Fighting the Fall Blues

Seasonal affective disorder treatment options

/ Author:  / Reviewed by: Chris Galloway, M.D.

As fall arrives and temperatures start to cool, many are enjoying the break from the heat. For others however, the change in season marks the beginning of a difficult time of year.

Seasonal affective disorder, or SAD, is a type of depression that shows up yearly, coinciding with a change in seasons. Symptoms usually strike in fall and worsen as the winter wears on ("winter depression"), but in less common cases, SAD can hit during the summer months.

There are various treatments available for SAD, along with a number of steps people can take themselves to help fight the fall and winter blues.

Why so SAD?

Common symptoms of seasonal affective disorder include hopelessness, loss of energy, social withdrawal and oversleeping.

The Mayo Clinic advises that while it is normal to feel sad from time to time, it may be time to go see your doctor if these feelings of hopelessness become the norm, saying, "This is particularly important if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.”

Since these symptoms are often similar to other depressive disorders, SAD usually won't be diagnosed unless the symptoms have reoccurred at the same time of year for at least two years, and unless these depressive periods are followed by periods without symptoms.

Certain groups may be at greater risk for the disorder. For example, women seem to be more likely to be affected by SAD, as are those who have close relatives with the disorder.

According to the Mayo Clinic, “Seasonal affective disorder appears to be more common among people who live far north or south of the equator,” possibly because the winter decrease in sunlight and length of day is more marked in these areas.

The exact causes of SAD are not known, but there are some factors that are suspected in playing a role in this seasonal disorder.

For one, a person's circadian rhythm, or natural biological clock, may be affected by the changes of light in the fall and winter. The reduced light could confuse the internal clock about when it is time to sleep or wake, and this confusion may cause feelings of depression.

A balance in body chemicals and processes may also be a contributing factor, as melatonin, a hormone involved in mood and sleep, can be affected by changes in season and serotonin, a brain chemical also connected to mood, can also be affected by reduced sunlight.

Treating SAD

The three most common treatments for SAD are light therapy, prescription drugs and psychotherapy, with light therapy being perhaps the most common and well-known treatment option.

This treatment consists of sitting near a specialized light therapy box that mimics outdoor light, exposing the patient to bright light, and hopefully stimulating brain chemicals linked to mood.

According to the Mayo Clinic, light therapy seems to be effective for helping many people with SAD symptoms, and “generally starts working in two to four days and causes few side effects.”

For those with more severe symptoms, antidepressants may be prescribed. Doctors may start treatment with these medications before the yearly symptoms strike as a preventative measure. The specific medication and dosage used varies from patient to patient, and some variations may be required before the right balance is found.

Since SAD is generally thought to be connected to brain chemistry, light therapy and prescription medication which aim to directly affect this aspect of mood are more traditionally treatments than psychotherapy, which aims at changing negative thought patterns and behaviors.

However, as the Mayo Clinic reports, “your mood and behavior also can add to symptoms” and research is further exploring psychotherapy as a treatment option.

The Validity of Therapy

This concept of psychotherapy as a treatment option for SAD was examined in a 2009 study led by Kelly Rohan, PhD, from the University of Vermont.

In the study, Dr. Rohan compared the effects of various SAD treatments in the long term.

Sixty-nine people coping with SAD were divided into four different treatment groups. Some received light therapy, some received psychotherapy in the form of CBT (cognitive behavior therapy), some received a combination of both and others did not receive treatment at all.

The following winter (one year later) the participants were surveyed to see how their symptoms had developed.

Results showed that 36.7 percent of the participants treated with light therapy had a reoccurrence of symptoms the next year, compared to only 7 percent of the participants receiving CBT. The group receiving a combination of both treatments had rates of reoccurrence at 5.5 percent.

Reoccurrence rates aside, CBT was also associated with less severe symptoms of depression after one year than either of the other treatment options.

However, it is important to note that this study looked at a small group of SAD patients, and that these rates may also be due to the nature of the treatments. For example, follow through may have been easier for those with appointments with a therapist than for those who needed to do light box treatment at home.

The study was published in September 2009 in the journal Behavioral Therapy. Larger scale research needs to be done to make strong conclusions about the best possible treatment for SAD.

It is, however, an interesting look into the validity of various options, and may be reason not to discount the somewhat unconventional treatment of psychotherapy for this disorder. Doctors can work with patients to find the best possible option for each individual case.

Taking Matters into Your Own Hands

These professional treatment options aside, the Mayo Clinic has several recommendations for steps people can take themselves to handle the difficulties that seasonal changes may bring.

Going outside and soaking up natural light (even when the weather is cold and cloudy) can sometimes help ease SAD symptoms. When indoors, try to increase your exposure to natural light by opening blinds and sitting near windows.

Take a walk outside to double up on benefits – not only will the natural light maybe help, but getting regular exercise can help ease a variety of depression symptoms. Exercise has long been known to help improve mood and reduce anxiety.

It can also be helpful to take a vacation to somewhere sunny and warm, if possible. This escape can help ease symptoms associated with SAD.

The Mayo Clinic also recommends making sure to remain social, even though this can be a difficult task when feeling depressed.

So, as the weather cools and the holidays approach, make an effort to celebrate and spend time with family and friends, possibly even outdoors!  And if symptoms go from a day or two of the fall blues to a unwavering period of winter depression, talk to a doctor about exploring the various treatment options available. 

Reviewed by: 
Review Date: 
October 20, 2012