If sleigh bells ringing and children singing make you want to go back to bed, you might be suffering from a serious condition, not a bad disposition.

Shorter days and less sunlight make this the season to be sad, not jolly, for an estimated 10 million Americans who suffer from Seasonal Affective Disorder (SAD).

The cyclical nature of SAD means that it ebbs and flows at certain times of the year. Among its symptoms are depression, anxiety, weight gain, oversleeping and lack of energy.

The Mayo Clinic staff reports that while alternative herbal remedies, mind-body techniques and supplements are commonly used to relieve SAD symptoms, it’s not clear how effective they are – but there are several that may help.

“Keep in mind, alternative treatments alone may not be enough to relieve your symptoms,” the Mayo Clinic Web site states. “Some alternative treatments may not be safe it you have other health conditions or take certain medication.”

An alternative approach:

Licensed acupuncturist and herbalist Ted Ray of Peninsula Acupuncture described SAD as having “the hallmarks of depression – hopelessness, loss of energy and social withdrawal – with the added element of seasonality.” Studies report that women are four times more likely than men to experience SAD.

SAD occurs primarily from December through February, with sufferers often rebounding in spring. The temperate climate here causes fewer Californians to develop SAD, “and that’s why so many come here and don’t go back,” Ray said. Approximately 20 million Americans endure a milder condition, called “winter blues,” which manifests in similar symptoms, he added.

Approximately 15 percent of the patients in Ray’s holistic practice suffer from depression or SAD.

After graduating from Cal Poly San Luis Obispo with a major in agribusiness, Ray earned a master’s degree from San Francisco’s American College of Traditional Chinese Medicine. While Western medicine might treat SAD with medications, Ray uses Eastern practices, including herbs, acupuncture, meditation, exercise, light therapy nutrition and even seasonal relocation to relieve symptoms.

SAD and winter blues: Chicken or egg?

Both SAD and the winter blues differ from garden-variety depression in that the symptoms increase in winter.

“As the days get shorter, there’s lower light, and the depression goes up,” Ray said.

A 2005 study of 1,000 patients, published in the Biological Psychiatry journal, reported that 60 percent with SAD had gone untreated for years.

To determine if a patient has SAD, Ray first rules out other possible causes of depression – for example, thyroid problems, low blood sugar, prolonged adrenal fatigue or poor nutrition.

When diagnosing SAD, Ray said he looks at “the three Ds: death, divorce and dismissal,” because recent loss can cause melancholy as well. Citing a psychiatrist with whom he works, Ray noted that depression may involve prolonged repressed anger.

However, SAD departs from depression because of its seasonal nature. Ray distributes a “seasonal pattern assessment questionnaire,” which he uses to determine the severity of patients’ SAD symptoms. Patients answer questions about sleep levels, weight gain, socializing and overall well-being. Those who have scored high in SAD symptoms experienced them predominantly during December through February, when their brains produced lower serotonin levels.

The questionnaire rates patients’ symptoms on an 18-point scale. They describe their behavior and mood at various times of the year, with those scoring from 8 to 10 probably having the milder winter blues.

Let there be light (therapy):

Sitting under fluorescent lighting at work can help SAD patients, because studies have shown that exposure to any kind of light can trick the brain into thinking it is spring or summer.

Because patients develop SAD during the shorter days of winter, light therapy is key to relieving the depression, according to Ray.

Several types of “light boxes” that replace the missing light are available for purchase, he said. Ray dismissed the idea that certain lights work better, saying there is no evidence that newer blue lights work any better than full-spectrum lights, which imitate the colors of sunlight. The prescription: The patient sits in front of the light box for 30-90 minutes a day.