Seasonal Affective Disorder (SAD) and Other Holiday Mental Health Conditions

As the holiday season approaches, it’s common to experience a mix of emotions, from joy and celebration to stress and occasional anxiety. The so-called “holiday blues” or “winter blues” can cast a shadow on what is meant to be a festive time for many. While it’s normal to feel overwhelmed or nostalgic during this period, sometimes these feelings persist or intensify, interfering with daily life and well-being. This is where seasonal depression, also known as Seasonal Affective Disorder (SAD), comes into focus.

SAD is a form of depression that follows a specific seasonal pattern, typically surfacing in fall and winter. Beyond the transient holiday stress, SAD involves persistent and often severe symptoms that impact individuals for about 4-5 months each year [11]. While there isn’t much individuals can do to prevent SAD, there are several treatments to improve symptoms and prevent them from worsening. In this article, we explore the nuances of Seasonal Affective Disorder (SAD), shedding light on its distinct seasonal patterns and offering practical insights to manage its impact on mental health.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is a form of depression associated with specific seasons, primarily fall and winter, impacting individuals for about 4-5 months each year [11]. The exact causes are not fully understood, but factors such as sunlight, genetics, and neurotransmitters are believed to play a role [11]. Symptoms include low mood, anxiety, and changes in sleep, appetite, and energy levels [11].

SAD Symptoms

Not everyone experiences SAD the same way, and symptoms can vary from person to person. Symptoms of winter-onset SAD can include: [1]:

  • Changes in appetite
  • Weight gain
  • Fatigue
  • Headache
  • Sleeping more than usual
  • Difficulty concentrating
  • Irritability
  • Avoidance of social situations
  • Feelings of guilt or hopelessness
  • Loss of interest in activities that were once enjoyed.
  • On the other hand, summer-onset symptoms involve [1]:
  • Loss of appetite
  • Weight loss
  • Insomnia or trouble sleeping
  • Increased irritability
  • Anxiety
  • Agitation

SAD symptoms tend to recur at the same time each year [1]. Treatment requires specific strategies because of the cyclical nature of the disorder and how it affects individuals during specific seasons. While it tends to impact individuals for 4-5 months each year, treatment often continues beyond the time that symptoms are present, and some people need continued treatment to control their symptoms [1].

What causes Seasonal Affective Disorder?

In the United States, SAD prevalence ranges from 4% to 6%, with an additional 10% to 20% experiencing milder forms [1]. It is frequently observed in northern regions with longer, harsher winters and reduced sunlight [1].

The exact causes of Seasonal Affective Disorder (SAD) are not fully understood, but there’s a recognized connection between this condition and the reduced sunlight typical in fall and winter [1]. Researchers suggest that the lack of sunlight during these seasons can affect the body in ways that might contribute to SAD [1,11]. Some of the factors include disruptions to the circadian rhythm or biological clock, potentially leading to feelings of depression [1].

Sunlight also plays an important role in maintaining serotonin levels, a neurotransmitter that influences mood, and the drop in sunlight may result in lower serotonin levels, potentially triggering depressive symptoms [1]. Additionally, the impact on melatonin levels, a chemical governing sleep, and the possible deficiency in vitamin D, which we mostly get from sunlight, highlight the relationship between seasonal changes and the development of SAD [1].

Who is at Risk for SAD?

Seasonal Affective Disorder doesn’t impact everyone the same way, and certain people are at higher risk, such as [1, 5]:

  •  Female: SAD is diagnosed four times more frequently in women than in men.
  •  Living far from the equator: Living in more northern regions of the United States increases the probability of health risks due to receiving less sunlight during the fall and winter seasons.
  •  Family history of SAD or other mood disorders: Your chances of developing SAD or different types of depression are higher if you have family members who suffer from mood disorders such as major depression and bipolar disorder.
  •  Younger people: Depression, also known as SAD, is prevalent in younger adults and has been observed in teenagers and children as well. As one grows older, the likelihood of experiencing this condition decreases.

While seasonal affective disorder is considered a fall and winter disorder, there are two forms: winter-onset and summer-onset. Although winter-onset SAD is more common, the existence of summer-onset SAD adds a layer of complexity to our understanding of this condition. In the case of summer-onset SAD or summer depression, depressive symptoms emerge during the spring or early summer, contributing to the nuanced nature of seasonal affective disorders [10].

Winter Depression, Holiday Stress, and Anxiety

Navigating the holiday season proves challenging for many, stirring a mix of emotions and stressors. The so-called “holiday blues” may surface due to various factors, such as hectic schedules, family tensions, and the distance from loved ones [3]. Beyond the festive exterior, the pressure to meet lofty expectations can amplify stress for organizers and hosts, compounding emotional challenges during this time.

The ongoing stressors, like trying to create a flawless holiday experience, coupled with financial constraints and social commitments, can cause people to feel overwhelmed [2,10]. Research has shown that 31% of adults anticipate increased stress during this season, with concerns about affordability particularly impacting younger adults and those with lower incomes [2,10]. Negotiating workplace stress, balancing responsibilities, and striving for a perfect holiday atmosphere create a scenario where stress coexists with the traditional cheer of the holidays.

These stressors can also contribute to people experiencing increased anxiety, reported by 41% of Americans [11]. It’s crucial to recognize signs of depression for effective management — prolonged feelings of sadness, diminished interest in once-enjoyed activities, persistent anxiety, and sleep disturbances may be a sign of seasonal affective disorder [3]. As we navigate the holiday season, acknowledging and addressing these emotional challenges is essential for a healthier and more fulfilling experience.

Tips for Handling Holiday Stress

Practical strategies for managing stress and depression during the holidays involve various approaches. Acknowledging and remembering loved ones who are no longer present can be a positive experience, enriching the holiday season. Setting boundaries in challenging relationships, such as declining invitations or leaving events early, is recommended to alleviate stress. Staying connected with your family and engaging in charity work can combat loneliness, while limiting social media use helps avoid unrealistic comparisons. Seeking support through therapy or confiding in trusted loved ones is crucial for those experiencing heightened stress, depression, or anxiety during the holidays [3].

As the holiday season approaches, many individuals grapple with the dual emotions of joy and stress. Taking practical steps can help manage holiday stress and enhance overall well-being during this festive period [5]:

  • Acknowledge Your Feelings: Recognize and accept any sadness or grief that may arise, especially if you’ve recently lost loved ones. It’s crucial to allow yourself to experience these emotions, understanding that it’s okay to cry. Sharing your feelings with someone supportive can provide comfort, as you may discover that others share similar sentiments.
  •  Reach Out: Engaging in community, religious, or social events can foster connections and combat feelings of isolation. Utilize online platforms, social media, or virtual events to stay connected. Volunteering your time to help others can also be a powerful way to alleviate personal stress and contribute positively to the community.
  •  Be Realistic: Embrace the reality that it’s normal for holiday joy to fluctuate. Acknowledge family dynamics and traditions changes, adapting to new circumstances while holding onto cherished rituals. Find happiness in the evolving holiday experience through virtual celebrations or alternative activities.
  •  Set Aside Differences: Focus on the positive aspects of family members, avoiding contentious topics during gatherings. Understanding that others may also be experiencing holiday stress can foster empathy and tolerance. Choose this time to set aside grievances and prioritize harmony.
  •  Create a Budget: Gift-giving can contribute to financial stress. Establish a realistic budget before shopping to maintain control over expenses. Consider alternatives such as donating to charity, giving homemade gifts, or initiating a family gift exchange to minimize financial pressure.
  •  Plan Ahead: Schedule specific days for various holiday activities, from shopping to connecting with friends. Planning provides structure, turning obligations into anticipated events. This approach helps prevent the overwhelming feeling of too many tasks with limited time.
  •  Saying ‘No’ is Okay: Learn to decline invitations or projects when necessary, recognizing
  • g your limits. Colleagues and friends will likely understand, and setting boundaries prevents feelings of resentment or overwhelm.
  •  Maintain Healthy Habits: Amidst holiday indulgences, prioritize habits that promote physical and mental well-being. This includes having a healthy snack before celebrations, consuming balanced meals, ensuring sufficient sleep, engaging in regular physical activity, and incorporating stress-reducing practices like deep breathing, meditation, or yoga.
  •  Give Yourself a Break: Amidst the hustle and bustle, allocate time for yourself. Even a short break, free from distractions, can refresh your mind and restore inner calm. Whether it’s a daily walk, enjoying seasonal displays, or indulging in personal hobbies, these moments of respite are essential.
  •  Seek Professional Help: If persistent feelings of sadness and anxiety persist, consider consulting with a doctor or mental health professional. Seeking support is a proactive step towards managing emotional well-being during the holiday season.

Treatment options

Navigating Seasonal Affective Disorder involves collaborating with healthcare professionals to explore various treatments to manage symptoms effectively. From therapy and medications to innovative approaches like Transcranial Magnetic Stimulation, individuals have diverse options to tailor their treatment plans based on personal preferences and needs.


Antidepressants: Medications that can help alleviate symptoms of depression by affecting neurotransmitters in the brain [6]. Antidepressant medications, particularly those known as selective serotonin reuptake inhibitors, can prove effective in addressing Seasonal Affective Disorder (SAD) either independently or when combined with psychotherapy [8-9]. This is due to the association between SAD and disruptions in serotonin activity, similar to other forms of depression. Bupropion, an extended-release antidepressant, is FDA-approved for preventing the recurrence of seasonal depressive episodes when taken daily from fall through early spring [8-9].

 Hormonal Therapy: Involves hormonal treatments to address imbalances, potentially affecting circadian rhythms and mood [6].

Light Therapy

It involves exposure to very bright light, especially blue light, to regulate melatonin and serotonin levels, positively impacting mood [6]. Since the 1980s, light therapy has been a primary treatment for winter-pattern SAD. It involves exposure to a bright light box (10,000 lux) for about 30-45 minutes daily, usually in the morning, from fall to spring. This aims to compensate for the reduced natural sunlight during darker months. The light box filters out potentially damaging UV light, making it a safe treatment for most individuals [9].


Psychotherapy, also known as talk therapy or counseling, is a beneficial intervention for individuals dealing with Seasonal Affective Disorder (SAD). By imparting new ways of thinking and behaving, it aims to break the habits contributing to depression.

Cognitive Behavioral Therapy (CBT), tailored for SAD as CBT-SAD, stands out as a focused psychotherapeutic approach. This method targets replacing negative thoughts associated with the season with more positive ones. A structured CBT-SAD program typically spans two weekly group sessions over six weeks, incorporating behavioral activation exercises. These sessions help participants identify and schedule enjoyable activities, offsetting the loss of interest commonly experienced during challenging winter or summer [9].

Broadly, CBT as a form of psychotherapy seeks to change patterns of thinking or behavior that contribute to individuals’ problems, influencing how they feel [6]. This comprehensive and goal-oriented approach is beneficial in breaking free from the negative cycles of Seasonal Affective Disorder, offering useful tools for lasting change.

Lifestyle and Holistic Treatments:

  • Dietary Modifications: Changes in diet, possibly including vitamin D supplementation, to address deficiencies related to sunlight exposure [6].
  •  Increased Exercises: Regular physical activity boosts dopamine levels and improves overall well-being [6].
  •  Meditation: Mindfulness practices that may help manage stress and improve mental health [6].
  •  Sleep Hygiene: Establishing good sleep habits and patterns to support overall mental health [6].
  •  Dawn Stimulation: Exposure to light, particularly in the morning, to regulate circadian rhythms and improve mood [6].
  •  Vitamin D Supplementation: Taking vitamin D addresses deficiencies related to sunlight exposure and supports overall health [6]. For winter-pattern SAD, where vitamin D deficiency may be a factor, vitamin D supplements may help improve symptoms.

Transcranial Magnetic Stimulation TMS

Transcranial Magnetic Stimulation (TMS) is a non-invasive medical procedure that uses magnetic fields targeted to specific areas of the brain associated with regulating mood [2]. TMS has emerged as a promising treatment for depression and other mental disorders, especially when traditional treatment options, such as medication and psychotherapy, are not effective [1]. It is approved by the US Food and Drug Administration (FDA) for the treatment of depression [7].

The underlying idea of TMS is to modulate neural activity in targeted regions, providing a non-invasive alternative for people who haven’t found relief through conventional methods [2]. One advantage of TMS is that it is considered safe and well-tolerated; generally, people experience minimal side effects  [4, 7].

Seek Support

Dealing with mental health challenges, like Seasonal Affective Disorder (SAD) involves recognizing patterns and individual triggers. The holiday season may bring stress, but prioritizing self-care and seeking support can make a difference. From traditional therapies to innovative options like Transcranial Magnetic Stimulation, there’s a range of approaches in the mental health landscape. Remember, there’s hope and help available for those navigating their journey towards emotional well-being.

 If you or someone you know is struggling with Seasonal Affective Disorder (SAD), Neuro Wellness Spa can help. Our team of experts offers a range of mental health treatments, including medication management and TMS therapy, that are proven to treat SAD symptoms. Take control of your well-being by contacting Neuro Wellness Spa today and learn how we can support you.


  1.  American Academy of Family Physicians. Seasonal Affective Disorder.
  2.  American Psychiatric Association (2022, December 1). As Holiday Season Begins, America’s Stress Rises, But Less About COVID-19.
  3.  Cleveland Clinic (2021, November 19). How To Cope With Holiday Stress and Depression.
  4.  Mayo Clinic (2023, April 7). Transcranial magnetic stimulation.
  5.  Mayo Clinic (2021, December 6). Tips for taking control of the holidays (so they don’t take control of you).
  6.  Munir S, Abbas M. Seasonal Depressive Disorder. [Updated 2023 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  7.  McClintock, S. M., Reti, I. M., Carpenter, L. L., McDonald, W. M., Dubin, M., Taylor, S. F., Cook, I. A., O’Reardon, J., Husain, M. M., Wall, C., Krystal, A. D., Sampson, S. M., Morales, O., Nelson, B. G., Latoussakis, V., George, M. S., Lisanby, S. H., National Network of Depression Centers rTMS Task Group, & American Psychiatric Association Council on Research Task Force on Novel Biomarkers and Treatments (2018). Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. The Journal of Clinical Psychiatry, 79(1), 16cs10905.
  8.  National Institute of Mental Health.Depression.
  9.  National Institute of Mental Health. Seasonal Affective Disorder.
  10. Holiday Stress.
  11.  (2022, December 5). ‘Tis The Season to Focus On Your Mental Health. Johns Hopkins Medicine.
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