When the days get short and dark, many people develop a predictable set of symptoms. At their extreme, they can be very difficult and disabling. Together we call them Seasonal Affective Disorder, or SAD - an apt name because of how down and blue people can feel at a time of year when we're all supposed to be gearing up to celebrate.Those of us who are less severely affected may be able to continue to do our work and discharge our responsibilities, but life still doesn't feel like fun. The zest seems to have disappeared with the autumn leaves and the balmy days of summer. This lesser variant we call the "winter blues." But those of us who have it know that it is quite bad enough.
Some 25 years ago my colleagues and I first described SAD and since then I have studied the condition as well as lived it. In this piece, I will let you know how you can determine how seasonal you are.
The questions below come from the Seasonal Pattern Assessment Questionnaire (the SPAQ), which we developed at the National Institute of Mental Health. If you want to find out how seasonal you are, answer these questions and then look below at the key that gives you a rough sense of where you fit on the seasonality spectrum.
Remember, a self-assessment checklist can never substitute for a clinical evaluation, so if you think you are affected, especially to a major degree, you would be best off checking in with your doctor for further guidance.
SAD Self Assessment Checklist
The purpose of this checklist is to find out how your mood and behavior change over time. Please fill in all the relevant squares. Note: answer this question about your own experience, not others whom you may have observed.
1. In answer to the following questions, fill in all the applicable months. You may fill in a single month, several months together, or all applicable months.
At what time of the year do you...
2. To what degree do the following change with the seasons?
(Fill in only one box for each question.)
3. If you experience changes with the seasons, do you feel that these are a problem for you?
YES _____ NO ______
If yes, is this problem:
MILD MODERATE MARKED SEVERE DISABLING
_____ _____ _____ _____ _____
How to interpret your scores
1. Your seasonal pattern
The first step in determining how seasonal you are is to rate your seasonal pattern by looking at your answer to the first question.
If you feel worst in December, January or February, you have a winter seasonal pattern.
Almost half of all people in the northern United States report that they feel worst during the winter and are said to have a winter pattern of seasonality. This pattern is more marked among people who live at higher latitudes. For example, a higher percentage of people dislike winter in New Hampshire (42 degrees north) than in Sarasota, Florida (27 degrees north). On the other hand, the closer people are to the equator, the more they dislike summer. In south Florida, for example, more people report disliking summer than winter, presumably because of the heat and humidity.
Most winter types report eating most, sleeping most, and gaining the most weight in the winter months and, conversely, eating and sleeping least and losing weight during the summer months. They also find it easier to socialize during the summer. Although they often join in the round of parties that takes place at Christmas, they find it hard to muster up the spontaneous pleasure of summer get-togethers, where they feel a true desire to mix with people. Rather, winter celebrations often take on the quality of a chore, a command performance, asked of people who would much rather be left alone with a dish of sweets. Indeed, people with SAD often report a strong preference for sweets and starches during the winter months - an exaggeration of an eating trend observed in the general population. People also commonly report preferring "heavy" foods - stews and casseroles - during the winter months, whereas salads, fresh fruit and vegetables, and protein-rich foods are preferred in the summer months.
The pattern of sleeping and eating more and gaining weight in the winter is often seen even in those who do not have SAD. What distinguishes people with SAD and the winter blues from the general population is the overall seasonality score, which is greater in people susceptible to SAD than it is in the population at large.
2. Your overall seasonality score
The severity of your seasonality is determined by examining the degree to which you experience seasonal changes in sleep length, social activity, mood (overall feeling of wellbeing), weight, appetite, and energy level, as presented in the second question above.
To derive your overall seasonality score, add up your scores for all six items, for a possible range of 0 to 24. This overall seasonality score would be expected to vary depending on where you live. For example, the same person who has a very high seasonality score during years spent in Alaska is likely to find the score greatly reduced after living for several years in Hawaii. Successful treatment is also likely to reduce one's overall seasonality score. In general, the six functions measured vary seasonally most markedly in people with SAD, but also in those less severely affected and to some extent in the general population. The extent to which they vary is reflected in the overall seasonality score.
Your overall seasonality score can provide you with a rough guideline as to whether you may be suffering from seasonal problems. For example, most people who do not experience seasonal problems have overall seasonality scores of 7 points or less. Most people with full-blown SAD have seasonality scores of 11 or more, while people with the winter blues may have scores of 8, 9 or 10. Remember, these are just rough guidelines, not hard-and-fast rules. Use these guidelines together with the other factors outlined in the following table to help you determine whether you may be suffering from SAD or the winter blues.
When to seek medical advice
It is likely that in the future, more and more people will become aware of comparatively minor, subtle seasonal difficulties and will attempt to modify their environmental lighting to cope with them. A self-help approach is reasonable as long as symptoms are mild. Those who score 12 or more on the SPAQ or consider their seasonal problems to be at least of moderate severity, however, may well benefit from a professional's care.
You should definitely seek medical help if:
1. Your functioning is impaired to a significant degree. For example, if you develop problems at work that are marked enough for others to notice, such as:
- Difficulty getting to work on time on a regular basis;
- Marked reduction in your ability to think and concentrate, so that you make frequent errors or take much longer than normal to finish a task;
- Difficulty completing tasks that you could previously master.
Be sure to catch the problem before your supervisors or clients do, and turn it around by getting appropriate help.
Problems can also occur in your personal life. For example, you may feel that you want to be left alone and withdraw significantly, which can cause difficulties with friends and family. Your spouse or partner may feel that you are distant and unavailable. It may be worth asking significant people in your life to what degree they feel your winter difficulties interfere with feeling close to you. If the degree is significant, it would pay to get help for the problem rather than to risk damage to important relationships.
You should also suspect that your ability to function is slipping if you begin to fall behind with bills and other necessary chores. Marked seasonal changes in thinking and getting things done can result in chaos in the administrative areas of one's life, which further amplifies feelings of depression and hopelessness and often consumes the spring months with digging out from under the winter mess.
2. You experience significant feelings of depression. This includes the following:
- Regularly feeling sad or having crying spells;
- Feeling that life is not worthwhile or wishing you would not wake up in the morning;
- Thinking negative thoughts about yourself - that you are a bad person, incompetent, unreliable, an impostor - which you would regard as inaccurate descriptions of yourself at other times of the year;
- Feeling guilty much of the time;
- Feeling pessimistic about the future.
3. Your physical functions are markedly disturbed during the winter. For example:
- You require several more hours of sleep per day or have great difficulty waking up in the morning;
- You would like to lie around for much of the day;
- You feel you have no control over your eating and weight.
All of these symptoms are indications that you should have the situation checked out and treated, if necessary, by an appropriate professional.
Portions of this article were excerpted from Winter Blues: Everything you need to know to beat Seasonal Affective Disorder, by Norman E. Rosenthal, M.D. (Guilford Press, 2006). For those who want more information, you may find the rest of the book to be of interest.
© Norman E. Rosenthal, 2008