Changes in seasons can sometime correspond with changes in mood. In some people, this natural connection between emotions and the weather can develop into a condition called seasonal affective disorder, or SAD.
Dr. Samar McCutcheon, assistant clinical professor in the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus, says that “seasonal affective disorder is diagnosed when a person with a mood disorder experiences a mood episode during the same season each year, for at least two years in a row.”
She adds that SAD is “not a disorder in and of itself, but rather a specifier called ‘with seasonal pattern’ that we add to an existing diagnosis like major depressive disorder or bipolar disorder.”
While most people think of SAD as depression during the winter months, it can actually take a variety of forms, McCutcheon notes. “The mood episodes a person experiences can be depression or mania; however, the most common seasonal pattern episode is winter depression.”
Symptoms of SAD
Susan Albers, a psychologist with the Cleveland Clinic in Ohio, says that SAD typically manifests as “feeling blue or depressed during the winter months. The symptoms appear to be similar to depression but in a milder form and often pass when the season changes again.” Symptoms may include:
— Feeling sad or down.
— Feeling unmotivated.
— Experiencing shifts in your normal sleeping patterns.
— Experiencing changes in appetite.
— Losing interest in things you previously enjoyed.
— Having difficulty focusing or concentrating.
— Having low energy.
— Experiencing a sudden increase in emotional eating.
“In extreme cases, it can spiral into feeling hopeless or suicidal,” Albers says.
Sometimes referred to as the winter blues or the winter doldrums, SAD can actually go much deeper than that, says Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic and assistant professor of psychiatry and behavioral sciences.
“It’s a mood disorder, much like major depressive disorder or bipolar disorder.” Whereas most people probably feel a little blah sometime in the winter, SAD is when that normal down feeling becomes more problematic. “It has a critical feel to it. That’s usually a marker of severity or dysfunction,” he says.
“I often see my patients at the exact same time each year,” Albers adds, as the symptoms happen predictably every year at the same time. “They say things like, ‘I’m just feeling really down. I’m having a hard time getting up in the morning. I just don’t feel like doing anything.'”
For people who are more vulnerable to periods of depression in the fall and winter, it may well be SAD at work.
What Causes SAD?
The American Psychiatric Association reports that SAD affects about 5% of Americans, and it usually lasts for about 40% of the year. But it’s unclear exactly why it occurs and why some people experience it while others don’t.
“There are several theories about the causes of winter depression including changes to circadian rhythms that occur with seasonal variations in sunlight, genetic risk and biochemical changes to the levels and processing of serotonin and melatonin in the brain,” McCutcheon says. Those neurotransmitters are critical to maintaining balance in the brain, and fluctuations in their levels can affect your moods.
“People who have had other mental health issues in the past like depression or anxiety can often be more susceptible to SAD,” Albers says. “Also, people who are experiencing stress or a significant change in their lives. These conditions also impact your serotonin levels, which are the feel-good chemicals in the brain.”
Nestadt notes that “lifestyle changes” that occur as the temperatures fall, such as heading indoors, socializing less frequently or getting less exercise can also contribute to symptoms of SAD.
Changes in dietary habits can be both a trigger and a result of SAD. “We tend to eat more carbohydrates” in the cooler months Nestadt says. Think comfort food. While it may feel soothing in the moment, reaching for that mac and cheese meal might actually be contributing to your feelings of seasonal affective disorder.
A sharp increase in emotional eating or carbohydrate cravings is also a “telltale sign” of SAD, Albers says. “A client recently admitted that as soon as fall began they were craving carbs and sweets 24/7.”
She adds that “a 2020 study indicated that people who start to feel the blues during the fall due to shorter days, also have a significant change in their eating habits. Eleven studies were reviewed and found that people who feel blue during the fall and winter months consume significantly larger dinners as well as more evening snacks during the weekdays and weekends. They also demonstrate a higher frequency of binge and emotional eating, more cravings for starchy food and high-fiber foods.”
Eating Right Can Improve Symptoms
Albers says that for her patients, she recommends a shift in diet to help combat SAD. “I say, ‘just like you change your outfit to coincide with the season and weather, it may be time to consider updating what you eat to align with the season and to prevent the emotional eating that accompanies SAD.'”
There’s little doubt that we get emotional feedback from the things we eat, but how exactly that impacts conditions like SAD is still unclear. “It’s tempting to jump to conclusions with nutritional science because of the way that studies of diet are done. They’re kind of all over the place,” Nestadt says. However, he says some of the basic tenets of eating right can make a big difference in this arena. In particular, he says limiting your intake of highly processed foods may help. “It’s clear that food plays a role in mental health in general, and we know that the gut microbiome is incredibly important for how mood is regulated in general.”
Beyond seasonal affective disorder specifically, “with mood in general we see an association with things like low vitamin D and low mood,” Nestadt says. “There have been studies done that say the same thing for omega-3s — that people who are not getting enough omega-3 fatty acids might be more vulnerable to lower moods or actual depression.”
Given the current state of knowledge, to help combat SAD, you may want to boost your intake of the following items:
— Foods rich in omega-3 fatty acids. Foods such as wild salmon, pasture-raised eggs and walnuts are rich sources of omega-3 fatty acids, which can support mood.
— Herbal teas. Is there anything more soothing than a steaming cup of herbal tea on a dreary winter day? Chai teas that also contain spices like cinnamon and ginger can lend a sense of warmth and comfort that may be soothing if you’re not feeling so great. And it’s a delicious way to hydrate.
— Cinnamon. “Cinnamon is clinically shown to help regulate your blood sugar, which ultimately can assist you in avoiding spikes in your blood sugar, which can lead to craving sugary foods,” Albers says. “Also, the scent of cinnamon is calming. Sprinkle cinnamon in your coffee, on yogurt or sip it in tea.”
— Fresh produce and a balanced diet. During the winter months, you should try to keep up with the healthy food habits that seem to come so easily during the summer. Eat a balanced diet and be sure to include good fats like avocados, nuts and olive oil. These fats can help you feel fuller longer and may discourage overeating or carbohydrate cravings.
— High-fiber foods. “It’s important to have a high-fiber diet because of its anti-inflammatory properties,” Nestadt says. “We think that some types of depression might be fueled by inflammatory processes.”
— Carbohydrates that are also high in fiber. McCutcheon says that when you’re experiencing SAD, you may have a craving for carbohydrates. When you do include carbs, make sure they’re also high in fiber, such as whole grains, fresh fruit and fresh vegetables. Fiber helps regulate blood sugar and can keep you feeling fuller longer, preventing overeating.
— Fermented foods. “There’s an interesting connection between your gut and your brain,” Albers notes. “People who have an increase in so-called ‘bad bacteria’ in their gut have higher levels of depression and anxiety, and 95% of your serotonin production happens in your gut not your brain. Studies have shown that one of the best things that you can do is take probiotics to help to increase the level of ‘good bacteria.’ You can also increase ‘good bacteria’ in your gut by eating fermented foods such as pickles, yogurt, kombucha and sauerkraut.”
— Root vegetables. High in fiber and full of vitamins, root vegetables such as sweet potatoes provide plenty of complex carbohydrates that break down slowly and help keep your blood sugar stable, Albers says. Other root vegetables like onions, beets and carrots are also good fall inclusions in your diet.
— Pumpkin seeds. If you’re carving a pumpkin for Halloween, save and roast the seeds. They’re chock full of magnesium, which may help improve mood. “Research has shown that people who have low magnesium also experience a great deal of anxiety because magnesium helps bind to receptors that are calming,” Albers says. “Also, magnesium blocks receptors and neurotransmitters that are more energizing. Unfortunately, about 79% of the world’s population is low in magnesium.” Other foods high in magnesium include leafy greens, nuts and beans.
— Serotonin-boosting foods. Albers also recommends adding foods that contain tryptophan, which can help boost serotonin levels in the body. Good sources of tryptophan include nuts, eggs, cheese, turkey, pineapple and salmon.
In addition, McCutcheon says you should limit your intake of alcohol. It has a depressant effect and can exacerbate depression and low mood.
Nestadt adds that addressing any other underlying medical conditions or dietary deficiencies can also help. “There’s lots of physical problems that can worsen mood or look like depression.” Things like anemia, which is an iron deficiency, can lead to feeling down. So can a folate deficiency. “These issues can make you feel tired and low energy. And it can really kick off low moods. It’s one of the first things that if I’m treating someone with treatment-resistant depression where normal treatments aren’t working, we look at the labs to check to check their thyroid levels and look for anemia.”
Discussions of eating to support mental well-being often include reference to vitamin D, as this essential nutrient has been shown to support mood. It also supports bone and immune system health, reduces inflammation and may even lower risk for certain kinds of cancer.
Your body actually makes vitamin D in your skin when it’s exposed to sunlight. But because this exposure is often limited for many people during the North American winter, it can become a little more challenging to make sure you’re getting enough. If your diet doesn’t supply enough of it, deficiency can result. This is true for some Americans; one study suggests that more than 18% of people have a vitamin D deficiency.
Nestadt says making sure you’re taking in enough vitamin D through dietary sources can be helpful for addressing depressive symptoms in the winter months — or perhaps anytime. “If you start to test everyone’s vitamin D levels in any sort of large epidemiological study, you’ll find out that Americans are basically all vitamin D deficient in the way we define it.”
While he says vitamin D isn’t necessarily a cure for SAD, “there’s an association with low vitamin D levels and lower mood. But it’s unclear that supplementing with vitamin D definitely helps. It stands to reason that it should,” but more research is needed before a blanket recommendation can be made.
Instead, adjusting your diet to make sure you’re getting plenty of vitamin D from the foods you eat might go a long way toward supporting better moods. Vitamin D is present in a variety of foods, most significantly:
— Salmon and other fatty fish such as herring and sardines.
— Canned tuna.
— Egg yolks.
— Fortified foods, such as milk, plant-based milks, cereal and orange juice. “One of the easiest things is to have milk that’s fortified with vitamin D because the calcium in milk is helpful for the absorption of vitamin D,” Nestadt says.
Talk to your doctor about whether you might be deficient in this important nutrient and whether taking a vitamin D supplement is a good choice for you.
Treatments for SAD
Albers says that knowing your triggers and “anticipating that SAD is coming is often helpful in treatment. Winter is coming. Be ready.” Indeed, the predictable annual cycle of the condition means you can prepare for it’s arrival by talking with a health care professional in the summer, before symptoms start.
Treatments for winter depression can include:
— Light therapy.
— Lifestyle interventions.
“For mild to moderate winter depression, some people opt to use light therapy alone. Light therapy is administered with a 10,000 lux lightbox used daily in the morning for approximately 30 minutes,” McCutcheon says. Lux is a measurement of the light’s brightness, and if you have any eye issues, such as diabetic retinopathy, you should be sure to check with your doctor prior to starting any kind of light therapy.
Light therapy tends to work faster than antidepressant medications. “You can expect to see improvement in symptoms within a few weeks,” McCutcheon says.
She also notes that if you have a vitamin D deficiency, “identifying and correcting that could make light therapy more effective. If you’re considering light therapy or vitamin D supplementation, we recommend consulting with your primary care provider before trying any new treatment option.”
In more severe cases of SAD, McCutcheon says antidepressants may be used alongside light therapy “to treat symptoms more thoroughly. Psychotherapy can also be helpful in combination with other treatments.”
Lifestyle interventions can run the gamut from increasing exercise to connecting with others in social settings. Some activities that can help boost your mood when you’re feeling down include:
— Engaging in regular cardiovascular exercise.
— Listening to uplifting music.
— Going on a vacation to a sunnier, warmer climate.
— Using bright lights during the day.
— Staying connected to friends and family.
— Prioritizing quality sleep.
Albers notes that exercise can help keep your serotonin levels in check. Keeping up with your exercise routine, even if it’s dark outside, can improve symptoms. “Unfortunately, shorter, colder days often make exercise routines come to a screeching halt. When it gets dark early, people often skip their evening walk or feel unmotivated to go to the gym. This decrease in exercise can exacerbate SAD.”
Exercise can be very helpful, but getting on a good sleep schedule may be even more so. “In general, I recommend practicing good sleep hygiene by having a set bedtime and wake-up time, taking daily walks outside and exercising. It can also be very helpful to maintain positive social relationships to avoid the social isolation that can occur with winter depression,” McCutcheon says.
Nestadt agrees that sleep “is the most important lifestyle-based change you can make to prevent seasonal affective disorder.”
Tips for getting better sleep include:
— Setting and adhering to a consistent bedtime and wake time.
— Creating a cool, dark place for sleeping beyond the reach of electronics and the stresses of the outside world.
— Avoiding naps during the day, as they can negatively impact your ability to sleep soundly during the night.
— Avoiding alcohol and sleeping medications.
— Using a bright light in the morning to help you fully wake up when it’s time to get up.
Albers adds that she recommends the use of a dawn simulator for her patients with SAD. “It’s a timed light that often mimics the sunrise, so the bedroom gradually becomes light over a 30-minute period of time. This can help to reset your circadian rhythms. People like them as they are a gentle way to wake up and get the benefits of a light box.”
Lastly, when it comes to sleep, keep it simple. “When people are having trouble sleeping, there are lot of interventions, but keep your bed for only sleep and sex,” Nestadt says.
Talk to Someone
“My main message is to take SAD seriously,” Albers says. “If you’re experiencing SAD, speak with your doctor and/or a mental health professional. They can help you to find the right treatment. For some, it is changing your behaviors and habits to include a healthy diet and exercise. For others, it may be taking medication.”
But she says the key is to get help. “If left untreated, SAD can unfortunately spiral into depression. Therefore, it’s important to take it seriously and treat it early.”
Nestadt agrees, noting there are plenty of medications that can help, “and it’s also important to recognize that suicidal thoughts, which can come as a consequence of depression or seasonal affective depression, can rapidly escalate. It can be a matter of hours that thoughts of life-weariness advance to acting on a suicidal impulse,” he says. So if you start having such thoughts, don’t delay. Reach our for help immediately by calling 911 or the National Suicide Prevention Lifeline at 800-273-8255.
More from U.S. News