As the days grow shorter and the air gets chillier, many people experience a shift in their mood. This feeling is not just a passing phase; it could be a sign of Seasonal Affective Disorder (SAD).  Individuals with SAD often find themselves feeling tired, irritable, and less motivated during the colder seasons. These changes are linked to the seasonal variations in sunlight, which can impact one's mental health.

Seasonal affective disorder often referred to as "SAD" is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A sub-syndromal type of SAD, or S-SAD "Sub-Syndromal Affective Disorder", is commonly known as “winter blues.” Less often, SAD causes depression in the spring or early summer. Symptoms focus on sad mood and low energy.

Those most at risk are female, are younger age (but it can occur in all age groups and genders), those who live far from the equator, and those with a family history of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ) developed by Dr. Rosenthal, MD in 1984.

The is the most widely used questionnaire to asses the significant effects that a seasonal pattern can have on mood and behaviour. The score is added to give a Seasonability Score (SS). Individuals with an SS of 9 or 10 and at least mildly experienced seasonal change as an issue also were classified as experiencing S-SAD commonly known as the "winter blues". A higher score correlates with severity of SAD, and can be seen to increase with a score of 11 or greater within the six dimensions.

Common treatments for SAD include antidepressant medications, light therapy, Vitamin D, exercise and cognitive behavioural therapy or counselling.

The change in seasons can trigger depressive episodes due to changes in light exposure. Reduced sunlight in winter affects melatonin and serotonin levels in the body. These changes can lead to symptoms of depression for some individuals.

Understanding Seasonal Affective Disorder (SAD)

The exact cause of SAD isn't fully known, but several factors contribute to its development.

Circadian Rhythm

Changes in daylight can disrupt your biological clock and the natural response of our brain and body to light and dark. This is what circadian rhythm is impacted by most affecting sleep and mood. Lower light exposure can decrease serotonin, a neurotransmitter that helps regulate mood. Increased darkness can elevate melatonin, which governs sleep patterns.

Vitamin D Deficiency

Inadequate sunlight contributes to lower vitamin D levels, potentially affecting mood. And living in countries in the Northern Hemisphere can predispose us to lower Vitamin D levels to begin with. Supplementation needs to be targeted dosing wise and specific to the individual. Don't start taking Vitamin D3 unless you are under the guidance of a health care provider.

Family History

A history of depression in your family increases your risk of developing SAD. Also women of all ages are more prone to depression. Research shows that younger women are more prone to SAD but I have also seen in my practice that during the perimenopausal and menopausal years mood issues can also become more pronounced.

Other factors like being female and living farther from the equator also raise the likelihood of experiencing SAD.

Vitamin D plays a foundational role in seasonal affective disorder, affecting depressive and seasonality factors, and people with darker skin pigmentation may experience greater risks for lower vitamin D levels, potentially contributing to psychiatric and physical health problems. (Stewart, et al., 2014)

Common signs include:

• Irritability: You may feel more easily annoyed or angry.
• Fatigue: A sense of low energy or tiredness is common.
• Loss of Interest: Activities once enjoyed may seem unappealing.
• Weight Gain: Some people experience changes in appetite, often craving carbohydrates.
• Sleeping Too Much: Increased sleep can also be a symptom.
• In severe cases, symptoms can mimic major depressive disorder or depressive disorder with seasonal pattern. For some, summer depression may occur, showing the opposite seasonal pattern.

Treatment and Management

Managing seasonal affective disorder (SAD) often involves a combination of therapies. Key approaches include light therapy, medication, and lifestyle changes that can support recovery and improve your overall well-being.

Light Therapy

Light therapy, also known as phototherapy, involves exposure to bright light using a special light box.

Many of my patients who move to Canada after having lived in countries closer to the equator, especially feel this change in sunlight and it's impact on their mood. This treatment can simulate natural sunlight, which is crucial, especially in winter months.

A typical light box emits about 10,000 lux. Daily sessions of 10 to 30 minutes in the morning can significantly help.

It's important to consult your healthcare provider before starting light therapy to ensure it’s appropriate for you. Some people may experience side effects, like eye strain or headaches. Adjusting the duration and intensity can help reduce these issues and side effects. Even starting with shorter durations such as 5 minutes in the morning can be beneficial.

Pharmacotherapy

Anti-depressant medication can also be effective for managing SAD. Selective serotonin re-uptake inhibitors (SSRIs) like Sertraline (Zoloft), fluoxetine (Prozac), Citalopram (Celexa), Escitalopram (Lexapro)and Paroxetine (Paxil) are commonly prescribed.  Another non-SSRI often prescribed is Bupropion (Wellbutrin XL).  These medications help balance chemicals in the brain and improve mood. Some individuals find Bupropion helpful, especially if fatigue is prominent.

Your healthcare provider may recommend starting medication before symptoms worsen. It can take several weeks to notice benefits, so speak to your health care provider about treatment and never discontinue therapy before speaking with your health care provider.

Cognitive Behavioural Therapy (CBT) and Lifestyle Changes

Incorporating cognitive behavioural therapy (CBT) can enhance your treatment for SAD. This form of counselling focuses on changing negative thought patterns and behaviours. Working with a therapist can help you develop coping strategies and address issues like social withdrawal.

Beginning a regular exercise routine is an important lifestyle strategy that can impact your mood as well as your heart, brain, muscle, and so much more. Physical activity can boost your endorphins, which ultimately improves mood and energy. If you have natural sunlight where you live, do your exercise outdoors or where you can get natural sunlight exposure such as by a large window. Outdoor winter activities are highly enjoyable such as skiing, skating, snowshoeing, sledding, tubing or hiking. The importance is to embrace the winter months and still find ways to be active every day.

Additionally, consider vitamin D supplementation if you have low levels based on your testing from serum blood values of 25-hydroxy Vitamin D. With optimal Vitamin D levels, a discussion on healthy diet and nutrition is also crucial. 

Dietary consumption of fish which is high in omega 3 fish oil have shown benefit in many factors including mood, cardiovascular health and brain health. A higher dietary intake of fish is associated with a lower risk of depression, which may include conditions like Seasonal Affective Disorder. If you would like to learn more about the Mediterranean Diet and the benefits for you download my free checklist here.

Fish consumption, particularly at 2 to 4 servings per week, is generally safe and beneficial for various health outcomes, with the largest risk reduction at this frequency. (Li, et al, 2020)

Other Considerations

When it comes to SAD or any form of mood condition, it is common for many to experience social withdrawal. One might find themself isolating from friends and family, which can worsen feelings of loneliness.

Some individuals also may have trouble sleeping, resulting in insomnia or oversleeping and waking up feeling tired or exhausted. With low energy, there can also be feelings of lower libido or sex drive. Other symptoms to watch for are a change in appetite - specifically a loss of appetite or the opposite of overeating.

Recognizing these signs can help in seeking appropriate support and treatment. I highly suggest individuals who feel symptoms such as this to reach out to get further testing and investigation as there can also be other underlying causes related to their mood, sleep, energy.

If you would like to book a free discovery call to work with me click here.

Wishing you health,

Dr. Amy Tung, ND

Naturopathic Doctor

Menopause Society Certified Practitioner

Disclaimer:

This content is for informational and educational purposes only. It is not intended as medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional before making any changes to your diet, lifestyle, or treatment plan.  Please consult your healthcare provider for personalized recommendations, especially when dealing with hormonal changes, emotional eating patterns, or mental health concerns.

References:

Seasonal Pattern Assessment Questionnaire (SPAQ) https://www.physio-pedia.com/Seasonal_Pattern_Assessment_Questionnaire

Forneris, C., Nussbaumer, B., Kaminski-Hartenthaler, A., Morgan, L., Gaynes, B., Sonis, J., Greenblatt, A., Wipplinger, J., Lux, L., Winkler, D., Van Noord, M., Hofmann, J., & Gartlehner, G. (2015). Psychological therapies for preventing seasonal affective disorder.. The Cochrane database of systematic reviews, 11, CD011270 . https://doi.org/10.1002/14651858.CD011270.pub2.

Li, N., Wu, X., Wen, Z., Xia, L., Chen, Y., Wu, C., Rao, Z., Du, L., Zhao, R., Yi, M., Wan, Q., & Zhou, Y. (2020). Fish consumption and multiple health outcomes: Umbrella review. Trends in Food Science & Technology. https://doi.org/10.1016/j.tifs.2020.02.033.

Magnússon, A. (2000). An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatrica Scandinavica, 101. https://doi.org/10.1034/j.1600-0447.2000.101003176.x.

Melrose, S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression Research and Treatment, 2015. https://doi.org/10.1155/2015/178564.

Stewart, A., Roecklein, K., Tanner, S., & Kimlin, M. (2014). Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder.. Medical hypotheses, 83 5, 517-25 . https://doi.org/10.1016/j.mehy.2014.09.010.

Thompson, C., Childs, P., Raheja, S., & Allen, N. (1994). Seasonal affective disorder. British Journal of Psychiatry, 164, 127 - 127. https://doi.org/10.1192/bjp.164.1.127a.