Seasonal Affective Disorder: Overview and Medication Treatment

Cooler temperatures can zap your energy and affect your mood, particularly in the fall and winter months following daylight savings time. However, don’t brush off those feeling as simply a case of the “winter blues.” What you think may be seasonal funk might actually be a clinical condition called seasonal affective disorder (SAD).

In part one of this three-part series, we’ll address what seasonal affective disorder is and the medications commonly used for its treatment.

What is Seasonal Affective Disorder?

According to the National Institute of Mental Health, seasonal affective disorder is a type of depression that comes and goes with the seasons. It typically starts in the late fall and early winter and resolves during the spring and summer. While depressive episodes linked to the summer can still occur, they are much less common than winter episodes of SAD.

Signs and symptoms

Seasonal affective disorder is not classified as its own separate disorder, but rather a subtype marked by a recurring seasonal pattern. It shares many of the symptoms as major depression, however, there are also some season specific symptoms to look out for as well.

Symptoms of major depression:

  • Feeling depressed most of the day, nearly every day

  • Feeling hopeless or worthless

  • Having low energy

  • Losing interest in activities you once enjoyed

  • Having problems with sleep

  • Experiencing changes in your appetite or weight

  • Feeling sluggish or agitated

  • Having difficulty concentrating

  • Having frequent thoughts of death or suicide

Symptoms of winter pattern SAD include:

  • Having low energy

  • Hypersomnia

  • Overeating

  • Weight gain

  • Craving for carbohydrates

  • Social withdrawal (feel like “hibernating”)

Symptoms of summer pattern SAD include:

  • Poor appetite associated with weight loss

  • Insomnia

  • Agitation

  • Restlessness

  • Anxiety

  • Episodes of violent behavior

How is seasonal affective disorder diagnosed?

Those who meet the full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least two years may be diagnosed with seasonal affective disorder. Seasonal depressions must be more frequent than any non-seasonal depressions.

There are several attributes that may increase one’s risk of developing seasonal affective disorder, such as:

  • Gender: Women are diagnosed with SAD four times more often than men.

  • Distance from the equator: Those who live far north or south of the equator may have an increased risk.

  • Family history: This includes those with a family history of other types of depression.

  • Having depression or bipolar disorder: If you have already been diagnosed with depression or bipolar disorder, your symptoms of depression may worsen with the seasons. However, it will only be diagnosed as seasonal affective disorder if your seasonal depressions are the most common.

  • Age: Younger adults have a higher risk of SAD than older adults. It has also been reported in children and teens.

What are the causes?

The causes of seasonal affective disorder are currently unknown. However, research has found some biological traits that have helped doctors gain a better understanding of the disorder. People with SAD may:

  • Have trouble regulating serotonin, one of the key neurotransmitters involved in mood

  • Overproduce melatonin, the hormone which regulates sleep

  • Produce less Vitamin D, which plays a significant role in serotonin activity

Treatment Options

There are four main treatment options available for seasonal affective disorder:

  • Medication

  • Light Therapy

  • Psychotherapy

  • Vitamin D

For this post, we will discuss medication treatment in more detail. The other treatment options will be addressed as a future part of this series.

Selective serotonin reuptake inhibitors (or SSRI) are a type of medication that is most commonly used to treat depression and anxiety. These medications work to increase the level of serotonin in the brain--the key neurotransmitter that helps regulate mood, sleep, appetite and digestion

The most common SSRIs that you may already be familiar with include Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram) and Paxil (paroxetine).

In 2006, another type of antidepressant called bupropion, was approved for use by the FDA to treat seasonal affective disorder.

Advances in medical research have led to the refinement of SSRIs so they are better able to target only specific serotonin receptors. This has resulted in a reduction of side effects, however, as with other medications, side effects are still possible.

The positive benefits of SSRIs are not immediate and may take two to four weeks before changes in the structure of neurons develop.

While these medications are easy to integrate into a busy lifestyle, bupropion is the only supported prevention strategy for seasonal affective disorder.

When to seek help

If you are experiencing the symptoms of major depression and/or the season-specific depression symptoms, it is important to consult with a medical professional right away. Our care team will work with you to find the most effective treatment option for your individual needs. If that treatment includes medication, they can help find the one that improves your symptoms without causing problematic side effects. Contact us at (646) 606-2663 and our intake coordinator will work with you to match you with the right clinician for your needs.