Seasonal affective disorder (seasonal depression)

"Seasonal affective disorder" is the common name. Clinically, it's diagnosed as major depression with a seasonal pattern; the same seasonal pattern can also apply to the low periods of bipolar I and bipolar II disorder. It isn't a separate diagnosis of its own.

With a seasonal pattern, the low periods start and end at about the same time each year. For most people they begin in the late fall or early winter, as the days get shorter, and ease in the spring and summer.

SAD brings the symptoms of depression: a low mood most of the day, nearly every day, losing interest in things you used to enjoy, low energy, trouble concentrating, and feeling hopeless or worthless. The winter pattern often adds:

• Sleeping much more than usual
• Overeating, especially craving carbohydrates, and weight gain
• Pulling away from people, a feeling of wanting to "hibernate"

The less common summer pattern

Some people have the opposite pattern, with depression that starts in the spring or summer and eases in the fall. The summer pattern more often brings trouble sleeping, a poor appetite and weight loss, restlessness or agitation, and anxiety.

Who it affects

SAD is more common in women than in men, and it often starts in young adulthood. It's more common in people who live farther north, where winter days are shorter. It's also more common in people who already live with depression or bipolar disorder, especially bipolar II, or with conditions such as anxiety, ADHD or an eating disorder, and it can run in families.

These signs are a general guide, not a checklist for diagnosis.

Depression in any season can bring thoughts of suicide. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

There's no lab test for SAD. A careful evaluation looks at your mood over time, and especially at whether it follows the seasons:

• When your symptoms start and ease each year, and how many years it has happened
• How they affect your sleep, appetite, energy, work and relationships
• Whether you also feel low at other times of year, which can point to depression that's there year-round, such as major depression or persistent depressive disorder
• Any past periods of unusually high energy, less need for sleep or racing thoughts, which can point toward bipolar II or another bipolar disorder and would change the treatment plan
• Your health and medications, since some medical conditions (such as thyroid problems) and some medications can cause similar symptoms
• What you've tried before, including light boxes, supplements or past treatment

A seasonal pattern is usually identified when it has repeated for at least 2 years in a row. The evaluation is part of a comprehensive psychiatric evaluation. Your provider may also suggest lab tests to check for medical causes. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

When to get evaluated

It's worth reaching out if low mood, sleep or appetite changes come back at the same time each year and get in the way of work, relationships or daily life, or if this season feels harder than the last one. Because SAD tends to return on a schedule, early in the season, or before your symptoms usually start, is a good time to make a plan. If you've been looking for a psychiatrist for seasonal depression in New Jersey, our board-certified psychiatric nurse practitioners can evaluate what's going on and talk through your options.

Medication, when appropriate. Antidepressants can help SAD, and one medication, bupropion extended-release, is FDA-approved to help prevent winter episodes when it's started before symptoms usually begin. We explain each option, its side effects and what to expect, so you can decide together with your provider. This is part of our medication management.

Real work in visits. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills. We also talk through practical steps that can help in the darker months, such as getting outside in daylight when you can and staying active.

Therapy, when it would help. Cognitive behavioral therapy adapted for SAD (CBT-SAD) has been studied, and in a large trial it worked about as well as light therapy. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Planning ahead, and regular follow-ups. Because SAD tends to come back, we look at the whole year, not just this winter. Regular follow-ups let us see what's working and adjust carefully. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

Light therapy means sitting near a special bright light box each day, usually in the morning, during the months when symptoms tend to happen. It's meant to make up for the natural sunlight lost in the darker months. It has been a mainstay of treatment for winter-pattern SAD since the 1980s. A light box isn't the same as a tanning bed or an ordinary lamp.

Light boxes are sold without a prescription, but the type of light box, the time of day and how long to use it are worth working out with a clinician rather than guessing. Possible side effects include eye strain and headaches.

Light therapy isn't right for everyone. In some people with bipolar disorder, it can trigger hypomania or mania. If you have bipolar disorder, an eye condition, or take medications that increase light sensitivity, talk with your provider about whether light therapy will help before starting.