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As the nights start to draw in and we get ready to turn the clocks back, some of us begin to feel down. In fact, according to the NHS, 1 in 15 people (approx. 6% of the UK population) experience this relatively common condition SAD every year, usually between September and April.
The condition is aptly known by the acronym SAD, Seasonal Affective Disorder, and is often described as “Winter Depression”. Low mood during the winter months has been documented as far back as 1845; however, it was not formally recognised as a disorder until the 1980s (Rosenthal et al).
Seasonal Affective Disorder (SAD) is a type of depression that is related to changes in seasons. SAD usually begins about the same time every year with the onset of shorter daylight hours and usually ends as the days begin to lengthen again. Light and darkness are thought to affect mood and behaviour via the complex interaction between the body’s daily rhythms and the biological clocks that control them.
The lack of sunlight could potentially cause the hypothalamus to not work correctly. The hypothalamus is a gland within the brain which is located almost right in the centre of it and it keeps various conditions within the human body constant, regulating our temperature, hunger levels and blood pressure.
If the hypothalamus is not working correctly, it is likely to negatively affect:
- The production of melatonin – Melatonin is a hormone that makes you feel sleepy; in people with SAD, the body may produce it in higher than normal levels.
- The production of serotonin – Serotonin is a hormone that affects your mood, appetite and sleep; a lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression.
- The body’s internal clock (circadian rhythm) – Your body uses sunlight to time various important functions, such as when you wake up, so lower light levels during the winter may disrupt your body clock and lead to symptoms of SAD.
Most people who experience SAD start to get symptoms for the first time in their 20s or 30s, however, children can be affected too. Women are about four times more likely to experience SAD than men.
Susceptibility to SAD is increased the further away you live from the equator, which means it is most often found in the Northern Hemisphere, and research has found that there is also a genetic component to SAD; in other words, you are more likely to experience SAD if a close relative is also affected by the condition.
In severe cases SAD sufferers spend over 40% of the year struggling with substantial depressive symptoms during most years, beginning in young adulthood; however, the prevalence rates appear to reduce in older age.
It is important to note that one bout of the “winter blues” does not automatically mean you have SAD; however, if you have had two or more recurring spells of depression at the same time of year, that get better in between times, you may suffer from SAD. A small number of people may experience the symptoms of SAD in the summer months rather than winter, however, research on this condition is more limited.
Symptoms of SAD
The symptoms of SAD can be very similar to those of depression, and the nature and severity of these symptoms can vary from person to person. For some people it is simply a feeling of being a bit down as the nights draw in; for others the feelings are far more severe and begin to impact on their day-to-day lives.
Symptoms may include all or some of the following:
- Being less active than usual.
- Feeling lethargic (lacking energy) and sleepy during the day.
- Sleeping for longer than normal and finding it more difficult to get up in the morning.
- Feeling that you want to “hibernate”.
- Finding it hard to concentrate.
- Feeling sluggish or agitated.
- Having an increased appetite – some people have a particular craving for foods containing lots of carbohydrates “comfort foods” and end up gaining weight as a result.
- Having a persistent low mood.
- Getting little or no pleasure or interest from normal everyday activities.
- Feeling irritable.
- Feelings of despair, guilt and worthlessness.
- Experiencing low self-esteem.
- Being more emotional, being tearful.
- Feeling stressed or anxious.
- Becoming less sociable.
- Losing interest in sex or physical contact.
- Being more prone to physical health problems, such as colds, infections or other illnesses.
How to Manage SAD
If your SAD symptoms are mild, you may find that making some small changes to your lifestyle can help.
As soon as you begin to notice the first symptoms of the season you can:
- Get as much natural sunlight as possible, even a brief lunchtime walk can be of benefit. If indoors, sit close to a window with the curtains wide open.
- Take plenty of regular exercise, particularly outdoors and in daylight.
- Eat a healthy, balanced diet including foods that boost serotonin – the “happiness hormone”. These foods include:
– Salmon – Salmon is a rich source of tryptophan, which is important for producing serotonin. In addition to helping increase serotonin levels, it contains high levels of omega-3 fatty acids that are beneficial for the skin, heart and bones. Salmon also contains Vitamin D, which is important for healthy bones and to aid in serotonin production.
– Nuts and Seeds – Nuts and seeds are natural sources of tryptophan and protein, as well as an adequate salmon replacement for those who prefer a vegetarian or vegan diet. Almost any variety of nuts or seeds is a great choice for snacking or adding to a meal, and many wholegrain breads are now available with nuts and seeds baked in.
– Turkey and Poultry – Turkey and poultry are also full of tryptophan and good sources of protein.
– Eggs – Eggs are full of protein and a favourite staple of athletes and body builders. Be careful of the way eggs are prepared though, to get the full health benefit. Boiled and poached eggs are the healthiest ways to cook them without adding any fat, unlike fried eggs.
– Tofu and Soy – Tofu is made of soy, and it is full of tryptophan. Soymilks have become popular in recent years, and soy products are a popular way for vegans and vegetarians to get tryptophan without eating meat.
– Milk and Cheese – Cheese and milk are excellent sources of tryptophan and as an added bonus they are rich in calcium for healthy bones and teeth. To stay on the healthy side, choose milk and cheese that are low in fat to receive all the benefits without gaining weight.
– Pineapple – Pineapple contains plenty of tryptophan to boost serotonin in the brain. Additionally, pineapple is full of bromelain, which is another fantastic protein that everyone should consume regularly because of its anti-inflammatory properties.
– Drinks, for example green tea, and probiotics also help to boost serotonin.
Too much caffeine, however, can reduce serotonin levels, as can alcohol, sugary foods and even artificial sweeteners, so reduce your intake of these substances wherever possible.
Aromatherapy may also help those with SAD. The essential oils can influence the area of the brain that is responsible for controlling moods and the body’s internal clock that influences sleep and appetite. You can add a few drops of essential oils to your bath at night to help you relax.
Stick to a Schedule – People who live with SAD often have trouble sleeping at night and getting up in the morning. Maintaining a regular schedule improves sleep, which can help alleviate symptoms of SAD. Keeping to a regular schedule will also expose you to natural sunlight at consistent and predictable times of the day.
When COVID restrictions allow, you may want to consider a winter sun holiday. Taking a winter sun break to warmer climates can help people who suffer from SAD; the excitement of planning and preparing for a break can lift your mood and can linger for a few weeks after you return.
You may find it useful to talk to other people about how you are feeling; others in your circle may be experiencing similar feelings as winter draws in or they may be able to help alleviate some of the symptoms you are experiencing by involving you in activities that can help lift your mood.
If you find it difficult to talk to people that you know, you can contact:
- Your GP or NHS 111.
- The Samaritans – You can call their free helpline 24 hours a day, 365 days a year on 116 123.
- MIND – Infoline 0300 123 3393 provides an information and signposting service, open 9am to 6pm, Monday to Friday (except for bank holidays).
- Seasonal Affective Disorders Association (SADA) is the UK’s non-commercial support organisation for SAD, a voluntary organisation and a registered charity. It provides information for the public and for health professionals and is dedicated to advising and supporting SAD sufferers nationwide.
For many people SAD is mild and self-manageable by implementing some or all of the suggestions outlined above. However, you should always take the signs and symptoms of Seasonal Affective Disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it is not treated.
These issues can include:
Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.
What help is available?
Your first port of call should be your GP or NHS 111.
To help diagnose SAD, your doctor may do a thorough evaluation, which generally includes:
- Physical examination. Your doctor may do a physical examination and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
- Laboratory tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
- Psychological evaluation. To check for signs of depression, your doctor asks about your symptoms, thoughts, feelings and behaviour patterns.
Treatments prescribed by your doctor to help combat Seasonal Affective Disorder may include light therapy, psychotherapy and medications. If you have bipolar disorder, be sure to tell your doctor as this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
Some people with SAD find that light therapy can help improve their mood considerably. This involves sitting by a special lamp called a light box, usually for around 30 minutes to an hour each morning. The light produced by the light box simulates the sunlight that is missing during the darker winter months.
Before you purchase a light box yourself, talk with your doctor about the best one for you, and familiarise yourself with the variety of features and options so that you buy a high-quality product that is safe and effective. Also ask your doctor about how and when to use the light box.
Other treatments available include cognitive behaviour therapy (CBT), where you talk to a trained therapist to help change the way you think and feel about situations. CBT has been shown to be an effective way of treating a number of different mental health conditions including SAD and you can be referred to a therapist on the NHS via your doctor.
CBT can help you to:
- Identify and change negative thoughts and behaviours that may be making you feel worse.
- Learn healthy ways to cope with SAD, especially with reducing avoidance behaviour and scheduling activities.
- Learn how to manage stress.
Antidepressant treatment can be effective for some people with SAD, especially if symptoms are severe. An extended-release version of the antidepressant bupropion may help prevent depressive episodes in people with a history of SAD. Other antidepressants may also commonly be used to treat SAD.
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year, and may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant.
In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. It is important that you discuss all the options with your doctor and fully explain the effects that SAD is having on your day-to-day life.
The symptoms of summer SAD can be a little different to winter SAD. If you have summer SAD, you may find it difficult to get to sleep and you may lose your appetite. If you have SAD in the summer months, it is best to discuss a personal treatment plan with your doctor.
Self-help could include staying out of the sun rather than seeking daylight, but instead of staying at home all the time, which might make you feel isolated, try to find activities to do in other indoor places out of the sun.