Winter is the time of the year when the days grow shorter, the nights grow longer and in many parts of the country, the time spent outdoors becomes less.

At the same time, the mirth and merriment of the holidays begins, helping many to substitute outdoor activities for more indoor pleasures.

But not everybody can enjoy the tradeoff. There are a number of people who withdraw at this time of year. While the reasons vary, there is a condition known as seasonal affective disorder (ironically, known by the acronym SAD), a form of depression that arrives with the seasons changing.

The recognition of seasonal affective disorder as a legitimate condition is relatively recent and how it occurs is still not completely understood. The condition seems to begin and end at around the same time every year. For most people, that means it commences with the arrival of fall and continues into winter, but some relatively rare cases begin in spring and go into summer.

Those affected share common symptoms of depression, including withdrawal, energy loss and moodiness, with changes in appetite and behaviors affecting their social interactions. In most cases, depression progresses, becoming more severe as the season advances.

Those afflicted report a depression that lasts most of each day, feeling worthless or hopeless; having low energy; losing interest in formerly pleasurable activities; sleep issues, including insomnia or sleeping too much; changes in weight; feeling sluggish or agitated; difficulty concentrating; and suicidal thoughts.

Winter seasonal affective disorder sufferers also report some specific issues, including irritability, low energy, problems dealing with others, hypersensitivity with rejection, a leaden feeling in the legs or arms, oversleeping, and a craving for high-carbohydrate foods, which can lead to weight gain.


Summer SAD sufferers report depression, weight loss, insomnia, anxiety, agitation and poor appetite.

Who May Be at Risk?

Those who have already been diagnosed with bipolar disorder may become manic in the summer and experience depression in the winter. While some down days are normal, having the feeling for days or weeks at a time is not. That’s when it may be time to consult a doctor, particularly if sleep patterns have changed.

Although research has still not identified a cause for seasonal affective disorder, the following issues may be involved:

1. Interruptions in circadian rhythm - Sometimes referred to as an internal biological clock, circadian rhythms are generally governed by your body’s reaction to daytime and nighttime. Thus, the reduced time of days in the winter may be the trigger for seasonal affective disorders and its accompanying depression.
2. Serotonin levels - Brain chemistry may be affected by reduced sunlight. Serotonin is a vital neurotransmitter, and lowering its levels may trigger depression.
3. Melatonin levels - This is a hormone that increases in darkness and lessens as it gets lighter. The changing of the seasons may disrupt its normal progression, which can, in turn, affect sleeping patterns and increase agitation.
4. Being female - Women experience seasonal affective disorder more than men, but men have more severe symptoms when they do get it.
5. Age - Young people are at higher risk of winter seasonal affective disorder.
6. Existing clinical depression or being bipolar - These seem to get worse during seasonal affective disorder periods in those who already have depression or other mental episodes.
   

7. Family history - If you have a blood relative who has depression or has been diagnosed with seasonal affective disorder, then you are more likely to have it.
8. Location - If you live far from the equator, you may be more subject to getting seasonal affective disorder because of decreased sunlight. It is particularly common among Nordic people who live in the far North.

As with any depression, symptoms of seasonal affective disorder have to be taken seriously and not shrugged off as mere moodiness. Suicidal thoughts may escalate bad behaviors and lead to social withdrawal, problems at work or school, and substance abuse in an effort to self-medicate. Treatments can include talk therapy, antidepressant medications, a physical exam to rule out other underlying conditions, lab tests for medical causes like thyroid function, and a psychological evaluation. Antidepressant medication may be recommended.

Seasonal affective disorder is considered a subtype of bipolar disorder or major depression. While it is difficult to pinpoint because the condition mirrors so many others, mental health professionals and insurance companies use the Diagnostic and Statistical Manual of Mental Disorders (known in the profession as the DSM-5), which is published by the American Psychiatric Association.

That manual will diagnose seasonal affective disorder if the patient has had the following symptoms for at least two years:

1. Depression beginning during a specific season
2. Depression that seems to end at a specific time each year
3. No other episodes at other times of the year
4. More seasons of depression than those without depression over the lifetime.

Getting Better

Some physicians may recommend a unique therapy called light therapy or phototherapy. For this treatment, patients sit near a special light therapy box that exposes them to bright light that mimics natural outdoor lighting. Subjects treated this way have been shown to have an uptick in serotonin and other brain chemicals that can elevate the mood. While the treatment is still experimental and research has been slow, it is considered one of the first treatments for seasonal affective disorders.

Doctors also recommend extended-release antidepressants, including Wellbutrin XL and Aplenzin, both believed to stave off deep depression in those who have seasonal affective disorder. Treatments may begin before actual symptoms emerge each year and may extend beyond the time when depression usually fades.

Finally, doctors recommend changes in the environment to help get over the hump with seasonal affective disorder. These recommendations include making sure that there is ample light in your living environment, including opening blinds, eliminating tree branches that may block sunlight, adding skylights to the home, and changing furniture or work desks so that they are nearer to the windows.

It is also a good idea to get outside at least for a short time each day, during lunch breaks or even a short walk while the sun is high. Adding exercise to the daily routine can help with stress and anxiety issues, both of which can increase seasonal affective disorder symptoms.