Liz Richards was around 12 when she first felt the sting of Seasonal Affective Disorder (SAD).

“I had always been a kind of anxious kid to begin with, an obsessive perfectionist who lived primarily in her imagination,” she says. “But by the time I was entering into puberty and middle school, my moods became increasingly unstable in all respects. My general anxiety heightened, which led to spirals of catastrophic thinking that ended most frequently in depression.”

With periods of therapy, she “toughed it out through high school and the majority of my college career,” all the while noting one important pattern. 

“It was always at its worst and most depressive end of the spectrum during the longest winter months in February and March,” Richards recalls.

SAD is a form of depression, a seasonal manifestation of Major Depressive Disorder, or even a Bipolar spectrum illness, says Angela Couch, adult psychiatric mental health nurse practitioner with the Lindner Center of HOPE.

What differentiates SAD from other kinds of depression is the fact that it is strongly biologically influenced, “whereas other types of depression can be more influenced by negative behavior or thought patterns,” says Dr. Christine Muller-Held, clinical psychologist at UC Health.

Although SAD can impact anyone, it may be more common in women, Couch says, adding that typical symptoms are low mood, oversleeping, low energy, carbohydrate craving, overeating and, potentially, weight gain.

Liz, now 24 and a media relations manager in New Haven, Conn., remembers how her daily school schedule only conspired against the condition.

“For me specifically—and I can only imagine it must be true of others as well—less exposure to sunlight during the daytime was a result of being trapped inside a school building,” she says. “By the time school had ended and I was heading home, the sun was already beginning to set. I wasn’t inclined to leave home while it was dark outside, and so I would become increasingly isolated.”

Reduced social relationships, irritability and lack of concentration are more symptoms of SAD, which the Cleveland Clinic reports affects approximately 500,000 people in the U.S., and touches 10 to 20 percent of the U.S. population with milder forms of the disorder, says Dr. Chris Tuell, a psychotherapist at the Lindner Center of HOPE.

Though it can begin at any age, SAD is more likely to develop before age 21, he adds.

“What I generally observe is that students might come in a few weeks after the time changes and the days feel notably shorter, and report that they feel down or sad rather persistently,” Muller-Held says. “This is especially true of students who come from brighter, warmer climates,” such as the deep South and Southern California, and international students from equatorial climates.

“Cincinnati winters can be challenging even for those of us who are used to them, but for people who are less accustomed to cold weather and gray days, this can be especially problematic,” she adds.

Nevertheless, with college students, Muller-Held notes, it is worth remembering that the onset time for SAD coincides with an already stressful period in the academic year, with midterms and finals, so SAD may not be the root cause of their troubles.

“If we know this is a student's seasonal pattern, it can be helpful to keep the time-limited, known nature of this difficulty in mind so that the student can keep an eye on the idea that there is a light at the end of this tunnel and that this is not a permanent state of existence,” Muller-Held says.

She also recommends students, and all sufferers of SAD, engage in daily behavioral interventions that include eating healthfully, exercising and getting enough sleep. For Liz, “eating well is an important aspect of mental wellbeing for me, and I would recommend to anyone that has the means to cook their own meals as often as possible.

“I make time to take at least a short walk every day, which serves the dual purpose of allowing myself to see the world in the sunlight and keeps me physically active,” she adds.

“It's especially important for students to maintain a strong daily routine so that class attendance and academic performance are minimally impacted by SAD symptoms,” Muller-Held says. “Students will want to be vigilant for any slipping of their daily routines—like missing classes, skipping social engagements, spending less time in the gym—and to begin actively and intentionally sticking to their routines, even if it is hard sometimes.

“Hitting the gym to keep moving, spending time outside—even when it's cold—on sunny days, and sticking to a regular sleep schedule—notoriously difficult for college students—are key for general wellbeing, and especially valuable for those who experience SAD.”

And if students have symptoms that impact their sleep, school performance or social relationships in a more significant way, “it would also be beneficial to seek a medication consultation with a physician, psychiatrist or nurse practitioner,” Muller-Held says.

Sometimes a short course of antidepressant medication can help sufferers ride out their symptoms until the season passes.

But experts agree the best, most effective treatment for SAD symptoms involves light box therapy because it “helps stimulate the parts of the brain that are most affected by

seasonal changes in light,” Muller-Held says, adding light boxes are easily purchased online, and are relatively inexpensive.

Couch adds, “Social supports are another important aspect of good mental health.

“Taking time to be with friends, attend a church, join clubs or fitness groups, or attend support groups is a great idea,” she says.

Though the exact causes of Seasonal Affective Disorder are unknown, theories include the notion that changes in the amount of light we are exposed to triggers the disorder because when light hits the eye’s retina, it sends a message to the hypothalamus—the part of the brain responsible for appetite, sleep, mood, sex drive and activity.

“Since there is a decrease amount of light during the winter months, these functions are likely to slow down,” Tuell says.

Another theory is that low levels of a neurotransmitter, serotonin, may also play a part in the cause of Seasonal Affective Disorder. Low levels of serotonin have been found in people who suffer from depression, particularly during winter months.

“Research has also found that people with Seasonal Affective Disorder also produce higher levels of the hormone melatonin in winter, compared with people who do not have the condition,” Tuell says. “When we are exposed to darkness the pineal gland in the brain produces melatonin, which causes us to sleep. When we are exposed to light, the pineal gland stops producing melatonin, making us wake up.”