COPING WITH S.A.D.
As winter approaches, there are fewer daylight hours and so, by December, we often get up in the dark and come home from work or college in darkness. What’s more, the shorter winter days don’t have the same light intensity that we get in summer.
When light hits the back of the eye (the retina), messages are passed to the part of the brain (the hypothalamus) that rules sleep, appetite, sex drive, temperature, mood and activity. If there’s not enough light, these functions are likely to slow down and gradually stop. Some people seem to need a lot more light than others, and these are the people who develop seasonal affective disorder (SAD), to a greater or lesser extent.
Many people report that they eat and sleep more in winter and that long stretches of grey skies make them feel low – this is all perfectly natural. But for those with SAD, the changes in mood and behaviour are much more severe, and happen regularly, each winter, following a seasonal pattern.
Once someone has experienced two or three winters of symptoms, they can be said to be suffering from SAD. The symptoms are many and varied, and people can experience any of the following common effects:
- lack of energy for everyday tasks
- being more prone to illness – some people with SAD may have a lowered immune system during the winter, and may be more likely to get colds, infections and other illnesses
- sleep problems
- depression – feeling sad, low, weepy, guilty, a failure; sometimes hopeless and despairing, sometimes apathetic and feeling nothing
- mood changes – in some people, bursts of over-activity and cheerfulness (known as hypomania) in spring and autumn
- anxiety – tenseness and inability to cope with everyday stresses; panic attacks
- social problems – irritability, and not wanting to see people; abusive behaviour
- concentration problems
- overeating – particularly craving carbohydrates and putting on weight (which may increase negative feelings)
- loss of interest in sex or physical contact
- alcohol and drug abuse
There are several brain chemicals involved in SAD, but the main one is serotonin. People experiencing depression have been found to have lower levels of serotonin, particularly in winter. It is thought that serotonin might not work properly in people with SAD.
Some people with SAD have likened their symptoms to a desire to hibernate for the winter. And it has been found that people with SAD produce much higher melatonin levels in winter than those who don’t have SAD symptoms, but their summer levels are normal.When treated with bright light, melatonin levels drop to normal. However,suppressing melatonin doesn’t cure the symptoms, so this factor isn’t likely to be the sole cause of SAD.
What sort of treatment is there?
Many people make their own diagnosis and treat themselves. However, talking to your GP will give you further information and treatment options. Ideally, any treatment (including light treatment) should be medically supervised, either by a GP or a SAD clinic. Unfortunately, there are only a few NHS clinics in this country, and you may have to wait a long time for an appointment.
Bright light is the most effective treatment for most people. Light therapy (phototherapy) helps many people, usually within three to five days. It means spending some time each day exposed to very bright light, at least ten times the intensity of domestic lighting. Ordinary light bulbs and fittings are not strong enough, and ordinary suntan lamps or boxes, which emit high levels of ultra violet (UV) light, should not be used. Light treatment with the correct lights is perfectly safe: enough UV is screened out, so there is no danger of eye problems or skin cancer.
Talking treatments, such as counselling, psychotherapy or cognitive behaviour therapy (CBT) can be extremely useful in helping people to cope with SAD symptoms. They also help to uncover other factors that may be contributing to your symptoms, and enable you to do something about them.
It’s possible to get CBT on the NHS in several places, and the NHS provision of CBT is developing fast under the government funded programme ‘Improved Access to Psychological Therapies’ (IAPT) (however, in some areas the service is still patchy). In addition to the services offered via IAPT, some counsellors and psychologists offer CBT under the NHS, for example at GP surgeries. Some nurses, doctors, occupational therapists and clinical psychologists working in community mental health teams can also provide CBT. Some NHS Trusts will have specialist therapy services. Your GP may be in the best position to give you information about local services. Various organisations offer low-fee schemes. (See Useful contacts for more information.)
SSRI (selective serotonin reuptake inhibitor) antidepressants, such as paroxetine (Seroxat), sertraline (Lustral) and fluoxetine (Prozac),which increase the activity of serotonin, have proved successful in severe cases of SAD. They can be combined with light treatment. Make the most of natural light
We know that being outdoors throughout the winter isn’t a cure, because many farmers and outdoor workers have SAD. However, it is still worth taking opportunities to be exposed to natural light when possible. Going outdoors, particularly around midday or on bright days, can be effective in reducing symptoms. If it is safe to do so (i.e. when you will not impair your vision), try to wear sunglasses a bit less often: this will allow greater exposure to natural light. Additionally, having pale colours within the home that reflect light from outside can be helpful.
You need to keep active during the winter, but with routine stress-free activities that don’t require too much concentration or drain your energy. There’s plenty of evidence to show how good physical activity is for mental wellbeing, and for helping with problems such as depression. One research study showed that a daily one-hour walk, in the middle of the day, could be as helpful as light treatment for coping with the winter blues.
A healthy diet is also important, and you should try to balance the common SAD craving for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables. Some people find that taking extra vitamin B12 is helpful.