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Seasonal Affective Disorder (SAD) Treatment to Beat the Winter Blues

Every winter, as sunlight dims and the days get shorter and colder, millions of people experience feelings of sadness, hopelessness, and low energy.

Seasonal affective disorder (SAD) is a severe form of depression that can cause significant disruption to your life and finances. It can lead to low productivity at work or school, substance abuse, eating disorders, or suicidal thoughts and behaviors.

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The COVID-19 pandemic might also be causing an increase in depression and anxiety. A September 2020 study in JAMA found a threefold increase in depression symptoms once the pandemic began. People with lower income, less than $5,000 in savings, and exposure to more stressors were at increased risk for depressive symptoms. Additional stay-at-home orders or job cuts might further increase rates of depression, including for those dealing with SAD.

Fortunately, cost-effective SAD treatments are available, and many people can effectively manage their symptoms with inexpensive lifestyle changes or a combination of medication and lifestyle changes.

What Is Seasonal Affective Disorder?

According to a 2015 analysis published in the journal Depression Research and Treatment, seasonal affective disorder is a type of recurrent major depression related to seasonal changes.

Some people refer to seasonal affective disorder as the “winter blues,” “seasonal depression,” “cabin fever,” or “winter doldrums.” However, SAD is more than a temporary change in mood when the weather turns cold and cloudy. It’s a mental illness that follows a seasonal pattern.

Typically, people with seasonal affective disorder experience symptoms in the fall, when days grow shorter and there’s less natural light, and these symptoms last through winter until spring. During the spring and summer months, people with SAD typically see a full remission of their symptoms.

While SAD is most common during the winter months, there is a rare form of SAD that occurs during the spring and summer.

How Many People Have SAD?

Seasonal affective disorder is more common than most people think. The Cleveland Clinic reports that up to half a million people in the United States experience winter seasonal affective disorder, while another 10% to 20% experience a milder form of “winter blues.”

According to the research of Norman Rosenthal, a psychiatrist and one of the researchers who first described the condition in 1984, women are 4 times more likely to receive a seasonal affective disorder diagnosis than men.

The National Institute of Mental Health (NIMH) reports that you’re at a higher risk of developing SAD if you:

  • Are female
  • Live far from the equator
  • Have a family history of depression
  • Are already diagnosed with depression or bipolar disorder
  • Are a younger adult

The factors listed above increase your risk of SAD. However, SAD can also occur in older adults, those who live near the equator, those with no family history of depression, and those who have not been diagnosed with depression or bipolar disorder.

Symptoms of SAD

The NIMH also notes SAD is not considered a separate disorder from depression. Rather, it’s a type of depression that follows a seasonal pattern, typically lasting four to five months each year. To be diagnosed with SAD, you must meet the full criteria for major depression, and these symptoms must manifest seasonally for at least two years. However, the NIMH also notes that not all people with SAD will experience all the symptoms below.

Symptoms of major depression include:

  • Almost daily feelings of depression for most of the day
  • Low energy
  • Loss of interest in hobbies or other activities you previously enjoyed
  • Feelings of hopelessness or worthlessness
  • Trouble sleeping
  • Overeating and experiencing weight gain or changes in appetite
  • Sluggish or agitated feelings
  • Difficulty concentrating
  • Frequent thoughts of death or suicide

In addition to experiencing some of the symptoms listed above, people with winter-pattern seasonal affective disorder might also experience the following:

  • Low energy
  • Hypersomnia (feeling excessively sleepy)
  • Overeating
  • Weight gain
  • Craving carbohydrates
  • Social withdrawal

Symptoms of summer-pattern seasonal affective disorder include:

  • Poor appetite and weight loss
  • Insomnia
  • Anxiety
  • Agitation
  • Restlessness
  • Episodes of violent behavior

Causes of SAD

The exact causes of seasonal affective disorder are still unknown. However, there are several theories as to what might cause this type of depression.

Serotonin Regulation

One theory is that serotonin regulation plays a role in SAD. Research cited in the Depression Research and Treatment analysis postulates that people with SAD have difficulty regulating serotonin, a neurotransmitter responsible for regulating mood and social behaviors.

Dolores Garcia-Arocena, who has a Ph.D. in cellular and molecular biology and is an expert in neurogenetics, explained in an article for The Jackson Laboratory that the link between serotonin and depression has to do with serotonin transporter (SERT) activity. The role of SERTs is to recapture released serotonin and recycle it. Sunlight naturally keeps SERT production low, which means more serotonin circulates in the body during summer months. However, as daylight hours decrease, SERT activity increases. This increase in SERT activity leads to a drop in serotonin levels and an increase in depressive symptoms in those with SAD.

Melatonin

People with SAD might also overproduce the hormone melatonin. According to the Mayo Clinic, melatonin tells your body it’s time for sleep. Your body increases its production of melatonin when it’s dark and decreases production during daylight hours.

Melatonin regulates your circadian rhythms, also known as your “internal clock.” However, as winter days become darker and there is less sunlight, some people might produce more melatonin than usual and become sleepy, have low energy levels, and experience a depressed mood.

Vitamin D

Many people spend less time outdoors during wintertime due to the cold weather. Less sunlight on your skin means your body produces less vitamin D. And some doctors hypothesize that low vitamin D levels could increase your risk of depression. A 2013 systematic review published in the British Journal of Psychiatry found that low vitamin D concentration is associated with depression. Another analysis, published in 2017 in the Journal of Affective Disorders, found a positive association between vitamin D deficiency and depression.

While these reviews are promising, other studies have found no link between vitamin D and winter SAD. For example, a 2014 study published in BMC Research Notes and a 2006 study published in the Journal of Nutrition, Health, and Aging concluded that vitamin D had little to no effect on depressive symptoms.

Vitamin D Sun Sky Outdoors Hand


Treatments for SAD

You can use many tools and strategies to lessen the symptoms of SAD, and you might need to try several different treatments simultaneously to notice symptom reduction. However, if your symptoms are severe or you’re experiencing thoughts of suicide or self-harm, talk to your doctor immediately. You can also call the Substance Abuse and Mental Health Services Administration’s free, confidential help line at 800-662-HELP (4357) for help 24 hours per day, 365 days per year.

1. Antidepressants

The NIMH reports that selective serotonin reuptake inhibitors (SSRIs) can effectively treat seasonal affective disorder. SSRIs work by increasing the levels of serotonin in the brain.

SSRIs may be required treatment for some people diagnosed with depression, and they are only available by prescription. So talk with your doctor or licensed therapist if you want to try this treatment. Note that SSRIs and other antidepressant medications can have serious side effects, and your doctor may need to try several combinations before your symptoms improve.

Although you can only take SSRI’s while under a doctor’s care, the medication itself is very affordable, even if you don’t have insurance. According to GoodRx, prices for name-brand SSRIs like Prozac and Zoloft start around $5 to $6. In some cases, paying cash for these drugs can save you more money than using your health insurance, especially if you use a coupon through GoodRx.

2. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy administered by a mental health professional or therapist. CBT helps you become more aware of negative thinking patterns or inaccurate assumptions or beliefs. Once you become more aware of your negative inner monologue, you can then reshape your thoughts to more positive, accurate, or helpful ones. CBT has been tailored for SAD, and this approach is called CBT-SAD.

The National Center for Complementary and Integrative Health states that CBT is an effective treatment for seasonal affective disorder. And a 2016 study published in the American Journal of Psychiatry found that CBT-SAD was more effective than light therapy in patients after two years.

But CBT can be expensive. Some health insurance plans cover psychotherapy, but only a limited number of sessions. Talk to your health insurance provider to find out if you’re covered. If not, look into options for low-cost mental health treatments, such as:

  • Sliding-scale therapists (you can find one by searching on GoodTherapy)
  • Teaching hospitals
  • Programs provided by your school or workplace
  • Community mental health clinics

3. Light Therapy

Bright light therapy is a standard treatment for seasonal affective disorder. Bright light therapy uses a light therapy lamp to combat the lack of sunlight during winter months. A 2020 meta-analysis published in the journal Psychotherapy and Psychosomatics found that bright light therapy is an effective treatment for SAD. Additionally, in a 2018 study published in the journal Depression and Anxiety, researchers studied how cognitive behavioral therapy and bright light therapy helped ease SAD symptoms. After six weeks, researchers concluded that light therapy treatment significantly speeded remission rates for four symptoms: early insomnia (difficulty falling asleep), psychic anxiety, hypersomnia, and social withdrawal.

Using a light therapy lamp can help reset your circadian rhythms so you feel more awake, positive, and alert on dark winter mornings. However, you must follow the directions. Misuse can result in eye damage or worsening of some symptoms, such as insomnia.

Typically, people with seasonal affective disorder sit in front of the lamp early in the morning for 10 minutes and up to one hour per day. Light therapy lamps are relatively affordable. Many highly-rated models on Amazon cost between $30 and $50.

Another option is to purchase a wake-up light to help ease you into your morning routine. Wake-up lights simulate sunrise, going from dark red to bright yellow before the alarm goes off. The room’s gradual lightening helps ease you out of deep sleep and help you feel more alert during the morning.

4. Exercise

Researcher Rosenthal also notes regular exercise can be an extremely effective treatment to combat SAD. And plenty of research supports exercise as an effective means for counteracting depression. For example, a 2017 study published in the American Journal of Psychiatry found that even just one hour of leisurely exercise per week could help prevent 12% of depressive cases. Exercise can also help you avoid the weight gain that’s common with seasonal affective disorder.

If you don’t relish the idea of hopping on a treadmill in a crowded gym, consider fun outdoor winter activities like snowshoeing, hiking, skiing, or ice-skating. Even taking a daily walk can help boost your mood and help relieve stress.

Exercising outdoors can provide you with other valuable benefits, getting more natural light, being out in nature, and getting more fresh air. The best time to be outdoors exercising is around noon, when the sun is brightest.

But if the weather is too cold for you to be outside, try doing indoor workouts at home. You can easily do exercises like yoga, Pilates, and kickboxing in your living room or basement, and they require little if any equipment. There are also plenty of ways to sneak a workout routine into your day without feeling like you’re exercising.

Note: Due to the pandemic, exercising alone outdoors and staying home are also safer options than a gym.

5. Eat a Healthy Diet

People with seasonal affective disorder often crave starchy foods, sweet foods, or carbohydrates during the winter. A 2018 study published in the Journal of Affective Disorders lists carbohydrate craving as a core symptom of SAD. This poor diet, coupled with a lack of exercise or excess sleeping, can contribute to depression symptoms and weight gain.

This gradual increase in unhealthy habits is why it’s crucial to eat a healthy diet rich in fruits, vegetables, and lean proteins. You also need to eliminate sugar from your diet as much as possible. A 2017 study published in the journal Scientific Reports found a positive link between excess sugar intake and common mental disorders such as depression and anxiety.

Sticking to a healthy diet and avoiding sugar can be challenging during the winter holiday season. So take steps to prevent holiday weight gain and maintain a healthy diet while you celebrate. For example, eat a small, healthy meal before you attend a holiday party so you’re too full to overindulge in sweets.

6. Let the Light In

Some people keep their blinds and curtains closed during the winter to keep heat in and cold out. However, if you have seasonal affective disorder, you need all the natural light you can get.

Keep your blinds and curtains open as much as possible to let in the sun and light. If you’re trying to keep heating costs down, consider using clear window insulating film instead of heavy thermal curtains.

7. Start a New Hobby

When SAD symptoms flare up, it’s all too easy to hibernate at home and binge-watch your favorite television show to take your mind off things. However, starting a new hobby can help you cope with feelings of sadness or hopelessness. It might take your mind off negative emotions better than the television will, especially if you can do it with a friend. If you find an activity you love, you might even be able to turn your hobby into a money-making business.

If you’re at a loss for ideas, consider some of these popular hobbies:

8. Focus on Self-Care & Wellness

It’s crucial to go easy on yourself during the winter months when you’re not feeling your best. Focusing on negative thoughts or berating yourself for not being “strong enough” to get through this does even more harm.

It can help to write down negative feelings in a journal so they don’t continue to circulate in your mind. Writing them down can also give you the distance you need to realize these negative thoughts don’t define who you are. They’re just thoughts.

It can also help to focus on self-care and overall wellness during the winter months.

  • Get Enough Sleep. If you have trouble sleeping, consider using natural sleep aids to fight insomnia.
  • Reduce Stress. People with seasonal affective disorder can find it harder to deal with stress during the winter months. Use techniques like deep breathing, meditation, or regular exercise to help reduce your stress.
  • Don’t Overschedule. It’s easy to overextend yourself when you want to stay busy, especially during the holidays. However, try to say yes only to truly meaningful commitments. Overscheduling yourself can lead to burnout or a worsening of your depressive symptoms.
  • Unplug. Consider spending an hour or more per day completely unplugged from your electronic devices. It gives your mind and soul a break from social media or negative news.
  • Fix an Annoyance. Is there something annoying or tedious on your to-do list that you keep putting off? If so, take a few minutes today to get it done. Although it might not seem like a self-care tip, think about how much time and energy you invest in thinking or dreading the tasks you procrastinate. Over time, these undone tasks can affect your quality of life.
  • Do Something That Makes You Happy. Do something just because it makes you happy once per week. Taking time for something joyful is an essential and often overlooked part of self-care. For example, if fresh flowers always bring a smile to your face, buy yourself a weekly bouquet to cheer up your home. If eating a heavenly ramen makes your heart sing, indulge in the delicious noodles every Wednesday.

9. Embrace Hygge

Hygge is an Old Norse word that translates as “comfort” or “console.” In Denmark, hygge is more than just a concept. It’s part of their culture.

Hygge is about taking comfort and solace in a cozy home, spending time with friends and family you love, spending time in nature, embracing simplicity, and being mindful in the present moment.

To add more hygge to your life, try the following tips:

  • Light candles
  • Wrap yourself in a cozy blanket
  • Make a fire in your fireplace or wood stove
  • Invest in a heated blanket
  • Take a walk with a friend
  • Wear comfortable clothes
  • Share a home-cooked meal
  • Drink a hot drink
  • Have a family game night

One of the most beneficial aspects of hygge is that it doesn’t cost a lot of money to start doing it. Hygge is all about slowing down and appreciating where you are right now. Appreciating the present moment can be challenging for those with seasonal affective disorder, but embracing the winter season and acknowledging the good it brings can help you overcome feelings of depression or hopelessness.

10. Find a New Way to Celebrate

In a September 2020 interview with The Guardian, Rosenthal made note that seasonal affective disorder could be particularly challenging this year due to the COVID-19 pandemic. Infection rates are still on the rise in many parts of the world, and with fears of a second wave mounting, the winter holidays will likely look very different this year.

The Centers for Disease Control and Prevention (CDC) advises against holiday travel and indoor celebrations with people not in your immediate household. Not being able to spend the holidays with family and friends could be a devastating blow for people with winter depression.

Rosenthal suggests trying something new for the holidays instead of focusing on everything you can’t do.

One idea is to celebrate virtually with family members and eat dinner together using Zoom. Or instead of sitting down to a big meal with extended family, go on a hike together and then cook a light meal over a campfire. You have to get creative with how you celebrate this year.

It can be hard to let go of cherished traditions, like gathering with loved ones around the holidays. However, remember these restrictions won’t last forever, and following CDC guidelines is one of the best ways to keep your loved ones safe.

11. Take a Vacation

If it’s within your budget, it can help to plan a winter trip to a sunny, warm location, such as Florida or the Caribbean. Having a vacation to look forward to can help you stay motivated during the winter months and give you a much-needed break from the cold and dark.

Travel can be costly. So stay within your vacation budget to avoid an unaffordable (and stress-inducing) credit card bill when you return. There are also plenty of ways to save money on vacation so you can still have fun without overspending.

Another option is to take a staycation and act like a tourist in your hometown. Most of us live in towns or cities that are full of things to do. But we’re often so busy with our routine and work schedule we never make time to do them. However, winter is the perfect time to find a new favorite restaurant, park, or museum and keep yourself busy when the days are gray. Taking a staycation is a smarter option when your budget is tight.

Note: Many countries, airlines, and hotels still have coronavirus travel restrictions in place, and these restrictions can change without warning. Weigh the risks of traveling during a pandemic carefully before booking a trip, and prepare to change your plans if something unexpected occurs before you leave.


Final Word

When I was a young adult living in Michigan, I experienced seasonal affective disorder. Every November, my symptoms would flare up without fail, and I would spend the next five months trying to make it to spring.

Although I no longer experience winter depression, I can still remember how difficult it was to get through the day sometimes. What helped most was taking care of myself daily. I bought myself flowers, exercised consistently, visited a nearby indoor botanical garden weekly, and made lots of soup and comforting hot drinks. And slowly through the years, each winter got a bit easier to bear.

Seasonal affective disorder can cause severe disruption and despair in your life, and you must take steps to combat and treat this condition. Thankfully, many of the tips and strategies that are most effective in dealing with SAD are low-cost or free. Investing in a light therapy lamp, getting more exercise, and spending time outdoors, even when it’s cold out, can have a positive effect on your mood, and they might even help you appreciate the unique benefits winter offers.

Do you experience seasonal affective disorder? What strategies and tips do you use to feel better?

If you’re experiencing symptoms of seasonal affective disorder (SAD) or depression, or you’re experiencing thoughts of suicide or self-harm, talk to your doctor immediately. You can also call the Substance Abuse and Mental Health Services Administration’s free, confidential help line at 800-662-HELP (4357) for help 24 hours per day, 365 days per year.

Heather Levin
Heather Levin is a writer with over 15 years experience covering personal finance, natural health, parenting, and green living. She lives in the mountains of Western North Carolina with her husband and two young sons, where they're often wandering on frequent picnics to find feathers and wildflowers.

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