Seasonal affective disorder — the Chinese medicine view of winter low mood

Seasonal affective disorder (SAD) is a recurrent depression that follows the seasons — low mood, fatigue, oversleeping and carbohydrate craving that arrive as the days shorten in autumn and lift again in spring. In traditional Chinese medicine this pattern maps closely onto a decline in yang — the warming, activating, uplifting energy of the body — as the outer world turns cold and dark. Acupuncture, Chinese herbal medicine and targeted lifestyle support are used as a complementary therapy alongside conventional care such as light therapy, talking therapy and, where needed, medication.

On this page

1. What is seasonal affective disorder?
2. Symptoms of SAD
3. Why SAD happens
4. Seasonal affective disorder in traditional Chinese medicine
5. Acupuncture for seasonal affective disorder
6. Chinese herbal medicine for SAD
7. Light, vitamin D and supplements
8. Self-care through the dark months
9. Commonly asked questions
10. References

1. What is seasonal affective disorder?

Seasonal affective disorder is a form of depression with a distinct seasonal pattern. For the great majority of sufferers it is a winter depression: symptoms begin as daylight shortens in October and November, deepen through December and January, and remit in spring. A much smaller number experience a summer-pattern SAD. It is more common in women, in younger adults, and at higher latitudes — which makes it a genuinely relevant condition in the UK, where winter days are short and often overcast.

SAD is more than “the winter blues”. It is a recognised clinical depression that recurs year after year, and it can significantly impair work, relationships and quality of life. It should be taken seriously, assessed properly, and — where it is moderate or severe — treated within conventional mental-health care. Acupuncture and Chinese medicine work best here as a supportive, complementary approach, not a replacement for that care.

2. Symptoms of SAD

Winter-pattern SAD has a characteristic symptom cluster that helps distinguish it from other depressions:

1. Persistent low mood — a flat, heavy, joyless mood present most of the day, most days, through the winter months
2. Low energy and fatigue — profound tiredness and a sense of the body slowing down, often out of proportion to activity
3. Oversleeping (hypersomnia) — sleeping longer than usual yet waking unrefreshed, and struggling to get up in the dark mornings
4. Carbohydrate craving and weight gain — increased appetite, particularly for starchy and sugary foods, with winter weight gain
5. Loss of interest and motivation — withdrawal from activities, social contact and things normally enjoyed
6. Poor concentration — difficulty focusing, thinking clearly and making decisions
7. Irritability and low tolerance — reduced resilience to stress and a shorter emotional fuse
8. Feelings of hopelessness or worthlessness — which, if severe or accompanied by any thoughts of self-harm, require urgent medical help

Please seek help promptly if low mood is severe, persistent, or accompanied by thoughts of harming yourself. Contact your doctor, or in the UK call NHS 111, the Samaritans on 116 123, or 999 in an emergency. Acupuncture is a complement to, and never a substitute for, this care.

3. Why SAD happens

The dominant explanation is reduced daylight. Shorter days disturb the body’s internal clock (the circadian rhythm), delay and prolong the night-time secretion of the sleep hormone melatonin, and lower daytime serotonin activity — a combination that produces the sleepiness, low mood and appetite changes typical of winter SAD. Reduced sunlight also lowers vitamin D synthesis in the skin, and vitamin D deficiency is extremely common in the UK through winter. A family history of depression or SAD, and living far from the equator, both increase risk.

4. Seasonal affective disorder in traditional Chinese medicine

In traditional Chinese medicine, the seasons are not merely a backdrop to health — they are an active influence on the balance of yin and yang within the body. Winter is the most yin season: cold, dark, still and inward. To stay well through it, the body must draw on its reserves of yang — the warming, activating force that lifts the spirit, drives the metabolism and keeps the mind bright. Where that yang is already weak, the darkness of winter can overwhelm it, and mood, energy and motivation sink with the light. This is the TCM picture of seasonal affective disorder.

The patterns most often seen are:

Spleen and Kidney yang deficiency

The core pattern in winter SAD. When the warming yang of the Spleen and Kidney is depleted, the whole system slows: profound fatigue, heaviness, oversleeping, cold intolerance, weight gain and carbohydrate craving, with a low, flat mood that mirrors the body’s lack of inner warmth. This is closely related to the general picture of yang deficiency.

Liver qi stagnation

Reduced light, confinement indoors and the frustration of a stalled, low-energy winter generate stagnation of Liver qi — the TCM engine of the free flow of emotion. This adds irritability, tension, a sense of being stuck and pent-up frustration to the low mood, and often overlaps with anxiety.

Heart and Spleen deficiency

Overthinking, worry and a poor winter diet deplete the Heart and Spleen, depriving the mind (shen) of nourishment. This produces low mood with poor concentration, unrefreshing sleep despite sleeping long, and a tendency to dwell and ruminate.

5. Acupuncture for seasonal affective disorder

Acupuncture has been studied primarily as a treatment for depression in general, of which winter SAD is a seasonal form. A 2024 multicentre randomised controlled trial found that adding intradermal acupuncture to standard antidepressant medication improved outcomes in people with major depressive disorder compared with medication plus sham acupuncture^[1]. Direct trial evidence for acupuncture in seasonal depression specifically remains limited, so it is best understood as a complementary support — used alongside light therapy, talking therapy and any medication — rather than a stand-alone treatment.

In TCM terms, treatment aims to warm and lift the yang, move stagnant Liver qi, and settle and nourish the mind. Moxibustion — the warming of acupuncture points with the herb mugwort — is particularly suited to the yang-deficient winter pattern, adding gentle warmth where the body is cold and slow. Many patients describe treatment as calming and restorative, and value having active support through the darkest months.

6. Chinese herbal medicine for SAD

Chinese herbal medicine is prescribed to match the individual pattern. For Spleen and Kidney yang deficiency, warming, qi-tonifying formulas are used to rebuild the body’s inner heat and lift energy and mood through the winter. Where Liver qi stagnation dominates, formulas from the Xiao Yao San family move qi, ease frustration and restore emotional flow. Where Heart and Spleen are depleted, Gui Pi Tang nourishes blood and calms the mind.

Prescriptions are bespoke, pharmaceutical-grade granules from Sun Ten in Taiwan and are reviewed at each follow-up. Online herbal consultations are available across the UK.

7. Light, vitamin D and supplements

These evidence-based measures sit comfortably alongside the TCM approach:

1. Light therapy — daily morning exposure to a 10,000-lux SAD lightbox is the best-established treatment for winter SAD and is a sensible first step. From a TCM viewpoint, it is a direct way to bring yang (light and warmth) to a body starved of it.
2. Vitamin D3 — UK public-health advice is that most adults should consider 10µg (400 IU) daily through autumn and winter; many practitioners use 1,000–2,000 IU. Deficiency is very common in British winters and is associated with low mood.
3. Omega-3 fish oil — provides EPA and DHA, which support brain and mood health; a daily dose combining EPA and DHA is commonly used.
4. Magnesium glycinate — 200–400mg in the evening supports the nervous system, sleep and stress resilience.

Please tell your doctor about any supplement you take, especially if you are on prescribed medication.

8. Self-care through the dark months

Get morning daylight

Getting outside within an hour or two of waking — even on a grey day, outdoor light is far brighter than indoor lighting — is one of the most effective things you can do to anchor the body clock and lift winter mood. A morning walk is ideal.

Keep warm and move

In TCM, warmth protects and builds yang. Keep the lower back and abdomen warm, favour warm cooked food over cold and raw, and take regular gentle exercise — walking, yoga, swimming — to move qi and lift the spirit.

Eat to warm and nourish

Favour warming, easily-digested winter foods — soups, stews, porridge, root vegetables, ginger — over the cold salads and iced drinks that further chill a yang-deficient system. My guide to eating for winter covers this in detail.

Protect your sleep rhythm

Rising at a consistent time, resisting the urge to sleep in through dark mornings, and avoiding oversleeping all help stabilise the circadian rhythm that SAD disturbs. My guide to TCM sleep optimisation has more.

9. Commonly asked questions about acupuncture for SAD

Can acupuncture help seasonal affective disorder?

Acupuncture is used as a complementary therapy for SAD alongside conventional care. The research evidence relates mainly to depression in general rather than seasonal depression specifically, so it is best seen as supportive — used together with light therapy, talking therapy and any medication — rather than a stand-alone treatment. Many patients find it calming and value active support through winter.

What is the TCM cause of winter depression?

In Chinese medicine, winter SAD is most often understood as a decline in yang — the body’s warming, activating energy — overwhelmed by the cold and darkness of the most yin season. Spleen and Kidney yang deficiency, Liver qi stagnation and Heart–Spleen depletion are the common patterns.

Does light therapy work, and how does it fit with acupuncture?

Daily morning light-box therapy is the best-established treatment for winter SAD and works well alongside acupuncture and Chinese herbal medicine. From a TCM perspective, light therapy directly restores the yang that winter depletes, while acupuncture and herbs address the underlying constitutional pattern.

How much does treatment cost?

Full pricing is on the treatment prices page. An initial acupuncture consultation is £70; follow-up sessions are £60. Chinese herbal medicine consultations start from £50, with bespoke prescriptions at £35 per week. Online herbal consultations are available across the UK.

References

[1] Zhao B, Li Z, Wang Y, et al. The efficacy and cerebral mechanism of intradermal acupuncture for major depressive disorder: a multicentre randomised controlled trial. Neuropsychopharmacology. 2024. https://doi.org/10.1038/s41386-024-02036-5.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide. After a full video consultation, Dr (TCM) Attilio D'Alberto formulates a bespoke herbal prescription and posts your Chinese herbs directly to your door.