Seasonal Affective Disorder

Many people experience the ‘winter blues’ or seasonal depression at some stage. For some people, these bouts of depression are much more than an isolated week or two of feeling down. If you note that you start to feel depressed every year, you may be dealing with seasonal affective disorder. 

Seasonal Affective Disorder (SAD) is a major depressive episode that occurs in relation to specific seasons of the year. The most traditional time for SAD is during fall and winter, but some people experience SAD during spring and summer. SAD is a subtype of clinical depression and shares symptoms.

SAD can cripple your life and can be present for as long as five months in a year. That is almost half your year spent in the grip of the black depression. Help is available, and different methods can be used according to individual needs and preferences.

What Is Seasonal Affective Disorder (SAD)?

SAD is a major depressive episode that recurs annually at approximately the same time each year. Depression in SAD lasts for several months or a season, followed by a recovery period. 

The most typical form of SAD occurs over the late fall and winter months. Recently psychologists have noted that some people have SAD over spring and summer, but this is rare. 

In prior years many medical doctors and even psychologists dismissed SAD because it seemed to resolve without intervention. They felt that this did not fall into a typical pattern of depression, and therefore, it did not fit the diagnosis for major depression.

In 1984 a psychologist named Rosenthal, who had relocated from South Africa to the United States, noted that he was less productive and experienced lower moods during winter. He completed a study and described SAD in detail. SAD was accepted into the Diagnostic Manual for Mental Disorders (DSM). This was a critical point as the DSM is followed by medical and psychology practitioners globally. 

Finally, everyone suffering for many years from annual depression could be diagnosed. Acknowledgment of their condition validated the individual. Many SAD patients were dismissed and informed that what they were experiencing was not real. 

The diagnosis prompted research into treatment programs that were critical in helping SAD sufferers. Research into treatment protocols is ongoing, and new approaches are being developed.

What Causes SAD

The causes of SAD have been debated, and there is still discussion as to the exact cause or possibly multiple causes. In the following few sections, we will begin to some of the potential causes.

Low Vitamin D Levels

Vitamin D is produced by our bodies in the presence of sunlight and plays a crucial role in the production of serotonin. During winter, people stay indoors, wear many layers of clothes outside, and the daylight hours are diminished. This all contributes to a potential vitamin D deficiency. 

It can be challenging to tell if SAD patients have low vitamin D, which causes SAD, or if their low mood causes them to spend less time outside during winter, which causes low vitamin D. 

Some people produce reduced vitamin D levels, even in sunlight. Individuals with low Vitamin D are at risk of developing SAD.

Melatonin & Seasonal Depression

The pineal gland produces a hormone called melatonin in the brain. The amount of melatonin produced is influenced by the number of daylight and night hours. During dark hours melatonin is released to make the body feel sleepy. 

In winter, daylight hours are reduced as the sun sets earlier and rises later. As a result, more melatonin is produced, making the individual feel sleepy and lethargic. People with SAD have an overproduction of melatonin in the winter months. 

You may have observed that even if you do not suffer from SAD, you tend to feel more tired and want to go to bed earlier in the winter months. This is a result of increased melatonin production. While melatonin does not cause SAD, it adds to feelings of apathy and low mood.

Does Your Circadian Rhythm Affect SAD?

Circadian rhythms are the biological clock that governs our waking and sleeping and are influenced by serotonin and melatonin. People that suffer from SAD have altered serotonin and melatonin during winter, resulting in a circadian rhythm that cannot adjust to the winter light-dark changes. 

SAD sufferers have circadian rhythms that cannot synchronise with shorter days and longer nights. Although researchers are still not certain of the exact nature of the link, they theorise that when circadian rhythms cannot adjust to seasonal changes, the result is a major depressive episode. 

It is thought that summer SAD may be caused by an inability of the body to adjust to the increased light levels in spring and summer. Not much research has been done on summer SAD, and as a result, the cause is still vague. 

Some psychologists postulate that people who cannot adjust to increased heat and temperature may be vulnerable to mood disorders in these months.

What Are The Symptoms Of SAD?

The symptoms are very similar to depression. These are some of the symptoms that may be seen:

1. Low mood and decreased energy.
2. Loss of interest in previous hobbies.
3. Inability to feel pleasure or disinterest in pleasurable activities.
4. Feeling sad and crying easily. The person may often express that they do not know why they are unhappy.
5. Withdrawal from social activities.
6. Decreased activity levels cause further depression as the natural mood boost that comes from exercise is not accessed.
7. Feeling worthless or experiencing guilt over past events.
8. Irritability is common in teenagers, children and people that have summer SAD.
9. Difficulty concentrating.
10. Hypersomnia – sleeping long hours and, in severe cases, spending concurrent days in bed.
11. Craving carbohydrates and, as a result, gaining weight. Serotonin is synthesised in response to carbohydrates, so low serotonin prompts carbohydrate cravings. Carbohydrates act as a natural tranquilliser which causes a psychological addiction to carbohydrates.
12. Losing weight because of apathy which results in poor motivation to cook or shop. This is less common than putting on weight due to carbohydrate cravings, and it is seen more commonly in summer SAD.
13. Suicidal ideation – thoughts of suicide. The individual may or may not express this to a therapist, friend or family member.

It is critical to note that every person experiences SAD uniquely. SAD sufferers seldom have all these symptoms—the DSM-V criteria for diagnosing SAD states that five symptoms should be present for two weeks. One of the symptoms should be a depressed mood or disinterest in pleasurable activities.

Some people have a milder form of SAD, known as subsyndromal SAD (S-SAD). The person exhibits similar symptoms but with less intensity. Medical personnel or laypeople sometimes refer to this as ‘winter blues.’

How is SAD Diagnosed

SAD is diagnosed by a psychologist, psychiatrist or medical doctor. Rosenthal developed a screening tool known as the Seasonal Pattern Assessment Questionnaire (SPAQ). This may be used to identify at-risk individuals. 

A full assessment by a psychologist or psychiatrist will determine if SAD is present. Medical doctors may also diagnose SAD by comparing symptoms to those described in the DSM-V. 

The medical professional will take a complete history and conduct blood tests to rule out other underlying conditions that may cause depression and lack of energy.

Treatment Options

Treatment for Seasonal Depression has focused chiefly on winter SAD, but some treatment methods apply to those suffering from summer SAD. Below is a list of some of the most common treatments.

Light Therapy (SAD Lamps)

SAD lamps emit a bright, white light similar in spectrum to natural sunlight. The light is typically at least 10,000 lux, much brighter than standard indoor lighting. The bright light is thought to trigger the release of neurotransmitters in the brain, such as serotonin, which can improve mood and alleviate symptoms of depression.

Our recommended SAD Lamp is the Lumie Brazil which is the most efficent way of treating SAD. A smaller form factor version, the Lumie Vitamin L is also an excellent choice, but will require you to sit closer or increase treatment time:

One of the most common and effective ways to use a SAD lamp is to sit in front of it for 30 minutes to an hour every morning, ideally within an hour of waking up. This helps to regulate the body’s circadian rhythm and can improve mood and energy levels throughout the day. Many people find that using a SAD lamp in the morning is more effective than using it later in the day.

What month should I start using a SAD lamp?

You should start using a SAD lamp in the early autumn months, typically around September or October, depending on when you begin to notice symptoms of seasonal affective disorder. Be sure to continue using it until the spring arrives, and your symptoms begin to subside. Remember that everyone’s needs might be slightly different, so pay attention to your own mood changes throughout the year and adjust accordingly.

Are SAD Lamps Safe?

SAD lamps are considered to be a safe and effective treatment for SAD. Some people may be sensitive to bright light or have underlying eye conditions. They should not be used as a replacement for other treatments, such as therapy or medication, but rather as a complementary treatment.

Overall, SAD lamps are a convenient, non-invasive, and effective way to alleviate the symptoms of SAD by mimicking natural sunlight, regulating the body’s circadian rhythm, and triggering the release of neurotransmitters that improve mood. It is essential to consult a healthcare professional before starting treatment and use it as a complementary treatment.

Vitamin D Supplementation

Many people diagnosed with SAD have low vitamin D levels, so doctors may prescribe vitamin D supplements. Following your doctor’s prescription for taking vitamin D is vital, as too much can be as harmful as too little. 

Vitamin D is known as Calciferol and is a fat-soluble vitamin. This means it should be taken with a meal containing fats to maximise the uptake.

Vitamin D is stored in fat in our body and is slowly released as needed. 

Vitamin D is essential in the production of serotonin. If your serotonin levels are low, it would be wise to have your vitamin D levels assessed by taking blood. The blood is analysed at a laboratory, and the doctor will recommend the correct course of vitamin D supplementation.

SSRI Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRI) are medications that increase the availability of serotonin in the body. There are numerous SSRI medicines, and your doctor will assist you in prescribing the best one for you. 

Some critical factors to note in the use of SSRIs are:

1. Finding the SSRI best suited to your body may take some time. If one is not working, return to your doctor and try another.
2. SSRIs take at least two weeks to begin showing an effect on mood, which can extend to up to four weeks.
3. SSRIs should be taken for at least three to six months to prevent relapse.
4. SSRIs may cause side effects that you find difficult to live with. Contact your doctor to discuss the medication.
5. Do not stop taking SSRIs suddenly unless your doctor instructs you to do so. 

Bupropion

Bupropion is usually known by its trade name Wellbutrin. It is a medication that increases dopamine in the body. Dopamine is the pleasure and calming neurotransmitter that our body naturally produces. Some people cannot tolerate SSRIs and do better with Wellbutrin.

An advantage of Wellbutrin is that it boosts energy levels and can aid concentration which are problems experienced by SAD sufferers.

Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is a good alternative for people who cannot tolerate medications or light therapy. Some people opt to use CBT as they feel they can learn a strategy for dealing with depression, and they do not have to keep going back annually. dealing with depression, and they do not have to keep returning annually. . Some people opt to use CBT as they feel they can learn a strategy for dealing with depression and do not have to keep going back annually. 

CBT can be used in conjunction with light therapy and medication. 

Cognitive behavioural therapy is a method of psychotherapy that focuses on changing thought patterns to influence mood and behaviour. CBT is becoming one of the most popular and effective forms of psychotherapy for many conditions.

Self Help for Overcoming SAD

There are several habits you can apply to help you deal with SAD. These suggestions are helpful even if you are on medication or using alternative methods to address your depression.

There are several habits you can apply to help you deal with SAD. These suggestions are helpful even if you are on medication or using alternative methods to address your depression.

1. Do not isolate yourself. Keeping in contact with others is vital. Even if you are reading a book, it is beneficial to do this in the same room as someone else. 
2. Go to social gatherings when you can. Being around people can help to give you energy and take your focus off your problems. 
3. Sit out in the sunlight every day. The best time is around noon as it has been shown that this is the most beneficial light for elevating mood. It will also help restore vitamin D levels.
4. Eat healthy meals and maintain a regular diet to ensure you get vitamins and minerals.
5. Exercise will help to boost your mood naturally. If you do not have the energy to overcome your SAD inertia, arrange with a friend to collect you or meet you for exercise. Give the friend permission to be forceful when insisting you accompany them to do exercise.
6. Concentrate on good sleep hygiene by keeping the same bedtime each night and getting up at the same time. Avoid binge watching television or staying up too late. Nights are often the times you will feel worse, increasing the difficulty of getting up in the mornings.  
7. Take your prescribed medication regularly. Do not stop as soon as you feel better.
8. Practice breathing exercises and mindfulness to help break you out of a negative thought cycle.
9. Request help if you are not coping. If you cannot summon the energy to find medical help, ask a friend or family member to assist you.
10. Spend time with a pet. Studies have shown that pets can improve mood, reduce stress and anxiety and even decrease high blood pressure.
11. Join a group that assists other people or animals. Focusing outwards will help you feel better as it takes your mind off your stress and depression. If you think it is too difficult to have the energy to start this, ask a friend to join you and help you become involved. 
12. Try to spend time outdoors in nature. Green therapy or ecotherapy has been shown to be immensely successful in overcoming mental health issues. 

Helpful Contacts

Anxiety UK

One option is to contact Anxiety UK, which offers a helpline (03444 775 774) and text service (07537 416 905) as well as information and support on their website (anxietyuk.org.uk). They can provide advice and support for people living with anxiety, which may be related to SAD.

BCAP

Another option is to reach out to the British Association for Counselling and Psychotherapy (BACP), which is a professional body for talking therapy and counselling. They have a website (bacp.co.uk) with information and a list of accredited therapists.

CALM

The Campaign Against Living Miserably (CALM) is another organization that provides listening services, information, and support for anyone who needs to talk, including a web chat service. They can be reached at 0800 58 58 58 or via their website (thecalmzone.net).

Depression UK

Depression UK is a self-help organization made up of individuals and local groups that can provide support and information related to depression, which is a common symptom of SAD. Their website (depressionuk.org) offers more information.

Nice

The National Institute for Health and Care Excellence (NICE) produces guidelines on best practices in healthcare and can be found on their website (nice.org.uk).

NHS UK

The NHS UK website (nhs.uk) also provides information about health problems and treatments, including details of local NHS services in England.

Rethink

Rethink Mental Illness is another organization that provides support and information for anyone affected by mental health problems, including local support groups. They can be reached at 0808 801 0525 or via their website (rethink.org).

Samaritans

Finally, the Samaritans are always available to talk, 24/7, at 116 123 or via email [email protected], freepost SAMARITANS LETTERS or their website (samaritans.org) . They also have a Welsh Language Line on 0808 164 0123 (7pm–11pm every day) for those who prefer to speak in Welsh.

It’s important to remember that SAD is a treatable condition and there are many resources available to help you. Remember to talk to your GP or mental health professional if you are experiencing symptoms of SAD, and never hesitate to reach out for help and support.

Frequently Asked Questions About SAD?