Seasonal Affective Disorder and Substance Use
Makeba Royall LCSW - Senior Practice Associate, Behavioral Health
November 2024
Seasonal affective disorder (SAD) is most prevalent during the fall and winter months. During these months, some people may experience depressive symptoms when daylight decreases at the end of the summer. Sadly, many people do not receive a diagnosis for SAD because it can manifest as other disorders like bipolar disorder. Because of the depressive symptoms some individuals turn to substance use as a means of controlling and reducing the symptoms associated with seasonal affective disorder. This type of self-medication can worsen symptoms and affect how people function daily. This behavioral health practice perspective aims to explain seasonal affective disorder and highlight the significance of screening for substance use during depressive episodes.
What is Seasonal Affective Disorder
Seasonal affective disorder is a form of depression; however, it typically occurs when there is a change in season from fall to winter. The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, Text Revision (DSM-5-TR™) terminology for SAD is Major Depressive Disorder with Seasonal Pattern. SAD’s symptoms include the following:
- Hopelessness
- Irritability, frustration, or restlessness
- Guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue and feeling slowed down
- Difficulty concentrating, remembering, or making decision
- Difficulty sleeping, waking early in the morning, or oversleeping
- Changes in appetite or weight
- Physical aches or pains, headaches, cramps, or digestive problems
- Thoughts of death or suicide or suicide attempts
SAD is a recurrent seasonal depression with symptoms that can last for 4-5 months out of the year. It can occur in late fall or early winter and in the United States the most challenging times are January and February where depressive symptoms appear to be the most severe. During this time hypersomnia, or oversleeping, carbohydrate cravings, and social disengagement, which resembles a need to hibernate from others—are among its symptoms. SAD is different from major depression in that its symptoms occur for at least two years consecutively during a specific season. The fact that these symptoms might not manifest annually should be kept in mind, as this can complicate diagnosis. The symptoms gradually improve with more daylight hours, and by spring and summer, they go away completely.
Who is Most Affected
Although rare, SAD may manifest during spring and summer months. Because of this, seasonal patterns should be monitored throughout the course of treatment. According to the National Institute of Mental Health (NIMH), “people who suffer from depression or bipolar disorder, particularly bipolar disorder II, are more likely to have SAD, and compared to men, women experience it more frequently.” It also happens to people who live far from the equator and have shorter winter days and individuals with SAD are more common in the North than in the South.
The Use of Substances to Manage Symptoms
Sometimes, people may turn to alcohol and other substances to help manage their depressive symptoms. The use of substances may help alleviate any unpleasant emotions, or discomforts one may be experiencing when having depressive episodes. Substance use can develop into a self-medication strategy that is used to boost feelings of happiness by elevating low moods or easing the fatigue and sluggishness that come with SAD.
According to Comprehensive Psychiatry, “some people may be using alcohol as a self-medication for an underlying seasonal affective disorder or exhibiting a seasonal pattern in alcohol-induced depression” (Sher, 2003). For this reason, it is crucial to perform comprehensive diagnostic interviews that address both substance use and SAD symptoms. According to the American Addiction Centers, “approximately 50% of individuals who struggle with a mental condition will eventually develop a substance use problem” (Depression & Substance Abuse Treatment Plans, Medication, Therapy, 2024).
The National Institute on Drug Abuse (NIDA) reports “around 1 in 4 individuals with a serious mental illness also have substance use disorder (National Institutes on Drug Abuse (US), 2020). Additionally, NIDA reports the high rate of comorbidity between substance use and other mental illnesses highlights the need for an “integrated approach to interventions that identifies and evaluates each disorder concurrently and provides treatment as appropriate for each particular constellation of disorders. Because of this, comprehensive assessment tools should be used to reduce the chance of a missed diagnosis”. (National Institutes on Drug Abuse (US), 2020). SAD can co-occur with other disorders including but not limited to, attention deficit disorder, alcoholism, and eating disorders, making it difficult to diagnose (Lurie et al., 2006).
How Social Workers Help
Clinical social workers (CSWs) are licensed mental health providers who diagnose and treat SAD. They have expertise in treating depression using treatment modalities such as individual, family, and group therapy. When diagnosing or assessing an individual, they use a holistic approach examining all the systems in the individual’s environment that may impact SAD. They also provide information and referrals.
CSWs are also experts in treating substance use disorders related to SAD. They use validated screening tools when assessing for Substance Use and SAD such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) and the DSM-5 measures.
Below are resources that may be used by social workers as a supplement to the intake process, midyear check in or annual update:
Resources
American Psychiatric Association, DSM-5 Online Assessment Measures. Retrieved January 17, 2024 from https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-assessment-measures
American Psychological Association. (2019, August). Depression Assessment Instruments. Retrieved February 1, 2024, from https://www.apa.org/depression-guideline/assessment/
Depression & Substance abuse treatment plans, medication, therapy. (2024, August 23). American Addiction Centers. https://americanaddictioncenters.org/co-occurring-disorders/depressive-disorders
Djukic, J. (2024, January 30). Feel Great Today Seasonal Affective Disorder [Video]. WJFW-TV. Retrieved February 1, 2024, from https://www.wjfw.com/feel-great-today-seasonal-affective-disorder-1-30-2024/video_a9336114-ccc3-5ea1-a7f5-256a00898711.html
Lurie, S. J., Gawinski, B., Pierce, D., Rousseau, S. J., & University of Rochester School of Medicine and Dentistry. (2006). Seasonal affective disorder. American Family Physician, 1521–1524. https://www.aafp.org/pubs/afp/issues/2006/1101/p1521.pdf
Melrose S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression research and treatment, 2015, 178564. https://doi.org/10.1155/2015/178564
National Institute of Mental Health, (Revised 2023). Seasonal Affective Disorder (NIH Publication No. 23-MH-8138) U.S. Department of Health and Human Services, National Institutes of Health. Retrieved January 11, 2024, from https://www.nimh.nih.gov/sites/default/files/documents/health/publications/seasonal-affective-disorder/seasonal-affective-disorder-508.pdf
National Institute of Mental Health, (2023, September). Depression. U.S. Department of Health and Human Services, National Institute of Health. Retrieved January 11, 2024, from https://www.nimh.nih.gov/health/topics/depression
National Institutes on Drug Abuse (US). (2020, April 1). Common Comorbidities with Substance Use Disorders Research Report. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK571451/#nidacomorbsubusedis.s3
Reynaud, E., Berna, F., Haffen, E., Weiner, L., Maruani, J., Lejoyeux, M., Schroder, C. M., Bourgin, P., & Geoffroy, P. A. (2021). Validity and Usage of the Seasonal Pattern Assessment Questionnaire (SPAQ) in a French Population of Patients with Depression, Bipolar Disorders and Controls. Journal of clinical medicine, 10(9), 1897. https://doi.org/10.3390/jcm10091897
Office of the Aging. (2023, December 19). Identifying and Treating Seasonal Affective Disorder (SAD). Office for the Aging. Retrieved February 1, 2024, from https://aging.ny.gov/news/identifying-and-treating-seasonal-affective-disorder-sad
Rosenthal, N., MD. (n.d.). Seasonality and the Seasonal Pattern Assessment Questionnaire. Norman E Rosenthal, M.D. Retrieved February 5, 2024, from https://www.normanrosenthal.com/spaq/
Sher, L. (2004). Alcoholism and seasonal affective disorder. Comprehensive Psychiatry, Volume 45(Issue 1), Pages 51-56. https://doi.org/10.1016/j.comppsych.2003.09.007
Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). Millions of Americans have mental and substance use disorders. Find treatment here. SAMHSA. Retrieved February 1, 2024, from https://findtreatment.gov/