Seasonal Affective Disorder

Feb. 21, 2021

Winters feel long especially for people who suffer from seasonal affective disorder (SAD), a harrowing reality combined with COVID-19 shut-ins.

Seasonal Affective Disorder and COVID-19 Fatigue: Similar Treatments?

SAD is a condition where a person experiences mood changes or depression when the season changes. For example, some people may feel “down” as the days become shorter in autumn and begin to feel better at the start of spring when daylight hours are longer. In some cases, these seasonal mood changes can become more serious and negatively impact how a person feels, thinks and handles daily activities.

Erik Nelson, MD, UC Health psychiatrist at the University of Cincinnati Gardner Neuroscience Institute’s Mood Disorders Center and associate professor of psychiatry at the UC College of Medicine, is an expert in SAD, and provides answers to the most common questions focused on SAD and how COVID-19 fatigue might also affect those who have this type of depression. 

What is seasonal affective disorder (SAD)?

Less sunlight and shorter days are thought to be linked to a chemical change in the brain and may be part of the cause of SAD. Melatonin, a sleep-related hormone, also has been linked to SAD. The body naturally makes more melatonin when it's dark. When the days are shorter and darker, more melatonin is made.

Seasonal affective disorder is typically defined as experiencing a seasonal pattern to the onset of major depression. The most common variant includes depression with a fall to winter onset, though it is possible for sufferers from SAD to experience recurrent depression in the spring and summer months instead. ​Many patients who have depressive episodes that don't strictly follow a seasonal pattern report worsening of their symptoms in the fall and/or winter months.

What are the signs and symptoms of SAD?

SAD includes the same signs and symptoms that we associate with major depression in general—the defining characteristic that separates SAD from other forms of major depression is the seasonal pattern of recurrence. Therefore, people who have SAD will typically experience a combination of low mood, lack of ability to take joy from their usual activities, low energy, sleep and appetite changes, a decrease in sexual drive, low self-esteem and even thoughts of death. Increased fatigue, sleep and appetite/weight gain are especially common symptoms in patients with winter depression.

How does SAD impact a person’s outlook and well-being?

During the fall and winter months, or more rarely spring and summer, patients with SAD will often have a “dark” outlook and experience a general loss of their sense of well-being. Even if they are not experiencing a full major depressive episode, patients may struggle with “winter blues.” Decreased interest and a diminished sense of pleasure from things a person usually enjoys are very common symptoms of depression due to SAD as well. 

Who is at risk for SAD?

SAD usually starts during adulthood. The risk of SAD increases with age. It is rare in people under age 20. Women are affected more often than men.

How long does SAD typically last?

SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms often lasting up to four to five months per year.

How would you describe the symptoms of someone experiencing COVID-19 fatigue?

COVID-19 can present in a variety of ways, and symptoms can include profound fatigue. However, even outside of those actually infected by COVID, many people are describing a significant emotional impact from anxiety around COVID, for themselves or loved ones--as well as from the many restrictions necessitated by the pandemic.

How can those who have SAD be further impacted by fatigue from dealing with the COVID-19 pandemic?

Episodes of depression are often precipitated by external stressors, which disturb our emotional equilibrium. The consequences of COVID-19 and anxiety around the pandemic can serve as a major stressor for vulnerable individuals.

Deeper into the winter, individuals who already have a propensity to mood disorders this time of year are at even greater risk of experiencing fatigue and other symptoms of depression. ​Given that fatigue is common in depression, and especially winter depression, people with SAD may be more severely affected by COVID-19-related fatigue. Treating the preexisting SAD using evidence-based strategies such as bright light therapy, psychotherapy, nutritional interventions and certain antidepressant medications may help reduce the "double whammy" of COVID-19 fatigue combined with symptoms of SAD.

What treatment is available for SAD?

SAD is treated like other forms of depression, but may be especially responsive to light therapy. This treatment uses a special type of light source called a lightbox, which is much brighter than a typical lamp or light fixture found within the home, and which is the type of light that has been determined to most likely improve SAD.

Light therapy is easy and safe with few side effects. Those who have eye problems or who take medications that cause sensitivity to light should not use light therapy without first consulting a doctor. Individuals with bipolar depression should also speak with their provider before using a lightbox.

Light therapy is usually started in the fall and continued through spring. It is usually prescribed for 30 minutes to two hours per day, depending on the intensity of the light used and individual response. Individuals who are just starting light therapy should begin using their lightbox for no more than 15 minutes and gradually increase their exposure.

The most common side effects of light therapy include headache, eye strain and nausea. You may feel tired during the first week of therapy due to changes in sleep-wake patterns, however, this typically goes away in a week or so. Patients with bipolar disorder who are considering using light therapy for winter depression may experience a breakthrough of manic symptoms and should therefore consult with their physician before beginning treatment.

Can SAD treatments also help with overcoming COVID-19 fatigue?

COVID-19-related factors can precipitate and exacerbate depression, while depression may make navigating the current COVID-19 environment even more difficult. Aggressively treating symptoms of depression through a range of approaches can help to mitigate the effects of COVID-19 and to maintain our general sense of well-being.

Discover More

UC Health Psychiatry, in conjunction with the UC College of Medicine Department of Psychiatry, is conducting a clinical trial for people who are not responding adequately to an antidepressant treatment. Those who have an interest in participating in this trial should call 513-558-4997 or click here for information.