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Seasonal Affective Disorder (SAD)

With the nights growing longer and the weather getting colder, it is safe to say that winter is well and truly upon us! But what does this mean for our psyche? Often these longer nights can lead to us feeling a bit down and cause us to lose interest in daily activities. This is known as Seasonal Affective Disorder (SAD) aka ‘The Winter Blues’, the symptoms of depression and lethargy tend to be present between December and February. During spring and summer, you may feel better, but symptoms may resurface when winter returns.

The Main Symptoms of SAD are:

  • Persistent low mood
  • Loss of interest in daily activities and life
  • Feeling lethargic – slow and lacking energy
  • Sleeping more
  • Eating more, so gaining weight
  • Feeling irritable

What are the Causes?

The exact cause of SAD is not fully understood. It is thought reduced sunlight in the winter months is a contributing factor. Daylight can affect mood, appetite and wakefulness, which are processes that the hypothalamus (a structure in the brain) controls.

However, SAD does not occur at a higher incidence in northern regions compared to southern regions, so there may be causes other than reduced daylight exposure. It is possible there is a genetic component as some cases run in families.

Women of childbearing age are more commonly affected by SAD and it is approximately 3 times more common in women than men.

How do I know if I have SAD?

The best way to know if you have SAD is to visit your GP. They will assess your mental health state by asking various questions. These include asking about your mood, daily activities, eating habits, sleep and how these differ throughout the seasons.

What are the Treatment Options?

Therapy for SAD can be similar to depression therapy: self-help, cognitive behavioural therapy (CBT) or counselling, or medications. There is also some evidence that light boxes can be helpful. You should discuss with your GP which treatment is the best option for you.

The Most Common Treatments Are:

Self-help

  • This involves continuing your daily activities and exercising regularly.
  • Trying to get as much daylight exposure as possible, perhaps take a morning or lunchtime walk.
  • Avoid overeating, try to eat more nutritious and fillings foods which are high in protein and fibre.
  • Talk to your friends and family about your mood so they can understand and support you.
  • Practice meditation and continue to do things that you enjoy and make you happy

Light Therapy

A light box may be used to provide the daylight you are missing out on in the winter. The light is similar to sunlight but the ones recommended for use are not harmful to the skin or eyes, as they have no ultraviolet radiation. It is thought the light helps the brain to make less of the hormone melatonin, reducing sleepiness, and more of the hormone serotonin, elevating mood. You should use the light box for 30 minutes to an hour each morning. If the light is working, an improvement is usually noticed within the first week of use. Lightboxes are short-term treatments meaning while you use them symptoms will improve but next winter your SAD may return.

If you have an eye condition or have increased sensitivity to light, this may not be a suitable treatment.

You will likely need to buy your own lightbox, so ensure you check the product is medically approved for treatment of SAD and how long you need to use the light for.

Cognitive Behavioural Therapy (CBT)

CBT focuses on changing the way we think about situations and how to deal with them. This is because the way we think can influence how we feel. A therapist will provide you with a programme of self-help depending on your goals.

Medication

Antidepressants are used to treat depression and can be helpful in severe cases of SAD where other treatments fail. There is evidence that it is best to take them before any symptoms appear, at the beginning of winter, and continue them until spring. Selective serotonin reuptake inhibitors (SSRIs) are preferred as any medications which can make you sleepy should be avoided. There is good evidence for the use of the SSRIs sertraline, citalopram or fluoxetine.

 

Dr Seth Rankin is Founder of London Doctors Clinic

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