reduced sunlight in fall and winter can disrupt your body’s internal clock, or circadian rhythm. This 24-hour “master clock” responds to cues in your surroundings, especially light and darkness. During the day, your brain sends signals to other parts of the body to help keep you awake and ready for action. At night, a tiny gland in the brain produces a chemical called melatonin, which helps you sleep. Shortened daylight hours in winter can alter this natural rhythm and lead to SAD in certain people.

Treatment Options

Light Therapy

National Institute of Health (NIH) researchers first recognized the link between light and seasonal depression back in the early 1980s. These scientists pioneered the use of light therapy, which has since become a standard treatment for SAD. In light therapy, patients generally sit in front of a light box every morning for 30 minutes or more, depending on the doctor’s recommendation. The box shines light much brighter than ordinary indoor lighting. Studies have shown that light therapy relieves SAD symptoms for as much as 70% of patients after a few weeks of treatment. Some improvement can be detected even sooner.

Medication

Light therapy is usually considered a first line treatment for SAD, but it doesn’t work for everyone. Studies show that certain antidepressant drugs can be effective in many cases of SAD. The antidepressant bupropion (Wellbutrin) has been approved by the U.S. Food and Drug Administration for treating SAD and for preventing winter depression. Doctors sometimes prescribe other antidepressants as well.

Cognitive Behavioral Therapy

Growing evidence suggests that cognitive behavioral therapy (CBT)—a type of talk therapy—can also help patients who have SAD. In CBT, the patient is encouraged to identify negative self-defeating thoughts they have, look objectively at the thought and then reframe it into something that’s less negative and more positive. Behavioral changes might include having lunch with friends, going out for a walk or volunteering in the community. According to the NIH, Dr. Kelly Rohan and colleagues compared CBT to light therapy. Both were found to be effective at relieving SAD symptoms over 6 weeks in the winter. Also, patients treated with CBT had less depression and less return of SAD the following winter compared to people who were treated with light therapy. A larger NIH-funded study is now under way to compare CBT to light therapy over 2 years of follow up.

Supplements

Some studies suggest that supplements like St. John's wort and melatonin may help with SAD. However, experts caution that St. John's wort can interact with many medications, and it's not known if long-term use of melatonin is safe.

The above information has been referenced from The National Institute of Health, and the Cleveland Clinic.