Seasonal Affective Disorder: What Medications Should You Take?

Seasonal affective disorder (SAD) or seasonal depression is a subtype of major depression caused by changes in season. Finding the right treatment will enable you to stay on top of SAD and potentially prevent some of your symptoms. 

What is seasonal affective disorder?

Seasonal affective disorder (SAD) is a type of depression linked to a particular season like winter or summer. Although SAD is commonly referred to as winter depression because it usually strikes people during wintertime, a rare kind of SAD affects some people during the summer instead. 

People who have SAD only experience this condition once a year during the season that is typical for them to begin feeling symptoms. After the season has passed, their depression enters remission until the same time the following year. 

Antidepressants are often the first-line treatment for SAD, and melatonin is another treatment option available. 

While these medications have significant benefits, lifestyle changes are also encouraged to provide further improvements. 

Symptoms

Winter SAD is the most common type of seasonal depression. 

Symptoms of winter SAD may include:

• Depression

• Feeling hopeless

• Social withdrawal 

• Tiredness

• Increased appetite 

• Cravings for carbohydrates or sweet food 

• Weight gain

• Delayed onset of sleep 

• Hypersomnia - oversleeping and daytime tiredness

The symptoms of winter SAD typically start around late fall or early winter and persist until late winter or early spring. Once winter SAD has passed, it doesn’t return until the following fall or winter. 

On the other hand, symptoms of summer SAD may include: 

• Depression

• Agitation 

• Irritability 

• Low mood

• Tiredness

• Decreased appetite

• Insomnia - difficulty falling asleep and staying asleep

The symptoms of summer SAD usually start during late spring or early summer and last until late summer or early fall. Once summer SAD has passed, it doesn’t return until the following spring or summer. 

Since winter SAD is more common, many people refer to SAD as winter depression. However, if you have summer SAD, you must remember that both winter and summer SAD refer to the same condition, but the symptoms differ. As a result, different winter and summer SAD treatments may be prescribed. 

What causes seasonal affective disorder?

SAD is influenced by a combination of environmental and biological factors. 

Environmental factors include seasonal changes, light, and location. Biological factors are related to your body clock and chemicals inside your body, such as melatonin and serotonin. 

Your body clock can become disrupted by environmental factors. When this occurs, melatonin and serotonin become imbalanced. As a result, your mood, sleep, and eating habits are impacted. 

Because a seasonal change triggers SAD, some people start taking their medication before the seasonal change occurs. Or, if they stopped taking their medication when they were feeling better, they may restart before symptom onset. Taking certain medications enables them to reduce or prevent some of the symptoms associated with SAD.

What medications should you take for seasonal depression?

Antidepressants

If your SAD is severe, your doctor might prescribe you an antidepressant as a first-line treatment if this medication is right for you. Antidepressants can be used for winter and summer SAD. 

A common antidepressant used for SAD is selective serotonin reuptake inhibitors (SSRIs). Many SSRIs are available, such as fluoxetine and sertraline. 

Researchers say that people with SAD have reduced serotonin. That’s why SSRIs are favored for treating SAD because they enable serotonin to have a longer effect on the brain to improve your mood. 

Sometimes finding the right type of antidepressant that works for you can be challenging. However, don’t feel discouraged if SSRIs don’t work well, as there are other antidepressants you can try. 

These include: 

• Serotonin-norepinephrine reuptake inhibitors

• Monoamine oxidase inhibitors

• Tricyclic antidepressants

Because SAD is seasonal, you don’t need to be on antidepressants full time unless your doctor advises you. Some people stop their medication once their affected season has passed and restart before SAD strikes again. 

For instance, if you experience winter SAD, you could restart your medication during mid-fall. Or, if you experience summer SAD, you could start retaking your medication during mid-spring. 

If you’re restarting your medication, you need to allow a few weeks for it to begin to work. So, it might be best to ask your doctor when you should start your medication again. 

Before discontinuing any antidepressant treatment, you need to discuss this option with your doctor before stopping your medication.

Discontinuing your antidepressants can have negative side effects if done suddenly. Your doctor will need to gradually reduce your dose until it’s safe for you to stop to prevent these effects. 

Potential side effects of taking antidepressants are:

• Anxiety

• Insomnia

• Tiredness

• Weight gain

• Nausea

• Dry mouth

• Headaches

• Dizziness

• Sweating

If your side effects are bad or if you think your treatment is making your SAD worse, see your doctor immediately.

Melatonin

Melatonin is a hormone that makes you feel sleepy, and a melatonin imbalance is linked to SAD. 

During the day, the light suppresses your brain from releasing melatonin. However, at night, darkness induces the release of melatonin. 

Due to the days being shorter in winter and longer during summer, it can be difficult for your body to adapt to new light exposure levels. As a result, your melatonin may not be released when it should be. 

For example, due to the decreased daylight during winter, your body might release melatonin well before bedtime. As a result, you might experience daytime tiredness.

If you have summer SAD, your melatonin might be suppressed due to the increased daylight. Because of this, you might have difficulty sleeping at night, or you wake up very early most mornings.

Researchers¹ have suggested that melatonin might be an effective treatment for SAD. 

If you have winter SAD, experts recommend trying a low dose of melatonin during the late afternoon. Doing so may readjust your body clock and prevent you from having a late sleep onset. 

Additionally, higher doses of melatonin can also help with insomnia. This treatment may suit you if you have insomnia due to summer SAD.

In comparison to antidepressants, melatonin has fewer side effects. Because of this, some people opt for melatonin over antidepressants. 

The potential side effects of melatonin include sleepiness and impaired cognition. If these side effects are bothering you or affecting your work, you should discuss this with your doctor. 

Vitamin D supplements

Although supplements aren’t medications, they can still benefit you if you want to try something extra. 

Due to the decreased amount of light during winter, you might have less vitamin D. A vitamin D deficiency could affect your serotonin levels. 

Therefore, a vitamin D supplement could help restore your serotonin levels and benefit your overall health. 

Vitamin D has various benefits, such as maintaining bone health, improving gut health, and improving immune function. Vitamin D can also reduce your risk of developing serious illnesses such as heart disease and cancer. 

If you have winter SAD, then you might notice that your health becomes significantly compromised during winter. Looking after your physical health can also improve your mental well-being. 

While a supplement can potentially boost your vitamin D levels, evidence suggests that more vitamin D is derived from sunlight than from anywhere else. Because of this, you should still make an effort to go outside during winter when the sun is out. 

Lifestyle changes

Treatment can undoubtedly help. However, making additional lifestyle changes will improve your outcome further. 

Recommended lifestyle changes include:

• Practicing good sleep hygiene

• Keeping in touch with family and friends

• Exercising

• Improving your diet

• Mindfulness and relaxation

• Going outdoors 

• Trying new hobbies and activities 

In addition to your treatment, you could also try light therapy. Light therapy involves increasing the amount of light in your home or workplace during winter. You could also try using fluorescent lamps and dawn simulators in the morning. 

When to see a doctor

If you think you might need treatment or some other intervention for your SAD, you shouldn’t hesitate to see your doctor. 

You should also see a doctor when:

• Your treatment isn’t working adequately 

• You experience any unwanted side effects from your treatment

• Your SAD symptoms worsen

• You want to discontinue your treatment

The lowdown

There is a range of medications available to treat SAD. To find the right one, you need to discuss your options with your doctor. While medications can help alleviate some of the symptoms associated with SAD, lifestyle changes are still recommended.