The 'winter blues'

Special lamps can be purchased to try and stave off the effects of SAD. Photo / CityLife West

The nights are currently much longer and many people will feel like hibernating - some will also find themselves gaining weight, needing more sleep, craving carbohydrates and sugar, and just not coping as well as usual at work... funny, how it all gets better when spring arrives!

If you have some of these symptoms, then you are one of the 10 per cent of New Zealanders suffering from SAD or Seasonal Affective Disorder, sometimes called the "winter blues".

This condition is four times more common in women than in men and is also seen in children, however, it tends to start in the 20s or 30s.

The symptoms include seasonal variations in mood with depression starting in autumn and peaking in the winter, with relief once spring arrives. Other symptoms include the need for excessive sleep, daytime drowsiness, reduced concentration, carbohydrate cravings, weight gain, increased appetite and reduced energy. The symptoms may be so severe that they may cause problems at work and social disability.

SAD is worse in the very southern latitudes or very northern latitudes of the world as compared with those closer to the equator - this means that those in the South Island are at greater risk.

Although people can acclimatise to the problem - those who move south in New Zealand would be at higher risk than long time locals there.

There are variations in how severely SAD affects people, from a very mild effect where there is a hardly noticeable reduction in performance and slight increase in appetite, to very severe symptoms that require medical treatment.

In between these extremes there is the subclinical SAD (sub SAD) which is similar to SAD but with milder symptoms that do not impair function to a major degree.

In addition to all of this, many people who suffer SAD have other associated conditions such as bulimia - which tends to worsen during the winter - and anxiety disorders.

Women who suffer from premenstrual syndrome and SAD, find their symptoms worsen during the winter.

What is particularly important is that many sufferers don't know they have this problem and it can take years for them to seek help.

The causes of SAD are multiple and theories abound in relation to some of the causes.

It is known that mood disorders and SAD run in families so there is a genetic association.

There are theories in relation to abnormalities of neurotransmitters (brain chemistry) that implicate serotonin, dopamine and noradrenaline. There is also a theory about phase delay with the body's natural rhythm which is like jet lag.

There is a 70 per cent response rate when the first line treatment for SAD is used - this is light therapy. A normal house or office light generates about 300 lux. Light therapy uses light boxes in front of the person and administers 2500 lux for at least two hours a day - it takes a week to correct the problem. Other protocols would use 10,000 lux for 30 minutes a day.

Light therapy can also be administered as an increasingly bright light in the bedroom leading up to the morning, which is called dawn simulation. Light therapy can work for normal depression as well.

Medications that can be helpful include fluoxetine (Prozac®) and Venlafaxine Effexor®).

Natural substances that have been found useful include tryptophan or 5-hydroxy tryptophan which are both precursors of serotonin.

Indeed, in the cases where light therapy has failed, tryptophan has been found useful. St John's Wort helps as does SAMe (S-adenosylmethionine) - the latter helps with serotonin production in the brain.

A special note - tryptophan, 5-hydroxy tryptophan, St John's Wort and SAMe cannot be taken concurrently with antidepressants because they will excessively increase serotonin in the brain and cause severe overdose symptoms.

Melatonin, a natural substance released by the brain in response to darkness, when taken at night, can help improve the quality of sleep and vitality in these people.

Vitamin B6 also helps in serotonin production - you know you don't have enough vitamin B6 when you can't remember your dreams.

Omega 3 fish oils have an important role in the production of serotonin. It has been found that Icelandic people don't get SAD and when fish consumption reduces, SAD increases.

My other tips would be to include sunny holidays in your mid-winter plans, and to go for a morning walk, especially in the winter time, to get that bright sunshine to help reset your brain chemistry.

If you have any of these symptoms you do not have to suffer them needlessly. Get some help.

- Dr Frances Pitsilis
drfrances.co.nz

Pictured above: Special lamps can be purchased to try and stave off the effects of SAD. Photo / CityLife West