SAD is real: How to support mental health through seasonal shifts

Seasonal affective disorder (SAD) is a type of depression that shows up during certain seasons, often winter. More than holiday stress or the winter blues, SAD is a disorder listed in the Diagnostic and Statistical Manual of Mental Disorders ^[1] (DSM) — a tool used by healthcare providers to diagnose mental health conditions. 

With SAD, seasonal shifts can mark a significant change in the way you think, feel, and behave. If this sounds familiar, know that your experience is valid and help is available. It’s possible to manage your symptoms through seasonal shifts with the right support.

How seasonal affective disorder is diagnosed

Approximately 5% of U.S. adults experience some degree of SAD each year, though the number may actually be higher. Since SAD symptoms are similar to major depression, experts believe it may be underdiagnosed, especially in primary care settings ^[2]. 

The condition typically begins in your 20s, with symptoms persisting for four to five consecutive months each year. For many people, this means symptoms start in October or November and begin to subside around March or April. 

If you think you have SAD, the best thing to do is consult a healthcare provider like a therapist, psychiatrist, or primary care doctor. They have access to several screening instruments that can help recognize symptoms. 

To be diagnosed with major depressive disorder with seasonal pattern ^[3], you must meet the following criteria:

• Symptoms of depression, like feeling sad, hopeless, and irritable

• Your depressive episodes occur during a specific season, like winter or summer, for at least two consecutive years

• These depressive episodes are more frequent than depressive episodes at other times throughout the year

Why some people claim SAD is a myth

Misinformation is one of the biggest barriers to accessing appropriate treatment for your mental health challenges. Unfortunately, myths persist around SAD, with some people even believing that it’s not a “real” condition. 

These are six common misconceptions about SAD: 

Myth 1: SAD isn’t a real mental health condition 

Categorized as a subtype of major depressive disorder, SAD is absolutely real and not something to be taken lightly. While anyone can experience SAD, it’s more common among females ^[4] and people with a family history of SAD or mental health conditions like major depression and schizophrenia. Living farther from the equator, like in New England or Alaska, may also increase your chances of SAD. 

If you believe that you or someone you know is experiencing SAD, it’s best to meet with a healthcare professional for a complete evaluation. Receiving a diagnosis can help validate your experience and ensure that you receive appropriate care for your needs.

Myth 2: SAD is the same as depression 

SAD is a type of depression that's associated with changing seasons and amounts of sunlight. While it’s similar to major depression, there are several notable differences in terms of symptoms and diagnosis. 

Unlike major depression, SAD symptoms follow a seasonal pattern and are significantly worse during a specific time of year. To be diagnosed with SAD, this pattern must last for at least two consecutive years. With major depression, you can receive a diagnosis after you exhibit five or more symptoms during a single two-week period.

Myth 3: SAD only happens during the winter

SAD follows a seasonal cycle, which means that people’s symptoms begin and end around the same time each year. This typically means that symptoms start during late fall or early winter and resolve in spring or summer. 

Although much less common, it’s also possible to have summer-pattern SAD. This is when you experience symptoms during the spring and summer months. 

Symptoms of winter-pattern SAD include: 

• Oversleeping

• Overeating

• Social withdrawal 

Symptoms of summer-pattern SAD include:

• Trouble sleeping

• Restlessness

• Anxiety

• Violent behavior 

Myth 4: SAD only affects people in overcast climates

Location is considered a significant risk factor for developing SAD. Data show that the condition is most common in regions with colder climates and harsher winters, like the Midwest. 

That said, it’s still possible to develop SAD warmer climates too. While you’re more likely to experience SAD in New Hampshire ^[5] than in Florida, it can affect people in varying climates.

Myth 5: SAD doesn’t need treatment 

With the right resources and support, SAD is considered to be treatable. Like other types of depression, symptoms are often managed with a combination of talk therapy and medication management. 

Treating SAD is also important for effectively managing other health concerns. Research shows that SAD can co-occur with other mental health conditions, like: 

• Bipolar disorder

• Attention-deficit hyperactivity disorder (ADHD)

• Substance use disorder (SUD)

• Premenstrual dysphoric disorder (PMDD)

Myth 6: Lightboxes are the only treatment for SAD

Light therapy is considered an effective tool ^[6] for treating winter-pattern SAD. In fact, people may see an improvement after just several weeks of daily 30-minute light therapy. 

That said, lightboxes aren’t the only way to manage SAD. Many people also find success with self-care strategies like mindfulness, regular physical activity, and spending time with friends and loved ones.

Clinician’s take

In my experience, many clients with SAD also live with anxiety. The drop in light can stir up both low mood and constant worry, and people often don’t realize the two can show up together.

Brandy Chalmers, LPC

Clinical reviewer