Seasonal affective disorder: how to treat SAD

Every year in the UK, when the clocks go back in October, three million of us begin an annual battle with the winter misery known as SAD, or seasonal affective disorder. The condition is as debilitating as depression because that's what SAD is, only with the difference that it occurs during the winter months.

The darker mornings make getting up about as appealing as a cold bowl of porridge and an afternoon snooze certainly more alluring than a healthy walk in the open air. Stodgy foods and chocolate become irresistible and the pounds pile on until the clocks go forward again in spring.

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The influence of the seasons on mood has been known for centuries. But it wasn't until 1984 that US psychiatrist Dr Norman Rosenthal, himself a sufferer of seasonal depression, identified what he called seasonal affective disorder, or SAD. According to Rosenthal this is a subspecies of depression caused by lack of sunlight for which the best treatment is light therapy.

Most of us probably experience a touch of the blues come wintertime - in fact some figures say about one in three people will experience it, but for between 2.4 per cent and 3.5 per cent of people symptoms can be more severe, and women are 40 per cent more likely to experience it than men.

How to spot the signs of depression

What is seasonal affective disorder?

Seasonal affective disorder (SAD) is a seasonal depression that starts when the days get shorter, in fact it is often referred to as 'winter depression'. Researchers believe SAD occurs as a result of less exposure to sunlight, disrupting your biological clock and triggering changes in levels of serotonin, a chemical that you need to feel content and happy.

What causes SAD?

One longstanding theory is that it is due to a shift in the body's daily biological cycle caused by an excess of the brain hormone melatonin. Melatonin is produced during darkness and falls at dawn. Night workers and people with jet lag also report similar symptoms, although in the case of jet lag only for a short time.

But melatonin isn't the only factor. The stress hormone, cortisol, produced by the adrenal glands, tends to be higher in people with both 'ordinary' depression and SAD. Noradrenaline, another adrenal hormone, is also implicated, and there are also low levels of the brain chemical, serotonin, the 'happiness' hormone.

But new research indicates that although there is a light-related element to it, it doesn’t tell us the whole story.

It seems people with SAD produce less melanopsin, a pigment within the retina of the eye. This pigment is light-sensitive and so plays a role in how much light is absorbed and as a result, how the brain responds to light and darkness. Why do some people produce less melanopsin? Genetics, suggest the researchers. So for these people, the shorter daylight hours has a far more pronounced effect than it does on others.

Lack of sunlight affects the biological clock, upsets the natural balances of chemicals such as serotonin, but also cortisol and adrenalin, all of which are negatively impacted with low sunlight levels.

With some of your most important mood-related chemicals all out of sync, your mind and body is left in an unhappy state that’s difficult to overcome. Thankfully, there are treatments for those with SAD.

Winter blues or SAD?

Looking back through photos of summer it’s easy to feel as though you were happier then – eating lunch with friends or family al fresco, pottering around in the garden, perhaps enjoying a day at the beach. Whereas winter means mornings that make getting up to exercise feel like a punishment, afternoons spent bundled up with thick socks and slippers, and worse, dark evenings that don’t encourage you to explore and socialise.

How common is seasonal affective disorder?

Little wonder then, that for many of us, winter is not as happy a time as summer – in fact 20% of us experience lower energy levels and a general sense of 'feeling down' in winter. But for around 4% people in the UK, winter brings with it something even more severe than cold weather – it brings a type of depression, seasonal affective disorder (SAD).

Signs you could be suffering from SAD

You don’t want to socialise

A desire to stay home and get cosy in front of the TV rather than head out to socialise isn’t necessarily an indicator of SAD – we all tend to get more home-focused in winter. This is perfectly natural. It becomes something more serious when socialising itself – be it in your own home or someone else’s – also seems too much to bear. If you find yourself making excuses to avoid contact with friends and family, it’s a sign that you could be suffering with depression rather than just feeling a bit low. 

You’ve got no energy

We all enjoy a duvet day during winter, but if staying in bed feels like a necessity rather than a treat you’re more likely to be experiencing SAD rather than the usual winter-led instinct to hibernate a little. What’s more, staying in bed won’t make you feel good, it will leave you feeling more lethargic and like you want to stay in bed tomorrow and the next day and the next day after that. What's more, you'll feel worried about how much time you're spending in bed, too. 

Your diet fills you with guilt

Enjoying a big plate of pie and mash during winter is nothing to worry about, but if you find yourself comfort eating and piling on pounds – and feeling terrible about it, anxious and guilty – then this could be another symptom of SAD.

During colder months your body naturally craves carbohydrates and even sweet foods as a source of quick energy, but while it’s perfectly okay to enjoy indulging a little every now and again, if your desire for potatoes, bread and pasta feels out of control, it’s something to address.

Feel-good winter root veg

While eating carbs might feel good in the moment, it won’t provide you with the variety of nutrients you need to boost immunity during the winter months and if you put on weight too, it will only add to your anxiety. 

Treating yourself doesn’t feel like a treat

If the idea of baking yourself some fresh bread or a cake, snuggling under a blanket to listen to music or watch a film doesn’t fill you with warm fuzzies, then you’re likely feeling more than simple winter blues.

People with SAD can’t simply ‘cheer themselves up’ with a nice cup of tea and a couple of biscuits, or even a more elaborate treat – as with people who have year-round depression, SAD can’t be shaken off or fixed quickly and easily in this way. 

Depression: alternatives to drug treatment

You don’t feel like making plans

When you can’t find the energy to look forward to something in the future, it’s a sign that you’re suffering more than most. For people with SAD it can feel as though there is no light at the end of the tunnel even if they’re aware that what they have will pass come springtime when daylight hours increase. 

Which is why it's all the more important that you seek help to see you through the winter months.

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How to cure seasonal affective disorder

So how should SAD be treated? Research published in the American Journal of Psychiatry in 2006 shows that light therapy and the anti-depressant drug Prozac, that helps bring serotonin levels back into balance, are equally effective. Some GPs hire out light boxes. However you will usually have to buy one, which can cost around £125.

Another US study by Professor Kelly Rohan of the University of Vermont in America found that cognitive behavioural therapy (CBT), which involves changing your thought patterns to more positive ones, was effective, especially when combined with light therapy.

The good news is that like all types of depression SAD tends to become less common as we get older.

Treating SAD with lighting

Everyday lightbulbs won’t give you the dose of light you need to work against the effects of winter darkness – but a light box could. These bright lights – usually 10,000 lux or more indicates a useful range of light – work because when the light hits your retina that sends a signal to your hypothalamus which in turn controls your circadian rhythms – the way your body responds to light and darkness.

As Seasonal Affective Disorder is triggered by the shorter daylight hours, which in itself means less sunlight, light therapy works by 'tricking' your brain by providing more light than there is naturally in the day.

Research from the Mood Disorders Centre at UBC hospital, Canada, found that light therapy was as effective as the antidepressant fluoxetine (also known as Prozac) in relieving the symptoms of depression.

Look for a light box that emits white light and has a UV filter, to protect your eyes.

With the unremitting gloom of northern winters it is hardly surprising that Danes, Swedes and Norwegians are especially prone to SAD. There are even cafes in Scandinavia where you can eat under a light box.

Keep blood sugar stable

If your SAD symptoms see you struggling to peel yourself out of the duvet in the morning and then desperately wanting to crawl back into it in the afternoon, it could help to work on keep your blood sugar levels stable.

When you experience low blood sugar levels you might feel irritable, weak, anxious and confused. Combined with your general low feeling brought on by the lack of sun, this can be a serious problem.

Unfortunately the answer isn’t simply to eat high-sugar or high-carb foods to feed that need – because if you do, your insulin levels will spike, leading to a crash later on. This means opting for low-glycaemic index carbohydrates such as veg (except for potatoes with are starchy), sourdough or pumpernickel bread, wholewheat pasta, fruit and nuts.

Add protein to every meal to further maintain blood sugar levels (eggs, dairy, meat, fish, and legumes), and don’t forget the fat! Adding healthy fats such as a drizzle of olive oil or coconut oil, nuts or half an avocado to your meal will also help as they delay gastric emptying leaving your food to digest for longer, keeping you feeling fuller for longer.

Take control of your emotions

As with any disorder or illness there is a psychological and emotional aspect to it – if you can learn coping mechanisms to deal with symptoms, for example, it can relieve the emotional strain. ‘A client’s biggest struggle is understanding why they are feeling the way they do,” says Surrey-based psychotherapist Helen Donnison.

‘This lack of clarity creates anxiety and can lead to increased feelings of sadness and low self-esteem. If you think you may have SAD, one simple way of helping you to understand the way you are feeling, is keeping a daily journal.’

Using a scale from 1-5 to measure the intensity of your feelings, write down:

• How much sleep you had the night before
• How you feel when you wake up
• Whether you have the desire to skip food or comfort eat
• Do you feel sociable, or do you want to hide away under your duvet?
• How are you managing these feelings day to day?
• Are you looking after yourself (yoga, healthy eating)
• Are you punishing yourself (over-eating, drinking alcohol) for the way you feel?

‘By logging the ups and downs of your daily life,’ says Helen ‘you may start to be able to see patterns, learn how you respond to your feelings and gain clarity about what's going on for you. A journal can also provide support when seeking help from a doctor or rich material with which to start your journey with a psychotherapist or counsellor.’

Exercise to beat SAD

Exercise is the solve-all for almost any health issue and SAD is no exception. Research from the UC Davis Health System, US, has revealed how vigorous exercise increases levels of neurotransmitters, so that messaging within the brain is improved. Lower levels of these neurotransmitters is associated with depression. Vigorous exercise is key here – which means getting your heart rate up by walking briskly, cycling uphill or swimming fast. 

If that’s not an option, don’t worry, you can still amp up the effect by exposing yourself to greenery. Research published in Scandinavian Journal of Forest Research has shown that even viewing imagery of nature triggers pleasure receptors in the brain and, according to other research from the University of Essex, UK, just half an hour of walking among trees or grass reduced depression in 71% of patients. 

Cognitive behaviour therapy

Cognitive behaviour therapy doesn't take away the symptoms of SAD but it can help patients to accept and manage them better.

When you learn how to see SAD as just a part of your life it gives you choices. I would recommend behavioural changes such as using a daylight alarm clock that emits increasing light levels to simulate the arrival of dawn as you gradually wake up and regular aerobic exercise to encourage the body to produce endorphins, its own feel-good hormones.

It is important to give yourself the chance to cut down on stress at this time of year, so I would advise putting a sticker in your diary to remind you to go easier on yourself.

It's a good idea to make a list of things that make you feel better such as phoning a friend or relative and keeping this in several different places, so you have a kind of mental toolkit to call on when you feel down. And of course if you can afford it take a holiday somewhere sunny.

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