Beat the winter blues - Seasonal Affective Disorder

Do you get those down feelings as soon as the clocks go back? You’re not alone - It's estimated that 7% of people in the UK suffer from Seasonal Affective Disorder (SAD), a type of depression with a seasonal pattern. This is most common between the ages of 20-30, although it can develop at any time. More women are affected than men.

What are the symptoms of SAD?

As SAD is a type of depression its symptoms tend to be similar to those of depression. However, symptoms of SAD occur on a seasonal basis:
Recurrent episodes: People with SAD find that their symptoms return annually at the same time of year. Winter depression is more common than summer depression, so most people’s symptoms begin in the winter and improve in the spring. Symptoms tend to get worse as winter progresses and sunlight decreases. Between 70-80% of people with SAD have episodes of unipolar depression (only depressive symptoms) rather than bipolar depression (both depressive and manic periods). Symptoms vary from person to person.
Symptoms of depression: As with any form of depression, main symptoms include low moods and a loss of pleasure/interest in activities. Others may include:

• Irritable mood
• Feelings of despair, guilty and worthlessness
• Low self esteem
• Being indecisive
• Feeling stressed or anxious
• A reduced sex drive

Winter depression: In addition to those listed above, symptoms of winter SAD may include:

• Being less active and having less energy
• Feeling tired and sleeping more (hypersomnia)
• Not being able to concentrate
• Putting on weight/an increase in appetite
• Craving carbohydrates (starchy foods, such as bread and pasta)

What causes SAD?

The cause of SAD is not fully understood. It is thought to be linked to reduced exposure to sunlight during the shorter days of the year.

• One theory is that light stimulates a part of the brain called the hypothalamus, which controls mood, appetite and sleep.
• Melatonin is a hormone that affects the way we sleep – when it is dark, the pineal gland produces melatonin to make you feel sleep. People with SAD produce much higher levels of melatonin in the winter.
• Serotonin is a hormone which affects mood, appetite and sleep. People with SAD usually have lower-than-average levels of serotonin during the winter months, which may mean that messages between nerve cells are not being transmitted effectively, which may cause the symptoms of SAD.
• A reduced level of sunlight can disturb your circadian rhythm – a psychological process that helps to regulate your body’s internal ‘clock’ which lets you know when to sleep and when to wake up.

Depression has many different causes and contributing factors, some of which may also contribute to SAD. These include genetic and family factors, adverse childhood experiences, personality factors, psychological factors and social factors.

Diagnosis

A GP is a good first point of contact. He or she will ask about your day-to-day life – your mood, lifestyle, eating habits, sleeping patterns - and symptoms. One bout of the "winter blues" doesn't automatically mean you have SAD. But, if you have regular symptoms over at least two consecutive years in autumn/winter which clear in the spring, the diagnosis may be SAD. Your doctor may also want to rule out other forms of depression.

Treatment

Treatments include light therapy (or phototherapy), drug and psychological treatments such as cognitive behavioural therapy. However, there are a number of steps you can take to lessen the effects of SAD. Wherever possible, you should:
• Live and work in light, bright environments – this can be difficult in a hospital so…
• …Make time each day to walk, run or take a bike ride outside, especially if it's sunny
• Try to sit near windows when inside
• Take regular, moderate exercise - for more information on exercise, please see the Q-active factsheet 5.
• Eat foods for high energy - foods that give the best 'miles per gallon'. These foods are - unprocessed, organic, nutrient-rich whole foods such as apples, pears and berries and all vegetables, and also whole grains (oats, brown rice, and wholemeal bread), beans and lentils. If half your diet consists of these whole foods, you are on the right track for natural energy. Avoid processed foods and refined carbohydrates such as white bread, biscuits, cakes and white rice.

For more information on how your diet can affect your mood, see the ‘Food and Your Mood’ information sheet.

Useful websites

NHS information on Seasonal Affective Disorder - http://www.nhs.uk/Conditions/Seasonal-affective-disorder/Pages/Causes.aspx.

The Seasonal Affective Disorders Association - www.sada.org.uk.

Penny Williams, Nutritional Therapist, LifeFirst, 2005 - www.lifefirst.info.

Mind’s information sheet –
http://www.mind.org.uk/help/diagnoses_and_conditions/seasonal_affective_disorder.

Norman E. Rosenthal – Winter Blues, Guilford Press, New York (available through Amazon). This is the SAD ‘bible’ and very good for dipping into or read the following short article where Norman is talking about the discovery of SAD
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686645/.

Contact

Gail has had SAD for over 20 years, and with the aid of a light box at home and at work has developed many coping strategies which she is very happy to share with you.
Gail Spencer (Dept of Spiritual & Pastoral Care on 63799 or Gail.spencer@nuh.nhs.uk).