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Understanding Seasonal Affective Disorder: Insights from the DSM-5

Reviewed by Heather Cashell, LCSW · November 08, 2023 ·

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a critical tool used by healthcare professionals in the United States and much of the world for the classification and diagnosis of mental disorders. Published by the American Psychiatric Association (APA), the DSM-5 provides a common language and standard criteria for the classification of mental disorders, aiding in more accurate diagnosis, treatment plans, and research. It serves as an essential handbook for a wide range of professionals, from psychiatrists and psychologists to social workers and nurses.

Causes of Seasonal Affective Disorder

While the exact cause of SAD remains unclear, it is thought to be related to the reduced level of sunlight in fall and winter, which may affect an individual's biological clock or circadian rhythm, leading to feelings of depression. Additionally, the decrease in sunlight may cause a drop in serotonin, a neurotransmitter that affects mood, and disrupt the balance of melatonin, which impacts sleep patterns and mood.

DSM-5 Criteria for Seasonal Affective Disorder

According to the DSM-5, Seasonal Affective Disorder is not classified as a separate, distinct disorder. Instead, it is a specifier—known as the "seasonal pattern specifier"—that is applied to recurrent major depressive disorder or bipolar disorder to describe a seasonal pattern to the depressive episodes. To be diagnosed with a mood disorder with a seasonal pattern, certain criteria must be met:

  1. There is a temporal relationship between the onset of major depressive episodes in major depressive disorder or bipolar disorder and a particular time of year (e.g., in the fall or winter).
  2. Full remission (or a change from depression to mania or hypomania in bipolar disorders) also occurs at a characteristic time of year (e.g., spring).
  3. In the last two years, two major depressive episodes have occurred that demonstrate the seasonal pattern, with these episodes substantially outnumbering the non-seasonal depressive episodes over the individual's lifetime.
  4. The seasonal depressive episodes are not attributable to other seasonal-related psychosocial stressors, such as regularly being unemployed during the winter.

Differentiating SAD from Feeling Down

It is important to distinguish between SAD and the common experience of "feeling down" during less vibrant months. While it is normal for people to have days when they feel gloomy, SAD is characterized by a sustained period of depression that affects one's daily function and recurs seasonally. The DSM-5 criteria help mental health professionals distinguish SAD from a bad mood or "winter blues" by emphasizing the patterned nature of the depressive episodes and their significant impact on a person's life.

Treatment Options for SAD

Treatment for SAD may include light therapy, medication, psychotherapy, or a combination of these. Light therapy involves exposure to artificial light using a lightbox that mimics natural outdoor light, believed to cause a chemical change in the brain that lifts mood and alleviates other symptoms. Medications, particularly selective serotonin reuptake inhibitors (SSRIs), have been shown to be effective in treating SAD. Psychotherapy, such as cognitive-behavioral therapy (CBT), is also a viable treatment option, helping individuals identify and change negative thought patterns and behaviors that may be contributing to their depression.

Recommendations for Those Suffering from SAD

For individuals who suspect they may be suffering from SAD, the first step is to seek a professional evaluation from a healthcare provider. Accurate diagnosis is crucial for effective treatment.

Support Resources

If you are struggling with symptoms of SAD, remember that you are not alone, and help is available. Below is a list of resources that may provide support:

  • National Institute of Mental Health (NIMH): Offers information on SAD and a variety of mental health disorders.
  • Substance Abuse and Mental Health Services Administration (SAMHSA): Provides a mental health services locator and a 24/7 helpline (1-800-662-HELP).
  • American Psychiatric Association: Provides information on symptoms, treatment, and support for SAD.
  • Depression and Bipolar Support Alliance (DBSA): Offers in-person and online support groups for people with mood disorders.
  • Seasonal Affective Disorder Association (SADA): Offers advice and support for people affected by seasonal mood disorders.

In conclusion, Seasonal Affective Disorder is a real and impactful mood disorder that goes beyond mere winter blues. By understanding the DSM-5 criteria for SAD and the treatments available, individuals can take the first step toward managing their symptoms. Healthcare providers are the best source for diagnosis and treatment recommendations, but self-care and support resources also play a crucial role in managing SAD. As the seasons change, so too can the experiences of those living with SAD, but with the right tools and support, they can navigate their symptoms and find relief.

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