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How to Recognize Seasonal Affective Disorder in Clients: Signs, Symptoms, and SOAP Note Tips

Stanley Efrem

Apr 2, 2025

Seasonal affective disorder affects approximately 5% of adults in the United States. The prevalence rates show dramatic variations from 1.4% in Florida to 9.9% in Alaska. Many people experience the "winter blues" that affects 10-20% of Americans, but seasonal affective disorder represents a more severe condition that can substantially affect their daily functioning.

Clinicians must understand that the DSM-5 classifies seasonal affective disorder as a major depressive disorder with seasonal patterns. The condition's onset typically occurs between ages 18 and 30. Symptoms range from mild to severe and include social withdrawal, heightened rejection sensitivity, and feelings of hopelessness. These symptoms can lead to serious complications like substance abuse and suicidal thoughts when patients don't receive treatment.

This complete guide will show you how to identify, assess, and document your client's seasonal affective disorder. You'll learn to ensure accurate diagnosis and create effective treatment plans through proper SOAP note documentation.

Understanding Seasonal Affective Disorder in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies seasonal affective disorder as "major depressive disorder with seasonal pattern" rather than a separate condition. This classification shows how the disorder relates to timing while fitting it into the broader depression category.

Clinical definition and diagnostic criteria

Major depressive disorder with seasonal pattern is a recurring depression that follows specific seasonal patterns. The DSM-5 describes it as a condition where depressive episodes start and end during particular seasons. Most people experience winter-pattern SAD with symptoms in fall and winter, while others have summer-pattern SAD during warmer months [1].

Studies show about 5% of U.S. adults experience SAD, and symptoms usually last about 40% of the year [1]. The condition affects 1% to 10% of people across North America. Higher latitudes see more cases because winter days are shorter [2]. SAD usually starts between ages 18-30, and women get it more often than men [3].

Differentiating SAD from other mood disorders

Healthcare providers need a full picture of symptom patterns to tell SAD apart from other types of depression. The key difference lies in timing - symptoms that show up and go away during specific seasons [4].

Making the right diagnosis can be tricky because SAD looks similar to other forms of depression [5]. Doctors must first determine if a patient has major depressive disorder or bipolar disorder before they can add the seasonal pattern label [6]. This matters because while SAD can occur in both conditions, it shows up more in bipolar II disorder [7].

To confirm SAD diagnosis, healthcare providers usually need:

Physical examinations to check for other health issues
Lab tests including complete blood count and thyroid function
Psychological evaluations using special questionnaires [5]

Seasonal pattern specifier requirements

The DSM-5 lists these requirements to diagnose major depressive disorder with seasonal pattern:

Depression must start at the same time each year (usually fall/winter)
Symptoms must go away completely at a specific time (usually spring/summer)
This pattern must appear for at least two years in a row
Seasonal episodes must happen more often than non-seasonal ones over time [6]

The diagnosis rules out cases where seasonal stress like temporary job loss causes symptoms [6]. Doctors often need to track symptom patterns for several years before they can spot the seasonal connection reliably [8].

Key Symptoms of Seasonal Affective Disorder to Document

Medical professionals need to document distinct symptom patterns of seasonal affective disorder to diagnose it accurately. Your detailed observations as a clinician will help establish the seasonal connection that's vital for proper treatment planning.

Winter-pattern symptoms vs. summer-pattern symptoms

Winter-pattern SAD shows a characteristic group of symptoms that differ substantially from summer-pattern signs. Clients with winter-pattern SAD typically experience oversleeping (hypersomnia), increased appetite with specific carbohydrate cravings, weight gain, and feelings of low energy similar to hibernation [7]. Summer-pattern SAD demonstrates almost opposite symptoms—insomnia, poor appetite, weight loss, and noticeable restlessness or agitation [7]. Summer-pattern SAD patients might also show higher anxiety levels and maybe even violent or aggressive behavior rarely found in winter variants [3].

Physical manifestations

Physical symptoms need careful documentation as they offer objective evidence of seasonal patterns. Patients with winter patterns often feel lethargic and sleepy throughout the day [9]. They sleep much longer than usual and struggle to wake up in the morning [9]. Weight changes should be noted—winter patterns usually lead to weight gain from carbohydrate cravings [10], while summer patterns can result in weight loss [11]. Other physical signs include low energy, fatigue, headaches, and unexplained physical discomfort.

Cognitive and emotional indicators

Cognitive and emotional symptoms are the foundations of SAD documentation. The records should include persistent low mood, loss of pleasure in previously enjoyed activities (anhedonia), and feelings of despair, guilt, or worthlessness [10]. Patients might describe focus issues, memory problems, or decision-making challenges [3]. Sad mood serves as a bridge symptom that research links to depressive symptoms and cognitive areas, particularly memory function [12].

Behavioral changes to note

Behavioral signs provide vital diagnostic clues. Look for social withdrawal (patients often describe it as "hibernating") [7], reduced activity levels, and decreased productivity. Changes might include less interest in enjoyable activities, reduced social participation, and lower sex drive [9]. Summer-pattern patients might show agitation, restlessness, or unusual irritability [13]. The assessment must always include suicidal ideation documentation, since seasonal affective disorder can become life-threatening [1].

Clinical Assessment Techniques for Seasonal Depression

Doctors need specific assessment techniques to identify seasonal affective disorder and separate it from other mood disorders. Quick detection leads to better treatment and results for clients.

Effective screening questions

Basic screening starts with simple but useful questions. Two quick screening questions work well: "In the past month, have you lost interest or pleasure in things you usually like to do?" and "Have you felt sad, low, down, depressed or hopeless?" [14]. The doctor needs to assess further if the client answers yes to either question. Elderly clients respond better to a direct approach - "Do you often feel sad or depressed?" This works just as well as longer questionnaires [15].

To identify seasonal affective disorder, look for:

When symptoms appear and their seasonal patterns
How it affects daily life and relationships
Past episodes and response to treatments
Family's history of mood disorders [16]

Validated assessment tools

Clinicians use several reliable tools to assess seasonal depression:

The Seasonal Pattern Assessment Questionnaire (SPAQ) has been a standard tool since 1984 [1]. People use it to self-assess both SAD and subsyndromal SAD (S-SAD). A Global Seasonality Score (GSS) above 11 with moderate problems points to SAD. Scores between 9-10 with mild problems suggest S-SAD [1].

The Seasonal Health Questionnaire (SHQ) came out in 2001 and works better than SPAQ [2]. The Patient Health Questionnaire (PHQ-9) accurately diagnoses major depression with 88% accuracy [17].

Timeline and pattern documentation

A full picture of symptoms over multiple years helps establish the seasonal connection. Key things to track:

Exact times symptoms start and end
Pattern repeating for at least two years in a row
More seasonal episodes than non-seasonal ones
Ruling out obvious seasonal stress factors [16]

Doctors need careful tracking to tell true seasonal patterns from random winter depression. This is important because symptoms that last beyond normal seasonal timeframes might point to other disorders [18].

Writing Comprehensive SOAP Notes for SAD Clients

Quality mental health care depends on well-documented records, especially when treating conditions that follow cyclical patterns like seasonal affective disorder. SOAP notes give you a well-laid-out way to track these seasonal changes.

Subjective section: Capturing client experience

The Subjective section shows your client's own account of their seasonal depression. Start by recording their chief complaint with direct quotes that show the seasonal nature of symptoms. To cite an instance, see quotes like "I feel like I'm just dragging myself out of bed" or "I feel like I'm in hibernation" that capture winter-pattern SAD's common lethargy. On top of that, it helps to note when symptoms started relative to seasonal changes.

These details help clarify symptom patterns:

Energy levels and motivation changes
Sleep disturbances (usually oversleeping in winter-pattern)
Appetite and weight fluctuations
Social withdrawal patterns
Previous seasonal episodes

Objective section: Observable symptoms and assessment results

The Objective section needs facts and measurable data instead of interpretations. For clients with seasonal affective disorder, document:

Physical presentation (e.g., "Client appeared low in energy")
Behavioral observations (e.g., "Client was guarded as shown by crossed arms")
Assessment results from tools like SPAQ or PHQ-9
Changes in presentation compared to non-seasonal periods

SAD's subjective nature means you should back up observations with concrete evidence using "as evidenced by" statements.

Assessment section: Diagnostic considerations

This section lets you combine subjective and objective information to develop your clinical impression. Your notes should show whether symptoms line up with SAD criteria under DSM-5, with special attention to seasonal pattern requirements. The timing of symptom onset and remission across multiple years needs careful documentation. You should also think about other mood disorders that look similar.

Plan section: Treatment recommendations and follow-up

The Plan section outlines specific SAD treatments. Include:

Light therapy details if recommended
Psychotherapy approaches (usually CBT)
Medication options (often SSRIs)
Lifestyle changes (outdoor time, exercise)
Follow-up scheduling that matches predicted symptom patterns

Conclusion

Mental health professionals need to pay careful attention to seasonal affective disorder, given its cyclical nature and potential severity. Your diagnostic accuracy and treatment outcomes improve substantially when you take time to identify SAD patterns through detailed documentation.

Each client's seasonal pattern shows up differently. Your complete SOAP notes help track symptom progression, confirm diagnostic criteria, and adjust treatment plans. Better clinical decisions and continuity of care across multiple seasons depend on proper documentation.

You can serve clients better who struggle with seasonal depression by combining strategic screening questions, validated tools, and careful pattern documentation. These clinical insights and documentation strategies help clients break free from their cycle of seasonal mood changes.

FAQs

What are the main symptoms of Seasonal Affective Disorder (SAD)?

The primary symptoms of SAD include persistent low mood, loss of interest in activities, fatigue, changes in appetite and weight, and sleep disturbances. These symptoms typically follow a seasonal pattern, often worsening during fall and winter months.

How is Seasonal Affective Disorder different from regular depression?

The key difference is the seasonal pattern. SAD symptoms consistently begin and end during specific seasons, usually fall/winter, and fully remit during other seasons, typically spring/summer. This pattern must be observed for at least two consecutive years to meet diagnostic criteria.

Can Seasonal Affective Disorder occur in summer?

Yes, while less common, summer-pattern SAD does exist. It typically manifests with symptoms opposite to winter-pattern SAD, such as insomnia, poor appetite, weight loss, and increased agitation or anxiety.

How is Seasonal Affective Disorder diagnosed?

Diagnosis involves careful assessment of symptom patterns over time, usually at least two years. Clinicians use screening questions, validated assessment tools like the Seasonal Pattern Assessment Questionnaire (SPAQ), and thorough documentation of symptom onset and remission timing.

What treatment options are available for Seasonal Affective Disorder?

Treatment for SAD often includes a combination of light therapy, psychotherapy (typically Cognitive Behavioral Therapy), medication (often SSRIs), and lifestyle modifications such as increased outdoor time and exercise. The specific treatment plan is tailored to each individual's needs and symptom patterns.