Supporting military family mental health
Summary
Recognize specific seasonal symptoms as part of understanding and treating seasonal affective disorder (SAD), such as significant fatigue and shifts in appetite or weight during the winter months.
Establish a clinical diagnosis using DSM-5-TR criteria and the Seasonal Health Questionnaire (SHQ) to distinguish symptoms from general depression.
Utilize 10,000 lux light therapy for 20–60 minutes each morning to effectively regulate circadian rhythms and melatonin levels.
Explore evidence-based SAD therapy approaches, including cognitive behavioral therapy (CBT) and antidepressant medications to find a customized treatment plan.
Integrate lifestyle adjustments such as daily morning walks and Vitamin D supplementation to enhance the overall effectiveness of SAD therapy approaches.
Understanding and treating seasonal affective disorder (SAD) requires recognizing that it is more than the “winter blues.”
Affecting approximately 6% of the U.S. population, SAD can significantly disrupt daily functioning. This guide explains symptoms, diagnostic criteria, and evidence-based SAD therapy approaches.
A key component of understanding and treating SAD is knowing how to diagnose seasonal affective disorder and when symptoms meet criteria for a clinical condition. Symptoms usually start in the fall and continue through the winter months until spring, with January and February typically being the most challenging months.
Common symptoms include:
Fatigue
Changes to appetite (often overeating and craving carbohydrates)
Low energy
Persistent low mood
Loss of interest in activities
Sleep changes (typically oversleeping)
Feelings of hopelessness
Social withdrawal
A clear foundation of these symptoms is essential for understanding and treating seasonal affective disorder (SAD) effectively.
How to diagnose seasonal affective disorder
SAD is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as a major depressive disorder with seasonal pattern.
Major depressive disorder includes five or more of the following symptoms nearly every day, over two weeks, causing significant distress or impairment to important areas of functioning (social, occupational, and other important areas):
Depressed mood for most of the day
Markedly diminished interest or pleasure in all, or almost all, activities
Significant weight loss or weight gain
Decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, suicide attempt, or a specific suicide plan
Note: This diagnosis only applies if symptoms aren’t caused by substance use or another medical condition, schizoaffective disorders do not better explain at least one depressive episode, and the person has never experienced a manic or hypomanic episode.
There are two screening tools for SAD, including:
Seasonal Pattern Assessment Questionnaire (SPAQ): This 6-item Likert scale evaluates changes to sleep length, social activity, mood, weight, appetite, and energy levels.
The Seasonal Health Questionnaire (SHQ): This tool is considered more reliable and valid for assessing SAD.
Critics evaluating these tools found the SHQ more sensitive in assessing SAD, while the SPAQ was considered a more useful predictive tool. However, they also found that direct and structured interviewing was the most useful evaluation tool for SAD.
Knowing how to diagnose seasonal affective disorder is also essential for clinicians learning how to bill insurance for SAD treatment, as proper documentation must clearly support medical necessity.
Once a diagnosis is established, selecting appropriate SAD therapy approaches is the next critical step.
SAD therapy approaches
Evidence-based SAD therapy approaches typically include a combination of medication, light exposure, and psychotherapy.
Antidepressant medications: Certain medications such as fluoxetine (Prozac) or bupropion (Wellbutrin) are typically prescribed for SAD.
Light therapy: This involves the use of bright artificial lights or light boxes that emit a full-spectrum light similar to sunlight. Bright light therapy involves sitting in front of the light box early in the morning from fall until spring, for 20 to 60 minutes.
Early morning walks: Exposure to daylight, even when it is cloudy, can offer similar benefits as a lightbox, along with the therapeutic benefits of walking. Early morning light can also have a positive effect on the body’s circadian rhythm.
Vitamin D: Some research suggests low levels of vitamin D are associated with depression and SAD. Additionally, winter months and geographical location can make it more difficult for the body to synthesize vitamin D. Supplementation of vitamin D during winter months may prevent symptoms of depression.
Therapy: Treatments like cognitive behavioral therapy, interpersonal therapy, activity scheduling, and stress management can ease symptoms of depression.
Lifestyle changes: Regular exercise, limiting alcohol consumption, lowering stress levels, eating regular, balanced meals, and social interaction can all help to reduce symptoms of depression.
Ultimately, determining what medications work best for seasonal depression depends on symptom severity, medical history, and individual response. Effective care for seasonal depression often involves integrating multiple SAD therapy approaches based on symptom severity and personal preference.
For providers, choosing among these interventions may also involve understanding how to bill insurance for SAD treatment, including proper coding for major depressive disorder with seasonal pattern.
Frequently asked questions about SAD
Many readers exploring understanding and treating seasonal affective disorder (SAD) also have practical questions about symptoms and treatment.
When does seasonal depression typically start?
SAD usually starts in the fall and lasts until spring.
Can SAD occur in summer?
Yes. While less common, the American Psychiatric Association states that some people may experience SAD in the summer months, starting in late spring and lasting until summer.
What causes SAD?
While the underlying cause of seasonal affective disorder is unclear, some hypotheses propose that reduced sunlight can lower serotonin levels and disrupt the body’s circadian rhythm.
Seasonal changes can also impact melatonin levels, which affect sleeping patterns and mood regulation. Other studies suggest genetic factors and reduced retinal sensitivity may be at play.
Research into understanding and treating seasonal affective disorder (SAD) continues to evolve as scientists study light exposure and circadian rhythms.
What medications work best for seasonal depression?
For many individuals deciding between options, the question of what medications work best for seasonal depression often arises alongside whether light therapy alone is sufficient.
Medications that target serotonin deficiency, such as fluoxetine (Prozac), sertraline (Zoloft), and bupropion (Wellbutrin), have been promoted. Several studies have found that these medications were as effective as light therapy.
These findings continue to shape how clinicians evaluate and compare different SAD therapy approaches.
A 2021 Cochrane review of second-generation antidepressants (SGA), like Wellbutrin, found insufficient evidence on the use of SGA to treat seasonal affective disorder. Cochrane study authors found that up to 27% of study participants withdrew due to adverse side effects of the medication—underscoring why treatment decisions should always be made with a qualified provider.
What is the best light therapy for SAD?
Light therapy is one of the most widely studied components of understanding and treating seasonal affective disorder (SAD).
Light boxes or SAD lamps must provide a minimum of 10,000 lux (the measure of light intensity). Anyone considering light therapy should first check with their doctor or mental health professional, as there can be side effects and risks. People with bipolar disorder may be at risk, as light therapy can, in rare cases, trigger a manic episode.
Understanding and treating seasonal affective disorder (SAD) begins with accurate diagnosis and continues with individualized, evidence-based care.
Sources
Harvard Health Publishing. Corliss, J. (2022). Light therapy: Light therapy: Not just for seasonal depression?.
Johns Hopkins Medicine. (n.d.). What is seasonal affective disorder?.
Psychology Research and Behavior Management. Meesters, Y., & Gordijn, M. C. (2016). Seasonal affective disorder, winter type: current insights and treatment options, 9, 317–327. Depression Research and Treatment.
Melrose S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. StatPearls Publishing.
Munir, S., Gunturu, S., & Abbas, M. (2024). Seasonal Affective Disorder.
National Institute of Mental Health. (2023). Seasonal Affective Disorder.
Psychiatry (Edgmont). Targum, S. D., & Rosenthal, N. (2008). Seasonal Affective Disorder, 5(5), 31–33.
American Psychiatric Association. Torres, F. (2024). Seasonal Affective Disorder (SAD).
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