Are you feeling sad or S.A.D.?

11th February

It’s cold and wet,

cloudy and grey

the sun hasn’t shown

it’s face today……….

It’s that time of year again, the days are shorter and for some people it marks a clear downturn in mood and a tendency to withdraw into themselves. Although we generally agree that people are more cheerful in sunshine than in drizzle, you may wonder if what you’re feeling through the winter months is ‘normal’. As with all diagnoses in mental health, there is a continuum from normal to degrees of abnormal, with anything from mild to severe symptoms.

Throughout our human story in the winter months food was far more scarce during most of  prehistory, which means that a tendency towards low mood during the winter months would have been adaptive by reducing the need for calorie intake. We are, epigenetically speaking, more suited to the sofa than the workplace or the club in the winter months.

See a professional

It is also true that some people experience truly debilitating symptoms which seem to lift, typically in April, having started typically in October. Seasonal Affective Disorder or SAD is a subset of Major Depressive Disorder – the symptoms are mostly the same, but the most effective treatment is different. So it is important that you see a professional who can assess whether you have Major Depressive Disorder or SAD.

If you experience the symptoms described below every day for at least two weeks and if you feel this way only during the Autumn and Winter, it is highly likely that you suffer from SAD.

The most difficult symptoms are the emotional changes: feelings of sadness and despair, of losing interest in activities generally but especially a reluctance to socialise.

Anger and irritability are also common, especially in men. Research suggests that people with SAD are significantly more irritable than healthier individuals. They may also be more prone to anger than people with non-seasonal depression.

A 2006 study that compared groups of people with active SAD and regular depression found that more than 40% of the people in the SAD group experienced sudden fits of inappropriate anger, compared to just 29% in the other group. Those with SAD experienced 19 of these “anger attacks” a month, on average.

Difficulty concentrating

Mentally, your thoughts are (most of the time) extremely negative, you will tend to think about yourself in a negative way and other people, including your loved ones, come under your critical eye,  and seem far more disappointing, if not downright annoying – and it all feels more than you can bear! Difficulty concentrating is another change in your thinking process that you may notice. Research has shown SAD also affects verbal skills and memory.

Physically, you may feel exhausted on all or most days, you may literally feel heavier and there may be more physical aches and pains. People with SAD tend to feel the need to sleep more, sometimes a lot more. In one study published in the Journal of Psychosomatic Research in 1994, patients at a SAD clinic averaged about 7.5 hours of sleep in the Summer, 8.5 hours in the Spring and Autumn, and nearly 10 hours in the Winter.

Sadly (no pun intended), just because you’re sleeping more doesn’t mean you’ll feel rested! Other research has shown more insomnia and sleep disturbances, and more proneness to nodding off at work. Although, all that extra time in bed does nothing to help with a loss of interest in sex, which is very common in SAD.

Like depression in general, SAD can increase appetite in some people. Sixty-five percent of people with the disorder report being hungrier during the colder, darker months. The voracious appetite that sometimes accompanies SAD may be a biological response to a seasonal drop in Serotonin, a neurotransmitter that’s associated with mood and helps to control hunger.

Cravings for complex carbohydrates

Nearly 75% of people with SAD gain weight and one of the reasons for this is that the disorder can produce a strong craving for complex carbohydrates such as bread and pasta. Research has indicate that as many as 7 out of 10 people with SAD experience this symptom, overeating carbohydrates causes the levels of an amino acid called Tryptophan to rise in the brain. This in turn causes the release of Serotonin, which boosts mood. In effect, people with SAD use carbohydrates as a kind of anti-depressant medication and a bigger waistline is a common side effect.

Various causes of SAD  have been proposed. One possibility is that SAD is related to a lack of Seratonin, another theory is that the cause may be related to Melatonin production. As yet, research hasn’t been able to pin point a definitive cause but on balance the consensus is that it is related to light. An argument for this view is the proven effectiveness of bright-light therapy.

SAD is measurably more prevalent at latitudes in the Arctic region such as northern Finland (64°00′N)where the rate of SAD is 9.5%. In the UK the rate is 3%. There is evidence that many patients with SAD have a delay in their Circadian rhythm and that bright light treatment corrects the delays which cause the condition.

So the good news is that Seasonal Affective Disorder can be helped with the use of a light box. Studies show that if used early in the day (preferably at breakfast) everyday in the Autumn and Winter months and ideally for about 40 minutes for maximum benefit, then symptoms are significantly reduced. If you also include aerobic exercise every day (for about 30 mins) you will speed up your recovery.

You may be offered anti-depressants as a medical treatment for the condition. However, if you have SAD rather than Major Depressive Disorder, you are likely to do as well or better using a light box and aerobic exercise alone.

I can declare no economic interests whatsoever in light box companies or gyms!

Karen Thirtle, CPsychol., AFBPsS

Counselling Psychologist