Winter Blues or SAD?
Although the clocks go back every year in the winter in order to increase our exposure to day light hours, this is sometimes insufficient to prevent “winter depression” or what we call seasonal affective disorder (SAD). Natural daylight has many proven benefits; however, it is not always possible to live in countries near the equator where you are exposed to a lot of sunlight and vitamin D. Living in Britain is especially tough because our days in the winter are extremely short. This is one of the reasons why we are more susceptible to developing SAD. It is estimated that approximately 20% of the population in the UK alone suffers from a form of SAD. I want to elaborate on the word form; there aren’t different forms of SAD per se, however, there is a spectrum.On one end of the scale, some people are not at all affected by seasonal changes. Further along, those experiencing “winter blues” might find themselves feeling tired, grumpy and a bit down. At the other end of the spectrum, though, some people may have to take time off work and drastically limit their daily routines because the illness becomes too debilitating.
SAD is thought to be triggered by the lack of melatonin and serotonin in the brain. These are hormones that play a role in controlling mood, sleep, appetite and the circadian rhythms. Consequently, a lack of these hormones can create an imbalance with severe consequences. It is also thought that some people may be more susceptible due to their genetic background.
Symptoms are generally very severe in December, January and February as the days are shortest. It will generally manifest around autumn and disappear in the spring and summer. Some people may experience it only one time, whereas some may experience it repetitively every year. The reason for this is unknown, however, it is very likely that the environment we are in, our health and surroundings play a huge role.
The general symptoms would include a persistent low mood, a loss of pleasure or interest in normal everyday activities, irritability, feelings of despair, guilt and worthlessness, feeling lethargic (lacking in energy) and sleepy during the day, sleeping for longer than normal and finding it hard to get up in the morning, craving carbohydrates and gaining weight.
Diagnosing any form of depression is usually tricky because there are so many forms of it. First and foremost, your GP will carry out a psychological assessment to check your symptoms. A factor that differentiates SAD from generalised depression is that it follows a rhythmic pattern. Your symptoms will generally be worse in the winter and will progressively get better as summer approaches. Whereas, with other forms of depression, seasons do not tend to affect the symptoms as such.
Treatment must be tailored to your own need and symptoms. There are a variety of treatment options available.
The most common treatment is light therapy. Most of the population is stuck indoors for a large part of their day for example in offices. Unfortunately, our bodies are not tailored in this way and find it hard to adapt to the lack of day light, therefore, a treatment consisting of artificial daylight can help alleviate these symptoms. This involves sitting by a special lamp called a light box, usually for around 30 minutes to an hour each morning. Light boxes come in a variety of designs, including desk lamps and wall-mounted fixtures. They produce a very bright light. The intensity of the light is measured in lux – the higher lux, the brighter the light. The light produced by the light box simulates the sunlight that's missing during the darker winter months. Most people can use light therapy safely. The recommended light boxes have filters that remove harmful ultraviolent (UV) rays, so there's no risk of skin or eye damage for most people. However, exposure to very bright light may not be suitable if you have an eye condition or eye damage that makes your eyes particularly sensitive to light or are taking medication that increases your sensitivity to light, such as certain antibiotics and antipsychotics, or the herbal supplement St. John's Wort.
Light boxes aren't usually available on the NHS, so you'll need to buy one yourself if you want to try light therapy.
Before using a light box, you should check the manufacturer's information and instructions regarding:
- whether the product is suitable for treating SAD
- the light intensity you should be using
- the recommended length of time you need to use the light
Make sure that you choose a light box that is medically approved for the treatment of SAD and produced by a fully certified manufacturer. The Seasonal Affective Disorder Association can provide you with a list of recommended manufacturers.
There's mixed evidence regarding the overall effectiveness of light therapy, but some studies have concluded it is effective, particularly if used first thing in the morning.
It's thought that light therapy is best for producing short-term results. This means it may help relieve your symptoms when they occur, but you might still be affected by SAD next winter.
When light therapy has been found to help, most people noticed an improvement in their symptoms within a week or so.
Antidepressants can also be used for SAD. The treatment of choice is usually selective serotonin reuptake inhibitors (SSRIs). SSRIs help increase the amount of serotonin in your brain which is thought to be linked to SAD. Antidepressants can take up to 6 weeks to start working and cannot be stopped suddenly. The choice of antidepressants will depend entirely on the individual response to the medication. It is important to note that antidepressants can interact with certain foods and medicines.
Talking therapies are also considered to be very effective in depression. These would include cognitive behavioural therapy (CBT), counselling and psychodynamic psychotherapy. Counselling involves talking to trained counsellors about your worries and problems. Psychodynamic psychotherapy involves discussing how you feel and your past experiences to identify how your past is affecting you today. Finally, CBT concentrates on how you think and behave may affect the way you think about situations and what you can do to make yourself feel better. Talking therapies often require some time and can take weeks to months, however, the therapies will be highly tailored to the individual and will be a very personal treatment.