--- title: "TMS for Seasonal Affective Disorder: A Patient Guide" description: Here’s what patients should know about transcranial magnetic stimulation for seasonal affective disorder. image: https://www.cognitivefxusa.com/hubfs/tms-for-seasonal-affective-disorder.jpg --- ![Light-Mode-Sun-Icon-SVG](https://www.cognitivefxusa.com/hubfs/Sun.svg) ![Dark-Mode-Moon-Icon-SVG](https://www.cognitivefxusa.com/hubfs/moon.svg) ###### 280 W River Park Drive Suite 110 Provo, UT ###### [+1 385 446-4161](tel:+13854464161) ###### [hello@cognitivefxusa.com](mailto:hello@cognitivefxusa.com) [![Main_Logo_500px 1](https://www.cognitivefxusa.com/hubfs/Main_Logo_500px%201.svg) ](https://www.cognitivefxusa.com/) [**Get Started** ](https://www.cognitivefxusa.com/precision-mental-health-fmri-guided-transcranial-magnetic-stim) - [Brain Injury Treatments](https://www.cognitivefxusa.com/treatment) ![down arrow](https://www.cognitivefxusa.com/hubfs/down-arrow-1.svg) ### Your Treatment ###### [Post-Concussion Syndrome Treatment Our intensive EPIC program helps patients recover from symptoms that haven't responded to traditional care.](https://www.cognitivefxusa.com/treatment) ###### [POTS Treatment POTS treatment clinic using neurological retraining, vestibular recalibration & CO₂ therapy. 5-day intensive program in Utah.](https://www.cognitivefxusa.com/pots-treatment) ###### [Viral Brain Injury Treatment Long Covid-19, Post-Treatment Lyme, Encephalitis. 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TMS for Seasonal Affective Disorder: A Patient Guide # TMS for Seasonal Affective Disorder: A Patient Guide ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hubfs/Spangler_150px.webp) Dr. Diane Spangler, Ph.D. • Updated on 18 November, 2025 • Medically Reviewed by [Dr. Mark Allen](https://www.cognitivefxusa.com/dr-mark-allen-phd) [mailto:?subject=Check%20out%20https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder%20&body=Check%20out%20https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder&media=https://2921058.fs1.hubspotusercontent-na1.net/hubfs/2921058/tms-for-seasonal-affective-disorder.jpg](mailto:?subject=Check%20out%20https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder%20&body=Check%20out%20https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder&media=https://2921058.fs1.hubspotusercontent-na1.net/hubfs/2921058/tms-for-seasonal-affective-disorder.jpg) Many people have had experiences where dark winter days or cold weather have affected their moods. But for about 5% of adults in the U.S., getting through the winter is more than just unpleasant—it’s a serious mental health challenge known as seasonal affective disorder (SAD). Some SAD symptoms overlap with major depressive disorder (MDD)—low mood, fatigue, loss of interest—but others are unique, like craving carbohydrates and sleeping too much. It can feel like your body is shutting down and preparing to hibernate. In this article, you’ll learn what causes SAD, common symptoms and treatments, and how transcranial magnetic stimulation (TMS) may help relieve symptoms, especially if you’ve tried other options or prefer to avoid medication. **Below, we cover:** - [What Is Seasonal Affective Disorder?](https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder#what-is-seasonal-affective-disorder-sad) - [Common Treatments for Seasonal Affective Disorder](https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder#common-treatments-for-seasonal-affective-disorder) - [TMS as an Alternative Treatment Option](https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder#tms-therapy-as-an-alternative-treatment-for-sad) - [Coping with SAD at Home](https://www.cognitivefxusa.com/blog/tms-for-seasonal-affective-disorder#coping-with-sad-at-home) ## What Is Seasonal Affective Disorder (SAD)? Seasonal affective disorder (SAD) is a type of depression that occurs during specific seasons of the year. First [described](https://pubmed.ncbi.nlm.nih.gov/6581756/) in the early 1980s, it’s officially recognized as “depression with a seasonal pattern.” For most people, symptoms begin and end at roughly the same time each year, dissipating once the season changes. ### Fall-Onset vs. Spring-Onset Seasonal Affective Disorder There are two main types of SAD: 1. **Fall-Onset SAD (Winter Depression): **This is the most common type. Symptoms start in the fall and continue through winter, then fade in spring and summer. This isn’t the same as feeling stressed about the holidays or winter routines—it’s a clinical mood pattern linked to seasonal changes in light. 2. **Spring-Onset SAD (Summer Depression): **A rarer form in which symptoms appear in spring or summer and resolve in fall or winter. Sometimes called “reverse SAD,” it tends to feature agitation and insomnia rather than sluggishness. ### Common Symptoms of Seasonal Affective Disorder Symptoms of SAD vary, but most people experience several of the following: - Persistent sadness or low mood - Feelings of hopelessness or pessimism - Irritability or frustration - Anxiety or restlessness - Loss of interest in hobbies and activities - Fatigue or low energy levels - Difficulty concentrating or making decisions - Changes in sleep or appetite - Weight changes - Physical aches or headaches - Digestive problems - Decreased sex drive - Thoughts of death or suicide #### Additional Symptoms in Fall-Onset SAD - Oversleeping (hypersomnia) - Daytime drowsiness - Increased appetite or carbohydrate cravings (often leading to weight gain) - Social withdrawal (“hibernation mode”) - Slowed movement and thinking #### Additional Symptoms in Spring-Onset SAD - Insomnia or trouble sleeping - Decreased appetite and weight loss - Agitation or restlessness - Irritability or aggression ### Risk Factors for SAD Certain factors make you more likely to experience SAD: - **Family History:** SAD and other mood disorders can run in families. - **Gender and Age:** Women and younger adults are more commonly affected. - **Pre-Existing Mental Health Conditions:** People with depression or bipolar disorder may experience seasonal worsening. - **Location:** SAD is more common farther from the equator, where daylight hours are shorter in winter. - **Low Vitamin D Levels:** Reduced sunlight means less vitamin D, which can lower serotonin activity in the brain. ### What Causes SAD? The leading theory links SAD—especially fall-onset SAD—to **reduced exposure to sunlight** during shorter days. This affects several brain systems: - **Disrupted Circadian Rhythm:** Your internal clock relies on sunlight to regulate sleep, mood, and appetite. Less daylight can disrupt this rhythm. - **Increased Melatonin Production:** Darkness triggers melatonin, the sleep hormone. Excess melatonin can cause fatigue and sluggishness. - **Reduced Serotonin Levels:** Sunlight boosts serotonin, a key mood-regulating neurotransmitter. Low levels are associated with depression.  ### How Is SAD Diagnosed? If you notice seasonal mood changes lasting at least two years in a row, talk to a healthcare provider. Diagnosis usually involves: - Reviewing your mood, sleep, and energy patterns across seasons. - Confirming that symptoms occur during specific months and lift at other times. - Ruling out other medical or psychiatric conditions through a physical exam or lab work. ## Common Treatments for Seasonal Affective Disorder ### Bright Light Therapy (BLT) **Bright light therapy (BLT)** is considered the first-line treatment for SAD. It involves sitting near a special light box that mimics natural daylight for 30–60 minutes each morning. Multiple studies have demonstrated BLT to be [effective](https://pubmed.ncbi.nlm.nih.gov/15800134/) and well-tolerated by patients. In one [study](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204290), about two-thirds of patients responded within a few weeks. Potential side effects include mild headache or eye strain, which tend to dissipate quickly. Patients with glaucoma, cataracts, or light sensitivity should seek medical guidance from an ophthalmologist. You can purchase a light box without a prescription, but these devices are not currently regulated by the Food and Drug Administration (FDA) for SAD treatment. Talk to your doctor to ensure you buy the right light box, and always follow the manufacturer's guidelines. Light boxes should be specifically designed for light therapy, emit minimal UV light, and be rated for at least 10,000 lux. ### Cognitive Behavioral Therapy (CBT-SAD) A version of cognitive behavioral therapy designed for SAD ([CBT-SAD](https://pubmed.ncbi.nlm.nih.gov/37330257/)) helps patients identify negative, season-related thoughts—such as thoughts about the darkness of winter or lack of sunlight—and evaluate how accurate or helpful those thoughts really are. It also encourages behavioral activation, such as engaging in outdoor activities to increase light exposure. Some studies show that CBT-SAD’s effectiveness is [comparable](https://pmc.ncbi.nlm.nih.gov/articles/PMC4939843/) to bright light therapy, with benefits lasting longer than light therapy alone. For the best results, many patients combine the two. ### Antidepressant Medication [Antidepressant medications](https://pubmed.ncbi.nlm.nih.gov/14504682/)—used alone or alongside psychotherapy or bright light therapy—can also be effective for treating SAD. Because SAD is associated with altered levels of serotonin, the most common types of antidepressants used are **selective serotonin reuptake inhibitors (SSRIs) **or** norepinephrine and dopamine reuptake inhibitors (NDRIs).** At the moment, the only NDRI approved by the [FDA](https://www.ncbi.nlm.nih.gov/books/NBK470212/) to treat SAD is **bupropion** (Wellbutrin). This medication is often used to prevent the development of symptoms, and patients start taking it a few months before symptoms typically appear. Medications can take 6–8 weeks to work and may be less convenient for seasonal use. They also commonly have unpleasant side effects, which lead some patients to prioritize or prefer other types of treatments. ### Vitamin D Supplementation Vitamin D supplements may help improve symptoms in some SAD patients. However, studies testing its effectiveness have found [mixed results](https://pmc.ncbi.nlm.nih.gov/articles/PMC11206829/)—some suggesting it helps, others finding no benefit. Before taking any dietary supplements, consult your health care provider, especially if you’re on other medications, as vitamin D can interact with certain medications. ## TMS Therapy as an Alternative Treatment for SAD When light therapy and medications fall short—or when you’d rather avoid medication—**transcranial magnetic stimulation (TMS)** offers another option. ### How TMS Works TMS is a non-invasive treatment that uses magnetic pulses to stimulate the **dorsolateral prefrontal cortex (DLPFC)**—an area of the brain that handles mood regulation and decision-making. By essentially “rebooting” underactive circuits, TMS helps restore normal activity patterns and reduce symptoms. ### Research on TMS and SAD While research is limited, preliminary [evidence](https://www.sciencedirect.com/science/article/abs/pii/S0165178123004754) suggests rTMS may be just as effective for SAD patients as it is for depression patients, where [about 50%](https://journals.lww.com/co-psychiatry/fulltext/2019/09000/repetitive_transcranial_magnetic_stimulation.8.aspx) of patients respond and [about 30%](https://pubmed.ncbi.nlm.nih.gov/24922485/) achieve remission. Studies also show that TMS can reduce SAD-specific symptoms such as [hypersomnia](https://www.sciencedirect.com/science/article/abs/pii/S0278584619305500), increased [appetite](https://pubmed.ncbi.nlm.nih.gov/33442190/), and [weight gain](https://www.sciencedirect.com/science/article/abs/pii/S1935861X17310021) by helping re-regulate the brain’s internal clock—essentially helping the body emerge from “hibernation mode.” Unlike medication, which can take 6 to 8 weeks to begin working, TMS can be administered **proactively** before symptoms begin each winter, helping some patients prevent severe mood decline altogether. ## Accelerated fMRI TMS Treatment at Cognitive FX At Cognitive FX, we offer an advanced form of TMS called [accelerated fMRI-guided TMS](https://www.cognitivefxusa.com/precision-mental-health-fmri-guided-transcranial-magnetic-stim). It’s similar to Stanford Accelerated Intelligent Neuromodulation Therapy ([the SAINT™ protocol](https://www.cognitivefxusa.com/blog/saint-depression-treatment))—which produces some of the highest response and remission rates of any depression treatment. This form of TMS improves upon conventional protocols in important ways: ### 1. Precision Targeting Conventional TMS protocols use a manual measurement technique to identify the treatment target site, but studies have shown that missing the treatment target area by even a few millimeters can [significantly reduce](https://link.springer.com/chapter/10.1007/978-3-031-38563-6_20) TMS treatment effectiveness. At Cognitive FX, we use advanced fMRI brain imaging to identify the exact target site for each patient, and neuronavigation to ensure the magnetic pulses are delivered to that exact spot for every treatment session. ### 2. Condensed Treatment Schedule Conventional TMS protocols are delivered with daily sessions over 4 to 6 weeks, making it difficult to complete amidst work and life commitments. In contrast, our treatment is completed in just 5 days. ### 3. Improved Remission and Response Rates ![A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.](https://www.cognitivefxusa.com/hs-fs/hubfs/SAINT%20Shown%20to%20Outperform%20Other%20Treatments.png?width=808&height=561&name=SAINT%20Shown%20to%20Outperform%20Other%20Treatments.png) *A comparison of remission rates for rTMS/iTBS, ECT, and SAINT-iTBS.* There are no studies specifically evaluating SAINT TMS for SAD, but in a double-blind randomized clinical trial, [**about 86%**](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20101429?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed)** of patients with treatment-resistant depression responded to SAINT, and roughly 79% reached remission.** All participants had already failed at least two other depression treatments. One month after treatment, **60% remained in remission**. Our version applies the same core principles—iTBS, fMRI-guided targeting, and a condensed 5-day treatment schedule—but uses our **in-house fMRI analysis** rather than Magnus Medical’s proprietary software. Both protocols are safe, precise, and highly effective accelerated TMS approaches, but our fMRI-based targeting keeps costs significantly lower while maintaining precision and outcomes. ### More Information and Patient Considerations - Accelerated TMS protocols, including the one we offer at Cognitive FX, [are not yet covered by insurance](https://www.cognitivefxusa.com/blog/does-insurance-cover-tms-therapy). - We integrate cognitive behavioral therapy (CBT) alongside TMS, which research shows can [improve](https://journals.lww.com/co-psychiatry/fulltext/2019/09000/repetitive_transcranial_magnetic_stimulation.8.aspx) response and remission rates and extend results. - Our program is ideal for adults 18–65 with treatment-resistant or seasonal depression; we do not treat patients with a seizure history or those in active crisis care.  [***Click here***](https://www.cognitivefxusa.com/precision-mental-health-fmri-guided-transcranial-magnetic-stim)* to learn more about receiving accelerated fMRI TMS therapy at Cognitive FX or *[*take our quiz*](https://cognitivefxusa.typeform.com/depression?typeform-source=www.cognitivefxusa.com)* to see if you’re a good fit for treatment.* ## Coping with SAD at Home While professional treatment is important, lifestyle changes can make a meaningful difference. - **Get outside during daylight. **Even short walks help boost mood. Morning sunlight exposure (without sunglasses) is particularly beneficial. - **Brighten your environment.** Open curtains and sit near windows. - **Eat a balanced diet.** Choose fruits, vegetables, and whole grains over sugary “comfort” foods. - **Exercise regularly. **Movement improves energy, mood, and sleep. - **Keep a symptom diary.** Track patterns to anticipate seasonal shifts. - **Plan ahead.** Prepare meals, adjust your schedule, and plan relaxing activities before your low-mood season begins. ## Help Is Available Seasonal affective disorder can make winter months feel endless, but effective treatments exist. Light therapy, CBT, medication, and vitamin D can all help—and for those who don’t respond or prefer a non-medication approach,** TMS is a precise, proactive option.** At Cognitive FX, we combine advanced brain imaging with accelerated TMS and supportive therapy to help patients regain energy, motivation, and emotional balance—no matter the season. [***Click here***](https://www.cognitivefxusa.com/precision-mental-health-fmri-guided-transcranial-magnetic-stim)* to learn more about receiving accelerated fMRI TMS therapy at Cognitive FX or *[*take our quiz*](https://cognitivefxusa.typeform.com/depression?typeform-source=www.cognitivefxusa.com)* to see if you’re a good fit for treatment. * ## **Cited Research** - [The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence](https://pubmed.ncbi.nlm.nih.gov/15800134/) - [Bright Light Treatment of Winter Depression: A Placebo-Controlled Trial](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204290) - [Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression](https://pubmed.ncbi.nlm.nih.gov/37330257/) - [Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder](https://pmc.ncbi.nlm.nih.gov/articles/PMC4939843/) - [A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder](https://pubmed.ncbi.nlm.nih.gov/14504682/) - [The Role of Water-Soluble Vitamins and Vitamin D in Prevention and Treatment of Depression and Seasonal Affective Disorder in Adults](https://pmc.ncbi.nlm.nih.gov/articles/PMC11206829/) - [Seasonal Pattern and Depression Outcomes from Repetitive Transcranial Magnetic Stimulation](https://www.sciencedirect.com/science/article/abs/pii/S0165178123004754) - [Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial](https://psychiatryonline.org/doi/10.1176/appi.ajp.2021.20101429?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed) --- ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=150&name=Spangler_150px.webp) ### About the author [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) Dr. Spangler is a Clinical Psychologist with over 20 years of experience working in both clinical and academic settings. She earned her doctorate degree in Clinical Psychology at the University of Oregon followed by a Postdoctoral Research Fellowship in the Department of Psychiatry at the Stanford University School of Medicine. Dr. Spangler served as a Professor of Psychology at Brigham Young University for 15 years where she directed training in Cognitive Behavioral Therapy for the Clinical Psychology Doctoral Program, and conducted research on the etiology and treatment of depressive, anxiety, and eating disorders. She also served as a Visiting Professor in the Department of Psychiatry Cognitive Therapy Centre at Oxford University in England. Dr Spangler has authored over 60 publications and has lectured worldwide. She has received numerous awards for her collective work from the National Institute of Mental Health, the American Psychological Association, the International Association for Cognitive Psychotherapy, the Association for Behavioral and Cognitive Therapies, the Beck Institute, and the National Association of Professional Women. ## Related Posts ![Anxious Depression Treatment: What Patients Need to Know](https://www.cognitivefxusa.com/hs-fs/hubfs/anxious-depression-treatment.jpg?height=175&name=anxious-depression-treatment.jpg) ### Anxious Depression Treatment: What Patients Need to Know ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) Anxious depression, clinically referred to as mixed anxiety depressive disorder (MADD), is a challenging condition to treat. Standard approaches — such as antidepressant medication and psychotherapy... [Read the full article ](https://www.cognitivefxusa.com/blog/anxious-depression-treatment) ![7 Things Mental Health Professionals Should Know About New Generation TMS](https://www.cognitivefxusa.com/hs-fs/hubfs/what-mental-health-professionals-should-know-about-new-gen-tms.jpg?height=175&name=what-mental-health-professionals-should-know-about-new-gen-tms.jpg) ### 7 Things Clinicians Should Know About New-Gen TMS ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) If you’re a psychologist or mental health professional, chances are you’ve heard of transcranial magnetic stimulation (TMS)—maybe in the same breath as medications, ECT, or even ketamine. But the... [Read the full article ](https://www.cognitivefxusa.com/blog/what-mental-health-professionals-should-know-about-new-gen-tms) ![A Patient’s Guide to Anhedonia Treatment](https://www.cognitivefxusa.com/hs-fs/hubfs/patient-guide-to-anhedonia-treatment.jpg?height=175&name=patient-guide-to-anhedonia-treatment.jpg) ### Anhedonia Treatment: How to Feel Pleasure Again (Evidence-Based Guide) ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) For many people with anhedonia, life feels like the color has drained out of the world. Activities they used to enjoy — music, food, hobbies, relationships — suddenly feel flat. They can still feel... [Read the full article ](https://www.cognitivefxusa.com/blog/patient-guide-to-anhedonia-treatment) ![What to Do When Therapy Isn't Working for Depression](https://www.cognitivefxusa.com/hs-fs/hubfs/what-to-do-when-therapy-does-not-work-for-depression.jpg?height=175&name=what-to-do-when-therapy-does-not-work-for-depression.jpg) ### What to Do When Therapy Isn't Working for Depression ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) Psychotherapy helps many people with depression — but it isn’t effective for everyone. For example, a [large clinical trial](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/208460) found that nearly **60% of participants still met the criteria for major...** [Read the full article ](https://www.cognitivefxusa.com/blog/what-to-do-when-therapy-does-not-work-for-depression) ![Why Won’t Your Depression Go Away? (And What You Can Do About It)](https://www.cognitivefxusa.com/hs-fs/hubfs/why-wont-my-depression-go-away.jpg?height=175&name=why-wont-my-depression-go-away.jpg) ### Why Won’t Your Depression Go Away? (And What You Can Do) ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) To understand why your depressive symptoms aren’t going away, it’s important first to recognize that major depression is a [complex](https://www.bmj.com/content/365/bmj.l794.long) disorder influenced by various factors. Effective treatment requires... [Read the full article ](https://www.cognitivefxusa.com/blog/why-wont-my-depression-go-away) ![Why Aren’t My Antidepressant Medications Working? ](https://www.cognitivefxusa.com/hs-fs/hubfs/why-aren%E2%80%99t-my-antidepressant-medications-working.png?height=175&name=why-aren%E2%80%99t-my-antidepressant-medications-working.png) ### Why Aren’t My Antidepressant Medications Working? ![Image of Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Spangler_150px.webp?height=70&name=Spangler_150px.webp) [Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd) You've waited weeks. You've followed every instruction. And you still feel the same, or maybe even worse. If your antidepressant isn't working, you're not imagining things, and you're far from alone. 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