Seasonal affective disorder (SAD)

Even with a thorough evaluation, it can sometimes be difficult for your health care provider or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.

To help diagnose seasonal affective disorder (SAD), a thorough evaluation generally includes:

• Physical exam. Your health care provider may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your health care provider may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.
• Psychological evaluation. To check for signs of depression, your health care provider or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions.

Treatment for seasonal affective disorder may include light therapy, psychotherapy and medications. If you have bipolar disorder, tell your health care provider and mental health professional — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

Light therapy is one of the first line treatments for fall-onset . It generally starts working in a few days to a few weeks and causes very few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving symptoms.

Before you purchase a light box, talk with your health care provider about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask about how and when to use the light box.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat . A type of psychotherapy known as cognitive behavioral therapy can help you:

• Learn healthy ways to cope with , especially with reducing avoidance behavior and scheduling meaningful activities
• Identify and change negative thoughts and behaviors that may be making you feel worse
• Learn how to manage stress
• Build in healthy behaviors, such as increasing physical activity and improving your sleep patterns

Medications

Some people with benefit from antidepressant treatment, especially if symptoms are severe.

An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of . Other antidepressants also may commonly be used to treat .

Your health care provider may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.

In addition to your treatment plan for seasonal affective disorder:

• Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
• Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
• Normalize sleep patterns. Schedule reliable times to wake up and go to bed each day. Especially for fall-winter-onset , reduce or eliminate napping and oversleeping.

Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder.

Herbal remedies and dietary supplements aren't monitored by the U.S. Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider or pharmacist before taking any supplements.

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.

These steps can help you manage seasonal affective disorder:

• Stick to your treatment plan. Follow your treatment plan and attend therapy appointments when scheduled.
• Take care of yourself. Get enough sleep to help you feel rested, but be careful not to get too much rest, as symptoms often lead people to feel like hibernating. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don't turn to alcohol or recreational drugs for relief.
• Practice stress management. Learn techniques to manage your stress better. For example, you may try relaxation techniques such as yoga, tai chi and meditation. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
• Socialize. When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
• Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter or to cooler locations if you have summer .

You may start by seeing your health care provider or a mental health professional such as a psychiatrist or psychologist.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Your symptoms, such as feeling down, having a lack of energy, excess sleeping and appetite changes
• Your depression patterns, such as when your depression starts and what seems to make it better or worse
• Any other mental or physical health problems you have — both can affect mood
• Any major stressors or life changes you've had recently
• All medications, vitamins, herbs or other supplements you're taking, including dosages
• Questions to ask your health care provider or mental health professional

Some basic questions to ask may include:

• Are my symptoms likely caused by , or could they be due to something else?
• What else could be causing or worsening my symptoms of depression?
• What are the best treatment options?
• Would using a light box help my symptoms?
• Are there any restrictions that I need to follow or steps I should take to help improve my mood?
• Should I see a psychiatrist, psychologist or other mental health professional?
• Are medications likely to improve my symptoms?
• Is there a generic alternative to the medication you're prescribing me?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care provider or mental health professional is likely to ask you a number of questions, such as:

• What are your symptoms?
• When did you first begin having symptoms?
• Have your symptoms been continuous or occasional?
• How do your symptoms impact your daily activities?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you have any other physical or mental health conditions?
• Are you taking any medications, supplements or herbal remedies?
• Do you use alcohol or recreational drugs?
• Do any of your blood relatives have or another mental health condition?

Your health care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.