Seasonal Affective Disorder (SAD)

Many people can feel a bit down during the winter months, when the nights draw in and the daylight hours become shorter. However, for some this can develop into SAD.

What is SAD?

SAD is a type of depression that affects some people in the autumn and winter months due to reduced amounts of daylight; in particular during December, January and February.

For others, it is a mild condition causing discomfort but not severe suffering, and this is known as Subsyndromal SAD or 'winter blues.'

How common is SAD?

SAD affects around half a million people in the UK. Although it can happen at any age, it occurs more often in people (more women than men) aged between 18 and 30.

Interestingly, it occurs throughout the northern and southern hemispheres but is extremely rare in those living within 30 degrees of the Equator, where daylight hours are long, constant and extremely bright.

What are the symptoms ?

Symptoms vary between sufferers and are similar to other types of depression. Diagnosis is generally made after these have continued for 3 or more consecutive years. Typical symptoms recur every winter - the most common are:

Feeling low or depressed for most of the day
Irritability
Sleep problems, usually needing more than usual
Lethargy
Overeating
Anxiety
Mood swings
Periods of Hypomania (overactivity) during Spring and Autumn
Loss of Libido
Weakened immune system during winter

Such symptoms go away in Spring; sometimes suddenly with a short period of hypomania or hyperactivity; sometimes the symptoms disappear more gradually depending on the sunlight intensity.

How will SAD affect my life ?

It can become seriously disabling, preventing some people from functioning normally and needing continuous medical treatment.

What causes SAD?

It is caused by a biochemical imbalance in a part of the brain called the hypothalamus which controls mood, appetite and sleep.

This is thought to be due to the shortening of daylight hours and the lack of sunlight in winter. Sufferers seem to react to the decrease in light by secreting less Serotonin. This is a chemical in the brain which is found to 'lift' the mood. It is thought that people with SAD may have abnormally low levels of chemicals such as serotonin in winter and more of a hormone called melatonin, which slows down the body clock and affects sleeping patterns and your mood, however, medicines which suppress the secretion of melatonin have been found not to stop the symptoms of SAD, so this isn't the only factor.

If you have a close relative with SAD, you may be more likely to develop it.

What treatments are available?

Light therapy

This is an effective treatment for around 8 out of 10 people. It entails daily exposure to a very bright light from a specially designed light box (around 10 times brighter than normal domestic lighting). The recommended dose is 5,000 lux per day, this may be given as 2,500 lux for two hours or 10,000 lux for 30 minutes each day depending on the intensity of the light box. The light emitted is very similar to natural daylight and won't harm your eyes unlike ultraviolet (UV) light. Light boxes are available from specialist retailers; (contact the SAD Association www.sada.org.uk).

Many sufferers notice a real improvement in their symptoms in under a week. Light therapy should be continued daily until Springtime when the daylight hours begin to lengthen.

Antidepressants

Traditional tricyclic antidepressant drugs are not usually helpful for this condition as they exacerbate the lethargy that can be symptoms of SAD. SSRI drugs are more effective as they are non-sedative i.e. sertraline (Lustral), paroxetine (Seroxat) and fluoxetine (Prozac) and can help the depressive symptoms of SAD and work well with light therapy. If antidepressants are prescribed you should only need to take them during the autumn and winter seasons and not all the time.

Psychotherapy

CBT (Cognitive Therapy), Psychotherapy, counselling or any other complementary therapy which help sufferers relax, accept their illness and cope with its limitations are very useful.

How does cognitive behavioural therapy work?

Cognitive behavioural therapy tackles your negative thoughts. For example, when something bad happens depressed people blame themselves, but when good things happen they tell themselves that they've just been lucky. They also assume that other people are reacting negatively to them. Cognitive behavioural therapy helps people think in a more balanced way and challenges a person's assumptions about their lives. It aims to identify and change aspects of behaviour that may cause or prolong symptoms of depression.

What can I do to help myself?

There are many ways you can reduce the effects of SAD. If possible try to:

Get outside every day and go for a walk - especially if it's sunny
Try to sit next to a window when you are inside
Try to take regular exercise
Eat a well balanced diet
Plan ahead for the winter

Self help

Recommended reading :

Seasonal Affective Disorder (SAD) - Mental Health Foundation
Understanding Seasonal Affective Disorder - Mind
Seasonal Affective Disorder - SAD Association

Finding help

Contacting your GP is often the easiest way to get help and further treatment. He or she may refer you to a specialist for further assessment. This may lead to outpatient treatment or, if more serious, day or inpatient treatment.

If you're worried about talking to your GP, consider writing down your concerns and questions. You can:

take a friend or family member with you
see another doctor in the practice or
join a new GP practice

The type of professional support offered will depend on the services that are available in your area and the arrangements that your primary care trust (PCT) have with other health authorities or private providers. Treatment for SAD is also available privately through Priory.

If you feel that you or a close relative are developing SAD and would like help or more information, you can speak to your GP or contact any of the following organisations:-

Seasonal Affective Disorder Association - sada.org.uk

Mind - 0845 7660 163, www.mind.org.uk

Mental Health Foundation - 0207 803 1100

Priory - 0845 2 PRIORY (0845 2 774 679), www.priorygroup.com

To view a list of the Priory hospitals that can help with Seasonal Affective Disorder (SAD) please click here.

Why should I choose Priory?

Our service

At Priory, our committed and professional staff provide the highest standards of care, understanding and service for everyone. This service brings hope and confidence, allowing our patients to take control of their lives within a safe and secure environment.

Expertise and innovation

As Europe's leading independent provider of specialist mental health, neuro-rehabilitation and special education services, we bring experience and an excellent reputation. Through our close links with the public and private sectors, we've developed the expertise and innovation to offer consistent and successful treatment.