For Rocklin resident Linda Blackmarr, it happens every year like clockwork.
Literally.
“Every year I dread the time change—that’s when I start getting anxious,” she says. Thus begins the cycle: Each fall, when daylight saving time ends and we turn the clocks back an hour, Blackmarr begins anticipating winter weather and another season of SAD.
SAD could not be a more perfect acronym for seasonal affective disorder, which brings an annual cloak of sadness (think Sacramento fog) to about 5% of adults in the United States, according to the American Psychiatric Association. Classified in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, as a type of depression (major depressive disorder with seasonal pattern), SAD typically takes hold during the fall and winter months, when there is less sunlight, and reverses itself with the arrival of spring. Symptoms (in addition to sadness) commonly include lack of interest in previously enjoyed activities, changes in sleep and appetite, loss of energy, and difficulty focusing or making decisions. At its most severe, SAD can even lead to thoughts of death or suicide.
But wait! Here’s the sunny lining: SAD is treatable—and often easily so, with such cool gadgets as a light box or just a good pair of sneakers. (Exercise really helps.)
As with all things, knowledge is power. Here are seven things to know about SAD.
1. Yes, Sacramentans get it (though maybe not as many as in, say, Seattle). In a super-sunny city like Sacramento, how many people actually suffer from SAD? “We don’t really know,” says Mark Servis, M.D., a professor of clinical psychiatry at UC Davis who has a special interest in SAD and has treated patients for the condition. “But we have a lower rate here than many places, comparatively.” What we do know, says Servis, is this: The farther north you go and the less sunlight in the environment, the higher the incidence of SAD. So, yes, Seattle. (And Alaska.)
Still, Sacramentans are not immune—and the drearier and drippier the winter, the more susceptible we are, says Servis. Fog, too, can be a factor. “The foggy, dreary winters can have a dampening effect,” he says. “I’ve seen it be part of the challenge for patients here in Sacramento who are vulnerable to SAD.” Most SAD patients are women, he notes, with a ratio of about 4 to 1 (women to men).
2. This year may be double trouble. Although Sacramento is not traditionally a hot spot for SAD, mental health experts worry there may be a spike this year for an obvious reason: COVID-19. A survey study recently published in the JAMA Network Open found that symptoms of depression among U.S. adults were more than three times higher during the pandemic than prior to it, suggesting that the number of individuals experiencing SAD this winter may also increase. “With COVID, people are stuck at home more and aren’t getting out as much as they normally would, and we could see an increase in SAD this year as a result,” says Servis.
Maria Koshy, M.D., chief of psychiatry at Kaiser Permanente in South Sacramento, agrees. “This year there’s an added variable with the pre–existing stresses that have been going on since last year, including staying socially isolated and shifting indoors,” she says. “People who already have a susceptibility to SAD need to be extra-vigilant this winter.” How so? Koshy’s recommendations for people with SAD are the same as those who are isolated at home: Stay physically active and spend some time in sunlight (direct or indirect) every day. “Try early mornings or evenings, when there’s a shift in light,” she suggests.
3. Science is still sorting it out. Why do some people get SAD while others don’t? Science is still trying to find answers. But research suggests the “tonins”—serotonin and melatonin—are likely suspects. It’s a double whammy: Serotonin, the “feel good” brain chemical (neurotransmitter), can be reduced when there’s less sunlight. In addition, the body’s melatonin levels can be disrupted by the change in season, affecting sleep patterns and mood. Reduced sunlight can also throw off the body’s internal clock, or circadian rhythm, leading to feelings of depression. Genetics and environment also come into play, “like with any disease process,” says Kaiser’s Koshy. “There’s a lot of individual variation in the genes.”
Blackmarr offers a simpler explanation. “I’m solar-powered,” she says. “I have to have the sun.” In spring and summer, the 70-year-old retiree finds joy in the great outdoors, walking, hiking and bicycling. But when winter hits, “I hardly do those things, because I can’t make myself leave the house,” she says. “When the sun starts going away at 4 or 4:30 in the afternoon, it’s like I’m done. I put on my comfy clothes and just want to stay in and hibernate. I’m not a complete hermit or anything, but it’s a struggle.”
4. SAD is different from “regular” depression. But many of the symptoms are the same. So how do you know which is which? Primarily, it’s all about timing: Whereas SAD happens at specific times of year, regular depression is an equal–opportunity employer, not bound to any season.
But there are other telltale differences, too. Instead of sleeping and eating too little, which commonly happens with classic depression, people with winter-onset SAD tend to do just the opposite, notes Servis.
“Those are the two areas where the symptomology tends to be different, which helps me when I’m diagnosing it,” he says. “People with normal depression typically have trouble getting sleep and have no appetite; they might drop 15 to 20 pounds. But if you’re sleeping all the time and gaining weight, and your depressions happen in the winter months, that tells me it’s likely to be SAD.”
Blackmarr, who is self-diagnosed, fits that profile. “I usually gain 10 or 15 pounds in the winter. I call it my winter coat,” she says with a laugh. “There’s boredom eating, baking, all those things that go with winter. I turn on the movie, I become sedentary, which I would not normally do in the summer. So that’s the contrast right there. I try to take off the weight in the spring.”
5. There’s also “summer SAD.” In this sun-worshipping society, it may be hard to believe, but not everyone loves sun and heat. For some, it can even result in summer-pattern or “reverse” SAD, also known as summer depression. Though far less common than winter SAD, it can pack an equally depressive punch, though the symptomology is somewhat different: Unlike their winter counterparts, who tend to oversleep and overeat, summer SAD sufferers are more likely to sleep and eat too little, and may also experience restlessness and agitation, according to the National Institute of Mental Health.
Whether SAD happens in winter or summer, the depressive episodes must occur for at least two consecutive years for a diagnosis to be made, according to DSM-5 criteria.
6. Help is available. When should you seek professional help? Ask yourself this: How much is the disorder affecting your functioning? “If you are withdrawing from relationships, if you notice your ability to function at work and/or at home is decreasing, if you’re noticing changes in your eating and sleeping patterns, and obviously if you’re thinking about ending your life, you need to seek help,” advises Koshy.
Light therapy has been the cornerstone of treatment for SAD since the 1980s, and with good reason: It works. Typically, treatment involves sitting in front of a very bright light box (10,000 lux is standard) at a 16– to 24–inch distance for at least 20 minutes a day, usually in the early morning. While you can buy a light box without a prescription, experts advise making sure it’s bright enough and that it filters out harmful UV (ultraviolet) rays. Though generally safe, light boxes can cause side effects for some, so check with your doctor.
Other treatment options used independently or in conjunction with light therapy include antidepressant medications (most commonly SSRIs, or selective serotonin reuptake inhibitors) and psychotherapy. Online therapy, which has boomed during the COVID pandemic, also may make it more convenient for many to get the help they need. Of the various forms of therapy, cognitive behavioral therapy is especially beneficial in treating SAD, according to the American Psychiatric Association.
Vitamin D, the “sunshine vitamin,” has also been studied as a possible treatment option for SAD, but so far the jury’s out. Still, it may be worth trying since it has been helpful for some.
7. Self-care measures. Not everyone with SAD requires professional help. Basic self-care—healthy eating, regular exercise, getting enough sleep and staying connected (more challenging during a pandemic, perhaps, but still possible)—can go a long way toward alleviating or even preventing SAD symptoms. “For many people, the solution is right out the front door,” says Servis. “For normal depression, we recommend people get outside and exercise as a part of improving their well-being, and I believe part of the benefit might be the light people get by being outdoors. Light boxes are amazingly bright, but outside it’s tenfold brighter in a normal day. We sometimes don’t appreciate the profound benefit of being outside.”
Help in a Hurry
If you or someone you know needs immediate help, call the National Suicide Prevention Lifeline toll-free at (800) 273-TALK (8255). Their website, suicidepreventionlifeline.org, offers additional resources and information, including a Lifeline Chat. You can also reach a crisis counselor via the Crisis Text Line (crisistextline.org) at 741741. All services are available 24/7.
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