Seasonal Affective Disorder SAD is an insidious condition that affects many people and the big problem is that most sufferers don’t realize that something is seriously wrong for years.
So for example you suffer from depression for years, depression that starts in the autumn, as the evenings draw in. By Christmas you’re so low that you can barely get out of bed. You can’t cope with organizing the Christmas season celebrations and things like that. Some years you feel so bad you may go to bed say on Christmas Eve and refuse to move… it’s that bad! But now that you’re indisposed for Christmas – and seriously skipping it – you know something is seriously wrong!
It is estimated that seasonal affective disorder (SAD), also known as “winter depression” affects as many as a third of the population, but the condition often goes undiagnosed.
For tens of thousands of people SAD can be seriously disabling. This guide will show you how seasonal changes in light levels affect our behavior and our mood – and what you can do to improve your situation.
- 1 Why we experience seasonal mood changes
- 2 How light affects us
- 3 What are the effects of SAD?
- 4 What causes Seasonal Affective Disorder (SAD)?
- 5 Who gets seasonal affective disorder, SAD?
- 6 Issues and Problems Diagnosing SAD
- 7 What sort of treatment is there for SAD?
- 8 What else can you do to help yourself deal with SAD?
- 9 How can family and friends help a person with SAD?
Why we experience seasonal mood changes
Most people can relate with this experience… you feel better when the sun is bright. You’re more cheerful and you’re more energetic. But when the day is downcast and gloomy or grey, especially in winter time, you find yourself feeling less enthusiastic. You’re more inclined to stay indoors or even to stay in bed. You feel like working less, socializing less – and you tend to eat more.
These changes in our mood are due to the change in the quality and intensity of the light. There is less and less daylight as winter comes, we find ourselves getting up in the dark by December, and it’s already dark when we come home from work or from school.
So you’re getting shorter days and a lot less light.
Our sleeping patterns tend to follow the light and darkness cycle, and in times past, before electric lighting became a common feature of our lives people would wake up and start being active at dawn and go to sleep when nighttime came.
In the winter they would sleep longer and be less active. Today our lives are organized differently so we no longer follow these natural rhythms that our forefathers followed.
We have learned to manipulate the day to fit our needs and our “advanced” lifestyles. We can create daylight anytime we need it.This disrupts our body’s clock or circadian rhythms.
How light affects us
The lack of light affects us differently, some people more so than others. The hypothalamus is the part of our brains that governs sleep, appetite, sex drive, temperature, mood and activity. When light rays reach the retina, the receptor at the back of our eyes, messages are generated and transmitted to the hypothalamus. If the light reaching the retina is diminished, these functions that are governed by the hypothalamus are likely to slow down and gradually to stop. You can think of a car that’s running out of fuel.
Some people seem to need a lot more light than others to function normally, and these are the ones who succumb more easily to seasonal affective disorder (SAD).
What are the effects of SAD?
People with SAD experience seasonal changes of mood and behavior. The most common mood change is depression, which experts refer to as an“affective disorder.” Symptoms typically emerge between September and November and continue until March, April and sometimes as late as May.
About 1 in 5 cases of SAD are relatively mild, what are usually referred to as the “winter blues”, or “sub-syndromal” SAD. These cases typically occur in the December, January and February months.
About 2% to 5% of cases develop a severe form of SAD and these can’t function in winter without continuous treatment.
Many among this latter group may have trouble studying or keeping a job during this season because they feel sleepy or lacking energy to function or to concentrate.
They may become irritable, and unloving, and certainly unlovable themselves, which stresses and strains their relationships at home or at their place of work.
About 90% of people in the general population tend to eat more and to sleep more in winter and to feel down in the dumps during long stretches of grey skies – and this is natural. But for people with SAD the symptoms are more severe, and they happen regularly, whenever winter comes, and they experience this on a seasonal pattern.
In the spring the symptoms go away. This can happen suddenly, with the person experiencing a short period of hyperactivity, or the symptoms go away gradually, depending on the amount of sunlight in the spring and early summer.
The bad news is that SAD is often misdiagnosed or it’s overlooked both by the sufferers ad those around them. But if a person has experienced the symptoms of SAD two or three winters running, it is safe to assume that they’re suffering from SAD.
The symptoms of SAD are many, and they’re varied. Some of the common effects people experience include:
- Lethargy or fatigue.The person lacks energy and is unable to carry out their normal daily routine.
- Depression (including postnatal depression):Symptoms include feeling sad, or low, or weepy and guilty. The person may have feelings of being a failure or feel hopeless and full of despair. Or they’ll be apathetic and devoid of emotion.
- Mood changes: Some people may experience bursts of hyperactivity and cheerfulness (hypomania) in spring and in the autumn.
- Problems concentrating: The person has difficulty thinking straight or making decisions or concentrating on ordinary activities.
- Sleep problems. Symptoms include a tendency to oversleep, sleepiness during the day. Sometimes the person has trouble sleeping at night and wakes up very early in the mornings.
- Overeating: This can include things like craving carbohydrate foods and weight gain, which has the potential to increase negative feelings – and worsen the guilt feeling, the despair, etc.
- Bulimia: Symptoms may include eating excess amounts of food, followed with a bout of vomiting.
- Social problems: The person suffering from SAD becomes irritable. This happens especially among children. The person may exhibit abusive behavior and stop wanting to see people.
- Anxiety: The person is tense and unable to cope with the stresses of everyday activities. They may experience panic attacks.
- Loss of libido: Symptoms include lack of interest in sex or physical contact with another person.
- Period problems: Women with SAD may experience period problems in the winter months.
Other symptoms include alcohol and drug abuse and feeling under the weather. Most people suffering from SAD have a lowered immune system during the winter. They’re more likely to contract colds incessantly, and to experience infections and other illnesses
People who suffer from sub-syndromal SAD or the “winter blues” – the milder version of SAD – will experience similar symptoms as above, but they are less severe and last for shorter periods than full-blown SAD. The most common symptoms in their case include tiredness, lethargy, as well as sleeping and eating problems.
What causes Seasonal Affective Disorder (SAD)?
There are several different theories on what causes seasonal affective disorder, and where the problem lies. The major focus of inquiry is on how light triggers messages to the hypothalamus in our brains.
Low serotonin levels: Hormones mediate what messages are transmitted to the brain, and in what quantities. There are several hormones or “neurotransmitters” involved in SAD, but the main one is serotonin.
It has been established that levels of serotonin are lower in depressed people, and in most people in winter. It’s thought that this “serotonin network” might not be working properly in people with SAD.
Abnormally high melatonin levels: When the messages or impulses reach the hypothalamus, the center that governs some of our most important drives and emotions, the impulses then travel to a tiny organ behind it known as the pineal gland.
When it’s dark outside this gland produces the hormone melatonin, which starts a process to put us to sleep. Light achieves the opposite result – it stops the production of melatonin – which would reverse the process, so that we wake up.
While melatonin levels are normal in people with SAD during summer, it has been found that in winter they produce higher levels of this hormone than people without SAD symptoms. When the people suffering from SAD are treated with bright light however, their melatonin levels drop to normal.
Suppressing melatonin however doesn’t cure the symptoms, so it can be concluded that the melatonin factor isn’t likely to be the only cause of seasonal affective disorder.
Disrupted body clock: Another possibility researchers have investigated is a problem that affects the nerve “circuits” inside the brain. The theory is that a faulty “supra-chiasmatic nucleus”or SCN in one of these circuits could be slowing the body’s clock or circadian rhythm in people with SAD, which would cause lethargy and depression.
Treating these people with SAD with bright light “resets” the delayed circadian rhythms and alleviates the symptoms. But as this light treatment seems to work regardless what time of the day it’s used, it can be concluded that there is more to this than simply resetting the circadian rhythms.
Who gets seasonal affective disorder, SAD?
You can hardly find people suffering from SAD who live within 30 degrees of the equator. In these regions the daylight hours are long and extremely bright nearly all year round.
SAD is common in the northern and southern hemispheres, that is in Scandinavia, all throughout Europe, in most of North America and North Asia, and as far as the southern parts of Australia and South America. In these parts, some people even get SAD during dull stretches in the summer.
Issues and Problems Diagnosing SAD
Those who have lived near the tropics for part of their lives and then immigrate to the SAD prone areas of the world tend to be more vulnerable to SAD. It’s also true that people from different cultural backgrounds tend to exhibit different sets of symptoms, and so they’re sometimes misdiagnosed and told – wrongly – that they have schizophrenia or manic depression.
SAD most commonly affects people under the age of 21, but it can begin at any age, especially in the 18 to 30 age range. What triggers it is still a mystery, but when people were surveyed, researchers linked it to events such as childbirth, hysterectomy and other hormonal upheavals.
Fourteen percent of those who took part in the survey said that their SAD had been triggered by a major loss or bereavement and 11% per cent said it was precipitated by serious illness. Both of these are common triggers of depression.
It appears like SAD is twice as more common in women than in men, although it’s hard to get accurate demographic information. The truth though is that men typically find it harder to admit to symptoms of depression and for this reason they may seek relief through using alcohol and drugs than to go seek medical attention.
That being said, more men are now recognizing SAD symptoms for what they are – and going for medical attention.
SAD and postnatal depression: Some experts have suggested that postnatal depression may be a form of seasonal affective disorder that is triggered by the considerable stress that comes with having a baby.
So, if you already suffer from SAD and you’re planning to have a baby the best time to have a baby is probably in the spring.
SAD in children: Children with SAD tend to be irritable; they’re badly behaved and sleepy – they find it difficult to wake up or to stay awake. This set of symptoms could, unfortunately,earn them the label of being lazy or difficult. For this reason, if SAD is the underlying cause of these labels but then it goes undiagnosed, this can very negatively impact the child’s life and ruin their future.
What sort of treatment is there for SAD?
Many SAD sufferers diagnose and treat themselves. But it is always a good idea to talk to your doctor about your symptoms and the steps you’re taking to deal with the problem.Whatever treatment you choose, including light treatment, it should ideally be supervised by a medical professional or a SAD clinic.
Bright light therapy for SAD: Bright light therapy or photo therapy is the most effective treatment for the majority of SAD sufferers. Over 80 per cent of people respond to light therapy, usually within three to five days of treatment. The therapy involves spending some time each day exposed to very bright light, which, typically, is at least ten times the intensity of normal domestic lighting such as we use inside of homes and offices.
This means that ordinary light bulbs and fittings are not strong enough to achieve this level of brightness. Also, ordinary suntan lamps should not be used as these produce high levels of ultraviolet light, UV. But treatment with specialize light therapy lamps is perfectly safe. Many of them today use LED or light emitting diodes, whose light can be tailored during manufacturing.
These lamps have most of the UV filtered out, so there is no danger of eye problems or the risk of skin cancer.
You can use these therapeutic SAD lights at any time of day, except late evening. Morning light seems to work best for the “night owls” and evening light for the “morning larks”.
The benefits of using these light therapy lamps continue as long as they’re used every day. Average use is one or two hours a day and the maximum about four hours. Some lamps are much brighter, especially modern LED-based SAD lamps and these can cut treatment time down to half an hour.
Follow this link for a review we’ve done of the much acclaimed Carex DayLight Sky Bright Light Therapy Lamp.
Once you have established your light therapy routine you do not have to be locked in at home indefinitely however. You can take occasional days off or you can go away for a long weekend. But make sure to start again as soon as you return.
Something to note regarding light therapy is that if your symptoms are already very severe by the time you start the light therapy you’re unlikely to get much relief in a hurry.The best results come if you start the treatment early in the winter. It may also be best to try out the light treatment (or the lamps) before you buy the product.
As for the side effects of using light therapy for your SAD, some people report experiencing headaches, irritability and in very rare cases nausea. Changing your position may help, but if problems persist, you should then stop using the light treatment.
Another thing… when you start using light therapy regularly, you should inform your optician and have them check your eyesight at least once a year. If you have existing eye problems you should ask whether the lights you plan to use are safe for you. Most modern products on the market will likely have been taken though rigorous clinical trials – but one can’t take this for grated!
Talking treatments for SAD: Talking treatments include counseling, psychotherapy and cognitive behavior therapy. These can be very useful for helping people to cope with the symptoms of SAD.
These treatments can also help to get to the bottom of the causes of the problem and to find other factors that could be contributing to the problem so that you can deal with it.
Antidepressants: For managing severe cases of SAD, a group of antidepressants known as SSRI or “selective serotonin reuptake inhibitors”, including drugs such as paroxetine (Seroxat), sertraline (Lustral) and fluoxetine (Prozac), Paxil and Zoloft can be used. These act by increasing serotonin availability and utilization.
These drugs can be used along with light therapy. Today the earlier class of drugs including amitriptyline, imipramine and dothiepinhave become unpopular on account of their negative side effects – such as increasing sleepiness symptoms.
What else can you do to help yourself deal with SAD?
It’s now understood that being outdoors more per se during winter doesn’t cure SAD – or farmers and outdoor workers wouldn’t suffer from SAD as they do. But, for all that, it helps if you can make the most of the light that’s available.
So, go outdoors and enjoy the natural daylight as much as you can. Midday is a good time to enjoy this natural lighting. Also make the most of the bright days. Inside your home, choose pale colors for the décor, colors that reflect light from outside.
Also, sit near the windows whenever you can.
It helps if you can avoid putting yourself under stress. If your mind and your body are sending you messages that it’s time to take it easier and to go into hibernation, don’t dismiss these messages.
Of course it may not be practical to go into “hibernation” exactly, but you can simplify your life as much as possible during winter time.Avoid undertaking some tasks and goals during winter, and be ruthless about this. This might mean putting off certain activities and plans until summer – things like changing jobs, moving home, taking on extra housework or decorating and home repairs.
Plan ahead for winter. For example you could buy Christmas presents in the summer, or you could stock up store cupboards and give parties before winter comes.
The other thing is to keep active during winter. The trick is to engage in routine activities that do not stress you or that do not drain your energy or require too much concentration.
Physical activity is good for your mental wellbeing. It also helps with depression and for reducing stress. One study showed that taking a walk for one hour every day around midday can be as effective for combating the winter blues as using light treatment.
A healthy diet is equally very important. You should try to balance the craving for carbohydrates that SAD sometimes causes by taking lots of fresh fruit and vegetables along with say pasta and potatoes. Some SAD sufferers find some benefit from taking extra vitamin B12 supplements.
Massage helps, so have some whenever you can. Relaxation too, so learn to use relaxation exercises to unwind. You can also look into the benefits of complementary medicine to see if it can help.
Herbs that help with SAD: St John’s wort is a popular herbal remedy that some have found to be helpful for treating mild to moderate depression. It can therefore help with cases of the winter blues, but probably not for severe seasonal affective disorder.
But, although St John’s wort has helped some sufferers of SAD, others have reported that it causes long-term, negative side effects, among them over-sensitivity to light. This would of course interfere with light therapy, so if you’re planning to use light treatment, this herb would be contra-indicated as the doctors say.
The only permanent cure for SAD that nobody argues with is to choose to live within 30 degrees of the equator. Other than that, the other option is to take a holiday in sunny places during the winter.
Holiday destinations such as Southern Spain or the Canary Islands are a good choice for SAD sufferers. Another option is to go skiing, which has the benefit of bathing you in the extra brightness of the light reflected off the snow.
A word of caution though… some people with SAD have become much worse on returning to the gloom in their native countries after the very bright sunshine in places such as Africa. It appears that the contrast in light levels can do more harm than good sometimes! So, you should consult your doctor before and/or after going for a holiday in a tropical paradise.
Also, joining a support group can be very helpful, because sharing your experience with others who have experienced the condition can be very therapeutic. This will make your experience with SAD much more bearable. Additionally, try to get as much support as possible from family and friends.
Be open and tell them about your condition. This lets them know what to expect and how they can help. Find a supportive doctor that has experience with SAD, even if this means finding someone other than your family doctor.
How can family and friends help a person with SAD?
It’s not always easy, living with someone who suffers from SAD. It’s like being with two different people – one who is lively, and cheerful, and energetic during the summer; and a totally different person, one who is sleepy, morose and irritable, during the winter. In the summer, you have someone that’s hyperactive, one that can be hard to keep up with. And in the winter, you have someone you couldn’t even get much of a response from!
So, it’s important to accept that the person with SAD feels awful. It’s not that they’re being lazy, or that they’re not making an effort. He or she is sleeping because they have to – and they can’t help it. Don’t be hostile about it – or tease them – because this will likely make things worse.
Having SAD is a serious matter and some people have described it as “feeling half dead, half your life”. It has been known to drive some people to suicide!
Offer the person with SAD practical assistance whenever you can. Where you can help is by facilitating them to organize their affairs and their treatment ahead of time, during the summer because once winter starts a person with SAD quickly succumbs to apathy.
As soon as you notice signs of lethargy, encourage the person to start their treatment program – and to stick with it. If they are using light therapy, build it into their daily life. If the person needs an hour’s exposure to light before work or school for example, make sure that other chores and responsibilities they have do not interfere to prevent them getting it.
Help the SAD sufferer to pace themselves and take it easier. This means being extra sensitive towards them and not making too many demands on them. As we have seen some may have problems socializing, so something you might want to avoid is inviting a houseful of guests to stay.
It helps no one if a person suffering from SAD becomes more stressed.
SAD can stress personal relationships and so it can very easily upset you when the person with SAD is constantly irritable and seems unwilling to give or to accept love. This could strain your relationship with them to the breaking point if you begin to feel that it’s all one sided.
But, hard as it might be to imagine or to understand, being depressed can be emotionally paralyzing to the person with SAD. He or she is in the grip of something powerful and may be unable to feel happy, or caring and loving as they normally would. So even if it might look that way to you, they are not deliberately rejecting you. And yet they may be desperate for your love and care, even though they’re not able to accept it, when it’s offered.
Be patient, and especially insist they get treatment. You can then both look forward to better times ahead, after their bout with seasonal affective disorder!