Added 15 January 2023

How to overcome SAD (seasonal affective disorder)?

As the days get shorter, many people experience a lowered mood. For some, these mood shifts occur every year and continue throughout the fall and winter, when there is less natural sunlight at our latitude. How can we help ourselves during these darker days?

First of all, we need to distinguish between the so-called “winter blues” and the more serious seasonal affective disorder (SAD). “Winter blues” is an umbrella term, not a medical diagnosis, and is quite common, subsides spontaneously and usually has a rather mild course. Seasonal affective disorder is a more serious diagnosis that is associated with reduced daylight hours. It impedes daily functioning and follows a regular pattern, appearing each year in autumn and usually subsiding in spring and summer. 

Shorter days appear to be a major trigger for SAD. Reduced sunlight in autumn and winter can disrupt the body’s internal clock, or our natural circadian rhythm. Reduced hours of daylight in the winter can lead to the development of SAD in some people, something that has been studied by researchers since the 1980s, including those in the United States. In an effort to determine what the connection between light and seasonal affective disorder was, they began using light therapy, which has since become a standard treatment for SAD. 

Light therapy involves patients sitting in front of a special light box each morning for 30 minutes (or more), depending on the doctor’s recommendations. The box shines a much brighter light than the usual lighting used indoors. Studies have shown that light therapy relieves SAD symptoms in up to 70% of patients after a few weeks of treatment, but some improvement is detected even earlier in some. It is important that once light therapy is started, it should be continued every day until spring and not discontinued after the initial improvement in mood. Currently, light therapy is considered the first-line treatment for SAD.

In recent years,  there has been growing evidence that cognitive-behavioral therapy (CBT) can also help patients with SAD.  “For the ‘cognitive’ part of CBT, we work with patients to identify negative self-defeating thoughts they have,” says Dr. Kelly Rohan, a SAD specialist at the University of Vermont. “We try to look objectively at the thought and then reframe it into something that’s more accurate, less negative, and maybe even a little more positive. The ‘behavioral’ part of CBT tries to teach people new behaviors to engage in when they’re feeling depressed, to help them feel better.”

Behavioral changes might include having lunch with friends, going out for a walk or volunteering in the community. “We try to identify activities that are engaging and pleasurable, and we work with patients to try to schedule them into their daily routine,” says Rohan.

A preliminary study by Rohan and colleagues compared CBT to light therapy. Both were found effective at relieving SAD symptoms over 6 weeks in the winter. “We also found that people treated with CBT have less depression and less return of SAD the following winter compared to people who were treated with light therapy,” Rohan says. A larger NIH-funded study is now under way to compare CBT to light therapy over 2 years of follow up.

If you’re feeling blue this winter, and if the feelings last for several weeks, talk to a health care provider. “It’s true that SAD goes away on its own, but that could take 5 months or more. Five months of every year is a long time to be impaired and suffering,” says Rudorfer. “SAD is generally quite treatable, and the treatment options keep increasing and improving.”

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