Seasonal affective disorder (SAD, colloquially referred to as seasonal depression) is a mood disorder subset in which people who typically have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year. It is commonly, but not always, associated with the reductions or increases in total daily sunlight hours that occur during the winter or summer. Common symptoms include sleeping too much, having little to no energy, and overeating. The condition in the summer can include heightened anxiety. However, there are significant differences in the duration, severity, and symptoms of each individual's experience of SAD. For instance, in a fifth of patients, the disorder completely resolves in five to eleven years, whereas for 33–44% of patients, it progresses into non-seasonal major depression. In the DSM-IV and DSM-5, its status as a standalone condition was changed: It is no longer classified as a unique mood disorder but is now a specifier (called "with seasonal pattern") for recurrent major depressive disorder or bipolar disorder that occurs at a specific time of the year and fully remits otherwise. Although experts were initially skeptical, the condition eventually became recognized as a common disorder. However, the validity of SAD was called into question by a 2016 analysis from the Centers for Disease Control, when it found no links between depression, seasonality or sunlight exposure. In the United States, the percentage of the population affected by SAD ranges from 1.4% of the population in Florida to 9.9% in Alaska.
Signs and symptoms SAD is a type of major depressive disorder, and those with the condition may exhibit any of the associated symptoms, such as feelings of hopelessness and worthlessness, thoughts of suicide, loss of interest in activities, withdrawal from social interaction, sleep and appetite problems, difficulty with concentrating and making decisions, decreased libido, a lack of energy, or agitation. Symptoms of winter SAD often include falling asleep earlier or in less than 5 minutes in the evening, oversleeping or difficulty waking up in the morning, nausea, and a tendency to overeat, often with a craving for carbohydrates, which leads to weight gain. SAD is typically associated with winter depression, but springtime lethargy or other seasonal mood patterns are not uncommon. Although each individual case is different, in contrast to winter SAD, people who experience spring and summer depression may be more likely to show symptoms such as insomnia, decreased appetite and weight loss, and agitation or anxiety.
Bipolar disorder With seasonal pattern is a specifier for bipolar and related disorders, including bipolar I disorder and bipolar II disorder. Most people with SAD experience major depressive disorder, but as many as 20% may have a bipolar disorder. Bipolar disorder is characterized by alternating episodes of depression and mania or hypomania. Depressive episodes include symptoms such as low energy, difficulty concentrating, changes in sleep and appetite, feelings of hopelessness, and suicidal thoughts. Manic episodes, which are more common in bipolar I disorder, may include elevated mood, decreased need for sleep, impulsivity, and increased activity or risky behaviors. In contrast, hypomania (seen in bipolar II disorder) presents as a milder form of mania without significant impairment in daily life. It is important to distinguish between diagnoses because there are important treatment differences. In these cases, people who have the With seasonal pattern specifier may experience a depressive episode either due to major depressive disorder or as part of bipolar disorder during the winter and remit in the summer. Around 25% of patients with bipolar disorder may present with a depressive seasonal pattern, which is associated with bipolar II disorder, rapid cycling, eating disorders, and more depressive episodes. Differences in biological sex display distinct clinical characteristics associated to seasonal pattern: males present with more Bipolar II disorder and a higher number of depressive episodes, and females with rapid cycling and eating disorders.
ADHD A study by the National Institute of Health published findings in 2016 that concluded, "seasonal and circadian rhythm disturbances are significantly associated with ADHD symptoms." Participants in the study who had ADHD were three times more likely to have SAD symptoms (9.9% vs 3.3%), and about 2.7 times more likely to have s-SAD symptoms (12.5% vs 4.6%). Those with ADHD and SAD are likely to experience sluggishness, irritability, and withdrawal. A study published in the Journal of Affective Disorders found that approximately 27% of adults with ADHD also experience SAD, with women being more susceptible than men.
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