Seasonal affective disorder can bring depression, exhaustion, irritability and sleep issues. Photo / Getty Images
If the shorter days send your mood spiralling, here are the practical steps to boost your wellbeing.
Grey skies can darken anyone’s mood, but for those who suffer with seasonal affective disorder (SAD), winter can be especially miserable.
SAD can bring depression, exhaustion, irritability and sleep issues. But rather than dread the rest of winter, know that there are practical ways to stay positive.
“SAD is a type of depression that’s provoked by seasonal change,” says Dr Safia Debar, a GP at the Mayo Clinic Healthcare in London. “It’s sometimes known as ‘winter depression’ because this is when symptoms are more apparent and severe and it can be debilitating.”
Usually, the onset of SAD begins in the autumn or winter and gradually improves from the late spring or summer, as we have more daylight hours. Though it’s not impossible for SAD to cause depression, a sad mood and low energy can last as long as spring or early summer.
Despite it being a fully recognised medical disorder, it has historically been trivialised by some people who don’t understand the condition, explains Dr Norman Rosenthal, the psychiatrist whose landmark 1984 study was the first to describe SAD as a distinct mood disorder. “I think there is a tendency to diminish another person’s suffering if we’re not experiencing it ourselves”.
Here are some symptoms SAD can lead to:
Essentially, symptoms include all those we associate with depression.
“It’s a feeling of lack of energy, not being able to do things, a wish to withdraw from friends and family so as consequence, you then lose the boosting effects of good company,” explains Dr Rosenthal. “Then, because you don’t feel like moving your body and getting outdoors, you stay inside feeling low, and might start overeating, especially sweets and starches, and then you gain weight.
“For most people, carbohydrates have a sedating effect, but for those of us with SAD there’s an energising effect, so we crave them because we’ll naturally want to do anything to boost our energy. But overeating carbohydrates leads to weight gain so that can become another reason to feel sluggish and low.”
Debar also points out that the sleep disruption, anhedonia (loss of interest in things previously enjoyed), lethargy and fatigue can “all feel like a hard cycle to break”.
The exact cause of SAD is not fully understood, but as it’s linked to the seasons, the main theory is that a lack of sunlight might stop a part of the brain called the hypothalamus working properly. This has several effects, explains Debar, including:
“Melatonin is a hormone that makes you feel sleepy; in people with SAD, the body may produce it in higher than normal levels,” says Debar. “Meanwhile serotonin is a hormone that affects your mood, appetite and sleep, so a lack of sunlight may lead to lower serotonin levels, which is linked to feeling depressed.”
What’s more, our bodies have an internal clock which uses sunlight to time various important functions, explains Debar, such as when we wake up. So lower light levels during the winter can disrupt our circadian rhythm, leading to symptoms of SAD.
Those most at risk of developing SAD are:
SAD is more prevalent in regions with long, dark winters. “In general, the further north you go, the shorter your days are in the winter and the more likely you are to suffer,” says Dr Rosenthal.
“But there may also be genetic variability at play. For example, studies done in Iceland, show that it’s not as frequently experienced as you would expect there (even though it’s very far north) while it’s very common in Britain. There is speculation that Iceland has a population that is genetically fairly homogeneous, and perhaps those people who couldn’t tolerate the North moved south, while those who thrived stayed there, and that’s how the gene pool was positively influenced.”
“Women are also more likely to get it – especially during the reproductive years,” says Dr Rosenthal. “After the menarche (the beginning of menstruation) the prevalence in girls and women goes way up, and it stays up until after the menopause. So there seems to be something about the sex hormones that predisposes women to the condition,” he says.
Research indicates that women are about four times more likely to be affected, says Debar. “Though interesting, men may experience more severe symptoms when they do have it. People with a history of major depression are at higher risk of SAD, as are those who have bipolar disorder or other mood-related conditions. They may experience a worsening of symptoms during the seasonal changes,” she says.
Some research also suggests a hereditary component, and SAD does seem to run in families, say the experts.
The best way to decide whether it’s SAD or depression, says Dr Rosenthal, is to think about the history of when it occurs. “There’s a very characteristic cluster of symptoms, and people will often tell me that in the summer they’re the life and soul of the party and great company, but by winter they’ve become a hibernating bear.”
Rosenthal first diagnosed himself with the condition after moving from a warm climate to a colder one. “When this happened three times in a row I began to see a pattern.”
There is no blood test available for SAD – but don’t let this diminish the condition.
“For almost any psychiatric illness, whether regular depression, anxiety, or schizophrenia, blood tests won’t reveal anything,” says Rosenthal.
A diagnosis of SAD, explains Debar, can usually be confirmed if your depression occurs at a similar time each year for at least two years, and the periods of depression are followed by periods without depression, for instance when people are in full remission during a particular season, typically spring or summer.
“Because we see winter blues as a spectrum, the mild cases are often missed and people often put up with symptoms,” says Debar. “Recognising it earlier means SAD can be well managed before the symptoms set in.”
There are many different ways you can treat SAD ranging from changing your diet and lifestyle to prescription drugs. Here are some of the most effective ones:
1. Treatment options without drugs
“The most effective intervention is to get early morning sunlight – even on an overcast day, and even just for five minutes – as this resets the circadian rhythm and being outside naturally boosts mood,” says Dr Debar.
She explains to her patients that on bright, sunny days, outdoor light can range from 50,000 to 100,000 lux (how light is measured). On overcast days, outdoor light can still be around 1000 to 5000 lux, which is significantly more than standard indoor lighting (about 300-500 lux).
“If this isn’t possible or practical then light therapy – which mimics natural sunlight – is one of the most well-researched treatments for SAD,” says Dr Debar.
Clinical studies have demonstrated that light therapy significantly reduces depressive symptoms in people with SAD, with results similar to taking antidepressants.
Most SAD light boxes deliver 10,000 lux of artificial light and allow for a controlled and consistent daily exposure to bright light (and is more feasible than outdoor exposure in winter).
Rosenthal recommends buying a lamp from a reputable provider (he uses Lumie ones himself, which he keeps on his desk).
2. Treatment options with drugs
Antidepressants, such as selective serotonin reuptake inhibitors (SSRI) can be taken for part of the year, and they can be used preventively, says Rosenthal.
But Debar warns that while drugs are useful if other methods have failed, antidepressants shouldn’t be relied upon as a “quick fix”. She suggests psychotherapy may help as often there are other factors that need to be processed and addressed, and talking therapy offers validation of symptoms and support. “It’s also important to address other hormonal pathways including insulin, thyroid, cortisol and lifestyle factors.
Know that you are not alone and that it is not your fault. Taking steps before your mood dips too low makes it easier, these include:
Debar suggests having a general check-up to ensure everything else such as thyroid and vitamin D are normal and making dietary changes to include more plants, proteins and good fats – to help regulate mood.
“Reduce sugar and processed carbohydrates, which can cause energy spikes and crashes, and avoid further disruptors of the circadian rhythm, such as excessive screen use at night, alcohol, and heavy meals in the evening. And practising mindfulness or other stress-management techniques can improve resilience and help us stay grounded and calm in the face of seasonal changes.”
Rosenthal says it’s important to not give in to symptoms. “Don’t lie in bed under the covers. Humans are sociable animals and getting out will help.”
When does SAD start?
According to the NHS, the symptoms of SAD usually start in the winter or autumn.
How long do SAD symptoms last for?
Typically, people with SAD can experience symptoms for four to five months out of the year.
Can vitamin D supplements help with SAD?
While it has been found that some people with SAD are deficient in vitamin D, it is still unclear whether vitamin D supplements can actually help treat the condition in the long term.
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