Today is the shortest day of the year. For some people, this is a turning point. From today, the period of daylight will lengthen by about three minutes a day until the Summer Solstice in June. As the days lengthen, their mood will gradually lift, until the summer when they are restored to full health.
Seasonal affective disorder (SAD) was first described in the ‘80s, although the 'winter blues' have been written about for centuries. SAD is a lot more than just feeling a little down when it's dark on the way into work. It can cause severe changes in mood and the lack of daylight can trigger severe depression. SAD is thought to affect about 3% of people in the UK, most commonly women in their early 20s and 30s.
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Gemma, 31, has suffered from SAD since she was a teenager. Her symptoms usually begin in late September, with feelings of profound sadness and low energy levels. “I usually make jokes about it but SAD can be very difficult to deal with at times. It certainly seems to have gotten worse since I was a teenager and affects me each year until about February.”
SAD usually begins and ends at around the same time every year and symptoms are at their peak in winter when the days are shortest. People suffer from an extreme lack of energy, low mood, feeling hopeless and loss of enjoyment in their usual activities. The symptoms are similar to depression but usually involve an increase in eating and sleeping. While most of us feel like snuggling up in a duvet when it’s cold outside, the feelings associated with SAD are very different. Sufferers of SAD may become convinced their life is worthless and are at a higher risk of suicide.
People who are not familiar with the disease may trivialise it by comparing it to the December tiredness we all experience and the acronym “SAD” itself doesn’t really help with this perception. It is important to recognise that SAD is equally as serious as depression and needs similar levels of support from family and friends.
The exact cause of SAD is unknown, but is thought to relate to decreased levels of sunlight causing disruption to our circadian rhythm (biological clock). SAD is more common in countries further north such as the UK and particularly Scandinavia, where light levels vary considerably during the year. The decreased daylight during winter can cause lower levels of serotonin and melatonin, the natural hormones that regulate your mood and sleep patterns. People who are susceptible have lower hormone levels during the winter and this causes low mood and change in behaviour.
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Treatment is focused on increasing levels of natural sunlight as much as possible. Gemma always eats her lunch outside during the winter: “It’s already dark by the time I finish work so lunch time is the only chance to get any daylight. It makes a very noticeable difference to my SAD at this time of year. I also try and get outside as much as I can over the weekends”.
Light therapy is often prescribed. Light boxes, approximately 25 times as bright as the usual levels of domestic lighting, provide increased levels of light and patients are advised to sit in front of them for 30-60 minutes a day. The bright lights can sometimes cause headaches, eye strain or insomnia but are usually effective in improving mood. Some people may also benefit from taking antidepressant tablets during winter, although this should be discussed with a doctor.
Other natural ways to increase serotonin are also helpful, particularly regular exercise, although motivation is difficult when all you want to do is curl up and sleep. Healthy eating, especially green vegetables are recommended, while herbal remedies such as St John’s Wort and high dose vitamin D supplements have been extremely effective for some people. Melatonin supplements are also available and are already sometimes used to treat jet lag which is also caused by disruption to the circadian rhythm, but the safety of taking these tablets long term is not yet clear.
SAD often worsens anxiety and dealing with several months of low mood can be extremely difficult. Talking therapies such as cognitive behavioural therapy can help people in dealing with this while yoga and meditation are also helpful in improving focus and reducing anxiety. Friends of people with SAD can be a great support and help with the mood symptoms by listening and spending time with the person as well as reminding them that the symptoms will improve once the winter is over.
If you find you have seasonal low mood, talking to your doctor will help in making the diagnosis and he/she can advise which treatments are most suitable for you personally. Regular exercise and a healthy diet are always good advice, while letting your friends know what you are going through helps keep perspective during a very difficult time of year.
For more information, visit www.nhs.uk