by Marwan Hamed, MPH

Did you know?

DSM-5 was created by the American Psychiatric Association

DSM-5 took over 10 years and hundreds of mental health experts from across the globe to create.

DSM-5 is the most up to date mental health classification manual used by health professionals in the US and many other parts of the world.

Seasonal affective disorder — SAD, for short — is listed under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a type of depression. With SAD, people struggle with season-based periods of lows (depression), which can alternate with stretches of normal mood, or highs (hypomania), and — for some — extreme highs (mania).

In the most usual type of SAD, lows kick in as winter approaches, followed by relief (or highs, or extreme highs) in late spring, lasting through summer. With this type of SAD come the added symptoms of tiredness, increased food cravings, weight gain, and need for extra sleep. Most people with SAD experience these symptoms, and they are also the ones most likely to respond to light therapy.

It may be the most usual type, but it’s not the only seasonal mood pattern. In fact, for some people SAD lows begin during the warmer months, and they feel better  — some with highs or extreme highs  during the colder months. With this type of SAD come the added symptoms of restlessness, low appetite, weight loss, and difficulty getting to or staying asleep (insomnia).  For every person who experiences summer SAD, about ten times as many experience winter SAD. Clearly, there’s no lack of light in summer. Rather, heat and humidity may be the culprit.  (Strong air conditioning can help!)

Whatever type of SAD someone has, there are two common things that mental health professionals look for before diagnosing SAD:

  1. two season-based episodes of depression in the last two years, with no off-season episodes.

  2. a lot more seasonal episodes than non-seasonal ones over their lifetime.

➜How much more? It’s best to go over this with a mental health professional. Then, they can better diagnose and offer advice or treatment.

The bottom line: SAD diagnosis is going to be largely based on the patterns of highs and lows over the past two years, combined with lifetime experiences. Also, there are going to be differences for some people as to which seasons, and when during those seasons the lows begin.

SAD in the Big Apple: an example

A study in New York City surveyed a random sample of adults and found that as winter begins to roll in, people in general become more tired, their moods start lowering, and their need for sleep, cravings for food, and weight grow higher. Around the holidays, they get a temporary boost of energy and are more ready to meet and interact with others. Besides the holidays, people find themselves less interested in being social until the spring. During the hottest months, they sometimes have lower moods, but it does not affect their interest in being social. Also, their moods are not as low as during the winter.

The results of this study do not represent everyone, because it’s an average. This means that some people show these symptoms, some do not, and others are somewhere in the mix. But this information is helpful so people with SAD know that they are not alone in noticing these symptoms. They still need proper support, help, and treatment, because the lows of depression can severely interfere with life.  Keep in mind that SAD is just one kind depression, and many more people get depressed for varying periods of time, no matter what the season is. SAD stands out because the lows are predictable — you know in advance when they are going to hit.

SAD in Switzerland, year-by-year

A Swiss study gave a series of five interviews to 500 people who had periods of depression, whether or not it was strictly seasonal. The study lasted more than 20 years and was published in 2018. The researchers found that winter lows do not happen every year for people with SAD, but happen often enough that they came more often than the lows which could also occur in other seasons. Also, some winters were just gloomy for these people — almost the lows of depression but not quite there. And sometimes winters would pass without the person feeling down at all.

Seasonal symptoms can be bothersome even without depression

Some people can experience a set of bothersome seasonal symptoms — also seen in SAD — but without the lows. The have lower energy and feel the need for much more food and sleep. It becomes a challenge for them to wake up in time for school or work, and their weight gain is hard to control until the seasons change. Studies find that people with these symptoms may also respond to light therapy, but we need more research to know for sure.

These non-depressive symptoms can be very helpful to better understand and treat SAD. About a month before the seasonal lows begin to kick in, people struggling with SAD also start losing energy, sleeping longer, and eating too much. Knowing this can really help them, because they can take action and talk with their health care provider before they get to their winter lows, and they can even begin light therapy earlier. This way, they might even be able to avoid those extreme seasonal lows, altogether.

So, if winter is coming and you notice yourself spending time at night going through your fridge and cabinets searching for snacks, take action and talk to your mental healthcare provider. This could be an early warning sign of the approaching lows. Talking to your provider can help you get ready in advance. Think of it as spraying salt before the snow falls or carrying an umbrella when you know rain is on its way.

The opposite pattern: lows with decreased appetite and sleep

Occasionally, people with SAD find themselves sinking into the winter lows every year but without the food craving and sleepiness. In fact, they tend to lose appetite and experience insomnia. For these people, light therapy, alone, is much less likely to work. Antidepressant medication, prescribed by a psychiatrist, seems to be the way to go for people with this type of SAD. Now, could light therapy help as an added factor to the medicine? Maybe, but for now it’s not clear. Hopefully, future research will give us more answers, so people with all the variations of SAD can get the best quality, fine-tuned treatment they deserve!

Create a record with the details your provider will want to see

It makes good sense to come to an appointment armed with as much information as possible about your experience with SAD. Your provider may need to be convinced. And CET offers an easy way to prepare:

  1. If you are already feeling low, take the AutoSIGH online questionnaire, and print out the results.

  2. If you aren’t quite sure how much you follow a seasonal mood pattern, take the AutoPIDS questionnaire, and see how you compare with others who have experienced SAD.

Marwan Hamed is a freelance writer for CET.