Seasonal Affective Disorder Q&A

Niamh Carroll, MD is a primary care physician at Tufts Medical Center.It’s nice to have snow – every once in a while. A layer of fresh white powder has the ability to brighten a dreary day. But the grey skies that often accompany these short winter days can really do a number on a person’s mood. It’s not uncommon to feel a little down when you rarely see daylight.  But at what point does the “blah” feeling that comes with the dull days become a real issue you should address?

Niamh Carroll, MD a Primary Care Physician at Tufts Medical Center's Primary Care Boston practice, answered a few questions about Seasonal Affective Disorder, a type of depression that occurs when the gray days get to be a little too much to handle.

Q: So, what exactly is Seasonal Affective Disorder, or SAD?

A: Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.

People with SAD feel depressed during the shorter days of winter, and have more energy and are happier during the brightness of spring and summer. SAD occurs more often in young adults than older adults, and in women than in men. People who live further from the equator are also more likely to be affected by SAD – which means the short days and long winters we experience in Boston can really be a factor!

Q: What are the symptoms of SAD?

A: People who have SAD will experience a combination of the following symptoms during the fall and winter.  Often the symptoms will peak in January and February.

  • Depressed mood or feeling low
  • Feeling hopeless or guilty
  • Fatigue or loss of energy
  • Loss of interest in things you typically enjoy
  • Having problems with sleeping (too much or too little)
  • Change in your weight and appetite (either an increase or decrease)
  • Having difficulty concentrating
  • Suicidal ideation

Q: What’s the difference between SAD & depression?

A: SAD is similar to depression but there is a seasonal pattern. The symptoms of SAD are worse in winter and improve with sunshine. Patients with SAD may note that they sleep and eat more in the winter, that they socialize less and that sunnier weather helps their mood. They may also crave carbohydrates.

Q: A lot of SAD symptoms sound like something we all experience when the weather keeps us cooped up. What’s the difference between SAD and plain old winter blues?

A: It’s true that a lot of people experience some of the symptoms of SAD in mild ways – but don’t have SAD or depression. In the winter, many of us rarely see the sun, don’t exercise as often, eat heavier meals and find ourselves spending more time on the couch wrapped in a blanket. These lifestyle changes can contribute to a person feeling depressed and tired, or result in weight gain – all symptoms of SAD.  But, if these changes in your lifestyle and mood are easily improved by an increase in exercise or a walk outside, you likely have the winter blues. On the other hand, people with SAD struggle to shake off these winter blues symptoms.

Q: How do I know if I should talk to someone about whether or not I have SAD?

A: If you notice a seasonal pattern to any of the symptoms as mentioned above, you should talk to your doctor.  Even if you have mild symptoms of the winter blues, it can’t hurt to have a discussion with your primary care doctor about your concerns. 

Q: How is SAD treated?

A: The primary treatments for SAD are light therapy, psychotherapy and antidepressants.

Many trials indicate that artificial bright white light is effective for patients with SAD, typically leading to a positive response or remission of SAD in about 60% of patients.  Light therapy mimics the natural light you don’t see in the wintertime, and may cause a change in brain chemicals linked to mood.  You should talk to your physician if you are having SAD symptoms and think you might be a candidate for this.

In addition to light therapy, your doctor might recommend speaking with a therapist. Your physician also may prescribe antidepressants based on the severity of your SAD symptoms.

Q: If I don’t have SAD, are there ways I can combat the winter blues I do get?

A: Yes, we encourage all our patients to pay special attention to good sleep hygiene, to walk outside daily if possible, and to continue to exercise. It is important to maintain a regular sleep-wake cycle can help, so you should limit your blue light (phone, TV, computer) exposure before bed. When you wake up, turning on lights and opening curtains to expose yourself to as much light as possible may be beneficial.