Dual Diagnosis: Seasonal Affective Disorder (SAD)

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What is Seasonal Affective Disorder (SAD)?

With the right support we can and do recover. Dual Diagnosis Network can help you and carers to find the right resources to recover.

Some of us notice that we don’t feel so good in the winter months, particularly if we live somewhere where the climate changes a lot and it is dark during the winter..

This feeling can interfere with your life – some people say that it feels “like hibernation”.

This is what we call Seasonal Affective Disorder (SAD). The term “Winter Depression” and “Winter Blues” has also been used to describe this.

What is seasonal affective disorder (SAD)?

SAD has a lot in common with depression. Have a look at our general leaflet on  Depression before reading this information.

The main symptoms of SAD are similar to those of depression, but happen in the winter.

  • low mood 
  • lack of interest and enjoyment in life

Often also these symptoms occur also:

  • low energy
  • being less sociable
  • being less irritable
  • less interest in sex.

Common symptoms of SAD which are different from those in most depression are:

  • sleeping more
  • eating more.

If you have  SAD, you may find it hard to wake up on a winter’s morning and can often feel sleepy during the day. You may crave chocolate and high carbohydrate foods, such as white bread or sugary foods. You might find you put weight on.

SAD gets better in the spring. Indeed, around a third of people with SAD have a time when they feel more energetic than usual during the spring and summer.

Who is affected by SAD?

Like other types of depression, SAD is most common in women during the years when they can have children. It is about three times more common in women than it is in men. SAD is less common in children and in older adults, affecting men and women equally.

How common is SAD?

Depression is the predominant mental health problem worldwide, followed by anxiety, schizophrenia and bipolar disorder. In 2013, depression was the second leading cause of years lived with a disability worldwide, behind lower back pain. In 26 countries, depression was the primary driver of disability. In 2014, 19.7% of people in the UK aged 16 and over showed symptoms of anxiety or depression – a 1.5% increase from 2013. This percentage was higher among females (22.5%) than males (16.8%).

What causes SAD?

Some people can also feel very anxious when they become depressed.

You may feel on edge all the time, worried, fearful, and may find it hard to go out or be around people. Or you may experience physical symptoms such as dry mouth, sweating, breathlessness or stomach churning.

If you experience depression and anxiety, you will normally receive treatment for the one that is causing you the most difficulty.

What treatments are available for SAD?

SAD can be treated in the same way as depression. Treatment usually includes self-help and lifestyle changes, talking therapies and antidepressant medication. Light box treatments are also popular and have some evidence.

Self-help

Some symptoms of SAD can create extra problems which make you feel even worse – ‘vicious circles’:

  • If it is dark and you feel tired all the time, you will probably do less – and this can make SAD worse. Try to get as much natural sunlight as possible. Take a walk during daylight hours or carry on any exercise you would normally do. Remind yourself that days will get longer again in the spring.
  • If you are eating more, you may put on too much weight which makes you feel worse. Remind yourself that most people put on weight in autumn and early winter.
  • Sleepiness, lack of motivation and irritability can all cause problems at home, with your friends, and at work. The feelings of not getting things done can make you feel stressed. Tell your family and friends so that they can understand what is happening and be supportive.

Light therapy

The idea is to try to provide extra light and to make up for the shortage of daylight in winter. A “light box” is used. Its light is like sunlight, but without the ultraviolet rays, so it is not harmful to the skin or the eyes. It may help tell the brain to make less of a hormone, melatonin.

A light box is usually used for 30 minutes to an hour each day. It is most helpful if you use it at breakfast time. Light therapy works quite quickly. If it is going to help, most people will notice some improvement in the first week.

Fortunately, any side-effects are usually mild. They include headache, nausea or blurred vision. It is usually best not to use a light box after 5.00 pm because you may then find it hard to get to sleep.

Dawn-simulating alarm clocks are also used. These come on dimly about an hour before waking up time and gradually get brighter. They can be helpful if you find it hard to wake up on winter mornings.

Medication

Antidepressants may be helpful in SAD.

Any medication which would make people more tired or sleepy should be avoided, and so SSRI antidepressants are usually used. 

The best evidence is for the use of sertraline, citalopram or fluoxetine.  In SAD, it is usual to start antidepressants in the autumn and stop them in the spring.

A recent review of the evidence did not find a large effect, but you ask your doctor.

Cognitive behavioural therapy (CBT)

There is some evidence that CBT can help winter depression and may prevent it coming back in future winters. CBT is a treatment for anxiety and depression in general.

You have weekly sessions with a therapist and do some homework, like keeping a diary. 

What is the best treatment?

For mild symptoms, the self-help measures described in this leaflet will usually be enough.

If your symptoms are worse, the first choice is usually between a light box and antidepressants. The choice will often depend on what is available, what is convenient and what you prefer.

Disclaimer

This resource provides information, not advice.  

The content in this resource is provided for general information only. It is not intended to, and does not, amount to advice which you should rely on. It is not in any way an alternative to specific advice. 

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this resource.

If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.  

If you think you are experiencing any medical condition, you should seek immediate medical attention from a doctor or other professional healthcare provider.  

Although we make reasonable efforts to compile accurate information in our resources and to update the information in our resources, we make no representations, warranties or guarantees, whether express or implied, that the content in this resource is accurate, complete or up to date. 

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