This time of year is hard work for some people. Not just because it can be a triggering time, it’s expensive and there is a lot to do, but also because of the weather and season change.
People who feel sad when the days grow darker and colder may be suffering from a condition called seasonal affective disorder or S.A.D for short.
What is SAD?
According to the DSM-5 (the book of diagnostic criteria for psychiatrists), seasonal affective disorder is:
“a form of depression also known as SAD, seasonal depression or winter depression. In the Diagnostic Manual of Mental Disorders (DSM-5), this disorder is identified as a type of depression – Major Depressive Disorder with Seasonal Pattern.”
What causes SAD?
It’s more than just “winter blues” and the exact cause is not yet fully understood.
In people with SAD, it is thought that a lack of sunlight and a problem with certain brain chemicals stops the hypothalamus working properly. This is caused by shorter daylight hours and less sunlight exposure in winter.
The lack of light is thought to affect:
- Levels of melatonin in the brain (more sleep-inducing hormone than usual);
- Levels of serotonin brain (less happy hormone than usual);
- the circadian rhythm (our inbuilt 24 hour biological clock)
How many people have SAD?
SAD is more common in people living far from the equator where there are fewer daylight hours in the winter. In the UK, it impacts around 2 million people, including children.
How do you know if you have SAD?
You may find that throughout the spring and summer months, your mood is good. You have energy, you don’t mind socialising and you feel happier.
Come october, when the days are starting to get shorter, you may notice that your energy levels drop, you feel like hiding away, and your mood dips.
The symptoms of seasonal affective disorder are very similar to depression. These are some of the other symptoms that may be noticed:
- Loss of interest in previous hobbies or things that you enjoyed.
- Feeling sad and crying easily, not really knowing why.
- Feeling worthless or experiencing guilt over past events.
- Difficulty concentrating.
- Sleeping more than usual.
- Craving carbohydrates (the body’s natural serotonin booster).
- Suicidal thoughts in severe cases.
What can I do to help stop SAD?
Diet and Lifestyle
Due to the fact that SAD is triggered by the darker days, try to get outside when there is natural daylight around. It could be something simple like a short lunchtime walk in the fresh air away from your desk.
Don’t beat yourself up for craving more food to eat at this time of year – it’s part of your body’s coping strategy. Try to resist the urge to dive into the chocolate all the time though. While it can help boost your mood, the sugar crash afterwards can make you feel worse. Choose foods that can boost your tryptophan levels (which in turn help your serotonin levels) in a natural way. These include oily fish, eggs, cheese and fruit.
We can also be tempted to use alcohol to cope with feelings of low mood. It can help to mellow us out while imbibing, but unfortunately, alcohol also has a depressant effect and has the potential to make us feel worse, especially the next morning.
Light Therapy
There is evidence that light therapy can help combat feelings of SAD. The theory behind this is the stimulation of the hypothalamus to boost the levels of serotonin in the brain and reduce the melatonin levels helping you to feel more awake.
Light boxes give off light like sunlight, but without the harmful ultraviolet rays, so it is not harmful to the skin or the eyes.
A light box is usually used for 15-60 minutes every morning. There are many different forms of light box, ranging from alarm clocks, lamps that sit on the desk, and glasses you wear while walking around the house.
Fortunately, most people will notice some improvement in the first week of using it.
Any side-effects are usually mild, including headache, irritability, nausea or blurred vision. It is usually best not to use a light box in the late afternoon, early evening because it can interrupt your body’s production of melatonin that we need later in the day to trigger feelings of sleepiness.
Supplements
There isn’t a particular supplement that is recommended for SAD, but low levels of vitamin D, caused by low dietary intake of the vitamin or not enough exposure to sunshine have been found in people with SAD. There isn’t enough research though into whether vitamin D supplementation can help with SAD.
A few studies involving very small numbers of people have looked at melatonin and St. John’s wort for treatment of SAD, but the results are not consistent. Single small studies of vitamin B12 for treatment of SAD and Ginkgo biloba for prevention of SAD did not find that the supplements were beneficial.
Before starting any supplements, it’s worth making sure that nothing is going to interact with medications you are already taking. It’s best to run it by your doctor or pharmacist first. St. John’s Wort for example can make the contraceptive pill less effective and can lead to bleeding when taken with warfarin.
Acupuncture
Like with supplements, the research is conflicting and doesn’t firmly suggest it is helpful for symptoms of SAD. It is thought to help by bringing the body back into balance.
In my view, if you try it and get benefit from it, and as long as it isn’t harming you, then keep doing it. I’d love to know in the comments if this is something you’ve tried for SAD?
How can my GP help me stop SAD?
If you’re trying all the self-help things and still struggling, then antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors – fluoxetine, sertraline, citalopram) and talking therapy (such as CBT) may be options.
The evidence for the effectiveness of these methods is not great though, so unless your symptoms are severe, you may not want to start antidepressants. For some though, they can be a vital support through the winter months.
With talking therapy, the tools you learn to cope with low mood in winter months can be helpful for future episodes, so it’s worth exploring this option too.
Final Thoughts
Winter can feel like a lovely time of year for many people, and it’s hard to admit that you feel low when everyone else seems to be having fun. It’s not everyone’s experience, and we need to be aware and mindful of that. Menopause can especially make this time of year hard when already struggling with mood changes and fatigue.
The bottom line is, if you’re struggling with your mental health as the days get darker, seek support from your friends, family and doctor.
Until next time,
Dr Nikki x
Sources
- Seasonal Affective Disorder: https://www.psychiatry.org/patients-families/seasonal-affective-disorder
- NHS Scotland: https://www.nhsinform.scot/healthy-living/mental-wellbeing/low-mood-and-depression/beating-the-winter-blues/
- SADA: https://www.sada.org.uk/
- Foods to help boost serotonin levels: https://www.hollandandbarrett.com/the-health-hub/food-drink/nutrition/eat-your-way-to-happiness/
- Mental Health Foundation – Alcohol: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/alcohol-and-mental-health
- Golden, BN et al (2005) The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry, 162, 656-662. https://pubmed.ncbi.nlm.nih.gov/15800134/
- Vitamins and SAD: https://lloydspharmacy.com/blogs/vitamins-and-supplement-advice/vitamins-and-sad
- National Centre for Complementary and Integrative Health: https://www.nccih.nih.gov/health/seasonal-affective-disorder
- Mike Armour, Caroline A. Smith, Li-Qiong Wang, Dhevaksha Naidoo, Guo-Yan Yang, Hugh MacPherson, Myeong Soo Lee and Phillipa Hay (2019); Acupuncture for Depression: A Systematic Review and Meta-Analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722678/
- Thaler K, Delivuk M, Chapman A, Gaynes BN, Kaminski A, Gartlehner G. Second-generation antidepressants for seasonal affective disorder. Cochrane Database of Systematic Reviews 2011, Issue 12 https://pubmed.ncbi.nlm.nih.gov/33661528/
