Seasonal Affective Disorder Treatment for People Ready to Feel Like Themselves Year-Round

SAD produces the same symptoms of a major depressive episode with additional characteristics present in the winter-onset pattern:

Core depressive symptoms:

• Persistent low mood, sadness, or emotional emptiness
• Lack of interest in engaging in activities
• Excessive feelings of guilt, hopelessness, or worthlessness
• Inability to concentrate or make decisions
• Thoughts of suicide or death in severe instances

Symptoms particularly characteristic of winter-onset SAD:

• Oversleeping, fatigue, and low energy regardless of amount of sleep
• Significantly increased appetite, especially for carbohydrates
• Weight gain
• Social withdrawal and inclination to “hibernate”
• Heaviness in limbs — a heavy, lead-like sensation
• Low energy throughout the day that does not improve with rest

These features, particularly oversleeping, carbohydrate craving, weight gain, and social withdrawal, distinguish winter SAD from the more typical insomnia and appetite loss seen in non-seasonal major depression, and reflect the distinct neurobiological mechanisms driving the seasonal variant.[8]

There is much more known about the neurobiology behind SAD compared to many other types of mood disorders, pointing directly to the effects of reduced sunlight on key biological systems, including:

• Disrupted circadian rhythms — As daylight hours decrease during the fall and winter months, the body’s internal clock is altered, affecting how the body regulates sleep, releases hormones, and uses its own neurotransmitters to regulate mood. Disruption of the body’s internal clock is a major factor in developing SAD.[9]
• Serotonin dysregulation — Reduced natural sunlight decreases the activity of the serotonin transporter system, lowering serotonin availability in the brain; serotonin is a primary neurotransmitter governing mood, appetite, and sleep.[10]
• Melatonin overproduction — When there are long periods of darkness, the brain will increase production of melatonin, which causes excessive drowsiness, fatigue, and lethargy, all common symptoms of SAD.[11]
• Vitamin D deficiency — Low vitamin D levels are often found in people who do not receive adequate amounts of sunlight, and low vitamin D increases the likelihood of developing depression.[12] Research continues into the relationship between vitamin D and mood states.
• Genetic predisposition — Those who have a family history of depression, bipolar disorder, or previous SAD episodes are more likely to experience SAD.[13]

Agape’s approach to treating SAD starts with a comprehensive evaluation of the client’s past experiences with seasonal depressive episodes and any current co-occurring medical or psychological issues. Each person receives a customized plan. Common elements used to treat SAD at Agape include:

• Cognitive-Behavioral Therapy (CBT) — Evidence-based psychotherapy for SAD, referred to as CBT-SAD, targets specific patterns of thinking and behavior that contribute to seasonal depressive episodes. Studies show that CBT-SAD results in symptom reduction similar to light therapy but with more sustained effects post-treatment, providing excellent opportunities for reducing future episodes.[14]
• Light Therapy — Exposure to sunlight for 20 to 30 minutes per day is recognized as one of the best initial forms of treatment for winter-onset SAD.
• Medication Management — Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and fluoxetine (Prozac) are among the most supported antidepressants for SAD. Our psychiatric staff manages prescription medication alongside the rest of an individual’s treatment plan.
• Vitamin D Assessment and Support — Given the association between sunlight exposure, vitamin D levels, and mood state, our clinical staff assesses patients’ vitamin D levels and recommends supplementation when deemed medically necessary as part of a patient’s overall treatment program.
• Psychoeducation and Lifestyle Support — Education about the neurobiological mechanisms of SAD and offering suggestions for managing lifestyle factors that support mood regulation across all parts of the seasonal cycle, including light exposure, sleep hygiene practices, and social interaction.