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As the fallen leaves of autumn transition into the blustery cold of winter, many people around the world experience a seasonal type of depression known as seasonal affective disorder, commonly referred to as SAD. It’s been estimated that nearly 14 million Americans suffer from a severe form of SAD, while another 20 percent of the population exhibits some seasonal depression symptoms.

As for seasonal affective disorder statistics by state, the states with higher percentages tend to be situated at higher latitudes, with populations located closer to the poles particularly at risk. For example, only one percent of Floridians experience SAD compared to 9 percent for both Alaskans and New Englanders. These seasonal fluctuations are exceptionally pronounced in the Pacific Northwest with short December daylight hours often compounded by the gloominess of dense cloud coverage. Currently, about five percent of the Portland population suffers from severe seasonal depression with an additional 15 percent of the population experiencing moderate SAD symptoms.

“It’s not because of the clouds or the rain, it’s because of the latitude we live at, 45 degrees,” stated Dr. Alfred Lewy, professor of Psychiatry at Oregon Health and Science University. “The days are short in the winter and it’s not having the sun in the morning that’s what triggers it. We need to wake up in sunlight and in the winter solstice that’s very hard to do.”

Over the years, populations around the globe have developed rather clever ways to manage the effects of seasonal depression. For nearly half of the year, the mountains surrounding the small Norwegian town of Rjukan block direct sunlight for the inhabitants. To minimize the effects of this decreased sunlight, a series of massive mirrors were installed atop the mountains to track the sun and continuously reflect daylight toward the town. 

Fortunately, there are many more practical ways to treat seasonal affective disorder. While it’s possible to manage more mild cases of SAD with outdoor activity and exercises, some individuals may need medical intervention to cope with the seasonal effects of depression. 

Simply put: there’s no definitive opinion on how to fight seasonal depression. There are many effective options to help with all kinds of depression, including transcranial magnetic stimulation (TMS), a state-of-the-art treatment for depressive symptoms. 


During the colder winter months, it’s common for people to experience lethargy, sadness, and a disinterest in social activities. This general change in mood is known as the “winter blues,” and affects about 14 percent of the population annually. However, many individuals experience much more intense SAD symptoms, including weight gain, oversleeping, a lack of energy, appetite changes, a loss of interest in hobbies, feeling distracted, suicidal thoughts, and others. Those with a family history of depression are at an increased risk of seasonal depression and women are four times more likely to develop SAD than men.

While the exact underlying cause of SAD is still unknown, it is believed that with the arrival of fall and the decrease in natural sunlight exposure, there is a disruption in overall physiological chemistry involving various vitamins, hormones, neurotransmitters, and others. The phase-shift hypothesis, as it is called, posits that the shortened seasonal daylight hours causes a delay in melanin release leading to a disruption in our circadian rhythms.

“When light hits the retinas of our eyes, it stimulates certain receptors that send messages to the brain’s hypothalamus, which is like the ‘conductor of a symphony,’ telling the body when to release hormones, such as melatonin and cortisol, and signaling when the body should cool down and warm up,” per a recent seasonal depression update by The Seattle Times report.

Thankfully, there are many proven SAD treatment options available when this crucial circadian conductor seasonally falls out of rhythm. Once an individual has been diagnosed, and the severity of this seasonal depression is understood, a patient should embark on a depression therapy.


Each case of seasonal depression disorder is different and not every patient will respond to treatment in the same way. While mild to moderate SAD can possibly be managed with natural remedies and exercise, more severe symptoms may require medical intervention. Natural depression treatments are an increasingly popular for SAD sufferers and it has been estimated that up to one-quarter of the US adults seek and eventually acquire such alternative treatment for seasonal depression.

One effective “natural” remedy for mild SAD is simply ensuring an individual is exposed to enough sunlight during the winter months. This may involve going for a regular afternoon walks or switching to an outdoor exercise regimen. Extra sunlight exposure can increase Vitamin D and serotonin production and lead to mood improvements and decreased depression symptoms. For those exhibiting less severe depression symptoms, exercise may be just as effective as antidepressants when it comes to managing their symptoms, based on the latest research

“That kind of activity spurs the release of proteins called neurotrophic or growth factors, which cause nerve cells to grow and make new connections. The improvement in brain function makes you feel better,” according to the Harvard Medical School.

However, the majority of Americans fail to meet the daily exercise requirements of an effective exercise-based depression therapy. A typical symptom of seasonal depression disorder is lethargy, which increases the likelihood of missing the exercise treatments and sets the stage for relapse.

Artificial light therapy is an increasingly popular option for SAD sufferers around the globe. Melanin is a key hormone involved in the regulation of healthy sleep cycles and light therapy can be used to replicate the effects of sunlight and regulate melanin release.

“The idea behind light therapy is to replace the diminished sunshine of the fall and winter months using daily exposure to bright, artificial light,” according to a report by the National Institute of Mental Health.

The amount of time required for effective treatment will vary, but a typical session will range from 30 to 90 minutes. For those who need longer treatments for optimal results, light therapy sessions can be administered in shorter sessions throughout the day, for convenience. It can take up to four days for some patients to respond to artificial light therapy.

Psychotherapy, also known as “talk therapy,” is a common treatment for seasonal depression and cognitive behavioral therapy (CBT) is a popular long-term depression treatment. CBT treatment is designed to encourage patients to modify their typical thought patterns, helping them to recognize “unhelpful or negative thinking, change inaccurate beliefs, change behaviors that might make depression worse, and interact with others in more positive ways,” according to the American Psychological Association.

If the aforementioned treatments have not adequately treated a patient’s winter blues or SAD symptoms, a doctor may prescribe antidepressant drugs, usually selective serotonin reuptake inhibitors (SSRIs), to treat the condition. These SSRIs are designed to modify a person’s neurochemistry by blocking the absorption of the neurotransmitter serotonin resulting in decreased depression symptoms.

For those who have failed to experience symptom relief with the aforementioned strategies, including one or more drug therapy trials, a medical professional may recommend transcranial magnetic stimulation — a fast-acting, drug-free depression treatment.


For some patients, depressive symptoms are only experienced during the winter months as daylight decreases, but for many others, these winter months may constitute an intensification of a year-round depressive disorder. The Patient Health Questionnaire (PHQ-9) is used by clinicians to gauge the severity of depression. Remember: a formal diagnosis can only be made by a mental health practitioner! However, It’s possible for people concerned about the severity of their depression symptoms to self-assess whether they should see a professional, using our free PHQ-9 here

The treatment of major depressive disorder and even seasonal affective disorder is often focused on (frequently ineffective) medications. Only about one-in-three individuals respond to their initial antidepressant trial, and only about one-quarter of people switching to a second antidepressant can expect to experience remission. In 2018, about 25 million adults in the US had been prescribed antidepressants for more than two years. 

Thankfully, there is another other option to treat depression of all kinds. Transcranial magnetic stimulation (TMS) is a common pathway toward recovery for many individuals– especially those who have failed to experience symptom relief from one or more antidepressants. During TMS treatment, a magnetic coil is placed above the patient’s head and a magnetic field is used to alter the neurochemistry of the prefrontal cortex without pharmaceuticals. These individual sessions are approximately 20 minutes each and are easily tolerated for many patients. The most common side effects with TMS include headache and scalp irritation where the magnetic field has been directed, but over-the-counter medications can be used to manage this mild discomfort, if this occurs.

It’s important to remember that it may take up to eight weeks for a patient to experience the positive effects (if any) of antidepressants, meaning an individual could feasibly go through two-thirds of the seasonal affective season experimenting with an ineffective depression treatment. With TMS, many patients feel results by the fourth week of TMS treatment.

Struggling with SAD is painful enough without the added frustration of relentless drug therapy trial, error, and dosage tampering. For those who have failed to experience symptom relief with at least one antidepressant, TMS is a proven, fast-acting treatment for depression at any time of year. 


What is SAD?

SAD stands for seasonal affective disorder and is linked to reduced daylight hours which inhibits the production of melanin.It causes feelings of sadness and irritability.

What are the symptoms of SAD? 

For many people SAD manifests as lethargy, general sadness, and a disinterest in social activities but symptoms can also include weight gain, oversleeping, a lack of energy, appetite changes, a loss of interest in hobbies, feeling distracted, and suicidal thoughts.

What can I do to alleviate symptoms of SAD?

For many sufferers, getting outside and increasing their exposure to sunlight helps; going out for walks in daylight or other outdoor exercise is recommended. However, those with severe symptoms should consult with a medical practitioner for help and further treatment.

Can I take the PHQ-9 online?

Yes. The questionnaire is available here https://activepath.com/phq-9-test-online/

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Path website is solely at your own risk.

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