Have you ever noticed that as the days get shorter, so does your mood. Your energy dips and you become irritable. You could be living with Seasonal Affective Disorder (SAD).
SAD is a form of depression related to changes in the seasons. For most people SAD emerges during the autumn/winter months, and recedes in spring/summer. For a minority their seasonal depression occurs in spring or early summer, and is related to an increase in light.
The symptoms of SAD are the usual ones associated with depression including:
- Difficulty waking in the morning
- Feeling hopeless
- Having low energy
- Losing interest in activities you once enjoyed
- Having difficulty with concentration
- Having problems sleeping
- Experiencing changes in your appetite or weight, in particular a craving for foods high in carbohydrates
The specific cause of SAD is unknown, but the reduced level of sunlight during autumn/winter is thought to disrupt melatonin levels. Melatonin is a hormone that plays a role in sleep patterns and mood.
Besides the lack of daylight, the other contributing factors are biological predisposition and stress.
SAD affects about 3% of the population in Ireland. Young adults, women, and those who have blood relatives with SAD or another form of depression are most likely to develop SAD.
The good news is if your symptoms are mild to moderate then there are a number of self-care approaches that have been shown to be successful in the management of symptoms.
1. Light Therapy
Studies show that light therapy helps somewhere between 50% and 80% of people. Light therapy involves exposing yourself to bright light daily, usually done by sitting in front of a lightbox, a lamp that mimics daylight. Light is measured in lux, the higher the lux, the brighter the light. For the treatment of SAD the lightbox must provide at least 10,000 lux.
You will need to use the lightbox daily throughout the dark winter months for somewhere between 20 and 90 minutes a day. For most people the best time to use the lightbox is in the morning, but some people find the afternoon works better. It is important not to use a lightbox at nighttime, as this could cause insomnia, making your symptoms worse rather than better. Finally, even though it might sound obvious, you must keep your eyes open while using light therapy!
Light therapy is not a cure. It helps in the management of symptoms, but symptoms of SAD will typically return if you stop using the light treatment.
Light therapy is generally considered safe but check with your GP if you have any concerns. Certain antibiotics and antipsychotics increase your sensitivity to light, as does St John’s Wort, and take care if you have an eye condition that makes your eyes sensitive to light.
A word of caution though, light therapy has the potential of inducing a manic reaction in people with Bipolar disorder, so seek advice before you make any changes in your treatment program.
Tips and reviews about buying and using a lightbox for SAD can be found at the Seasonal Affective Disorder Association of the UK.
2. Stress Management
Stress is a contributing factor in SAD, so have a plan for managing your stress levels. Meditation, yoga, sports, exercise, and social interaction can all help reduce stress, just make sure to choose the things that help you most.
Exercise is indicated for most forms of depression, and is definitely worth trying if you are experiencing SAD. Make a point of getting outside in daylight, particularly on a sunny winters day. Even brief exposure to sunlight can be helpful. UK’s National Institute for Health and Care Excellence (NICE) recommends that people with mild to moderate depression take part in about three sessions a week, lasting 45 minutes to 1 hour, over 10 to 14 weeks.
People with SAD often find they crave carbohydrates so try getting more protein and complex carbohydrates into your diet, particularly at breakfast time, as this can help regulate the cravings throughout the day.
Vitamin supplementation can help. Research shows that people with depression often have low levels of Vitamin D, and researchers have found that for some people with a Vitamin D deficiency, supplementation can work as well as antidepressants. Similarly Vitamin B12 deficiency is linked to depression and supplementation can improve treatment outcomes.
Your GP can test your vitamin levels if you are considering supplementation.
Talk therapy can help you manage the symptoms of SAD. Good talk therapy for SAD will challenge your negative thoughts about winter and lack of light, and help you to identify behaviours, such as social isolation or lack of exercise, that might be contribute to your low mood.
A study comparing CBT for SAD to light treatment showed they both had a similar level of effectiveness at the time of treatment. However people treated with CBT were less likely to experience a recurrence of symptoms in the second winter (27.3% compared with 45.6%). It is worth nothing that this study examined a specific form of CBT tailored for SAD, which may not be generally available.
Research shows that in general most styles of psychotherapy are equally effective, and that the style of psychotherapy only accounts for about 15% of the outcome. If you are seeking therapy, the most important factors are that you feel a good rapport with the therapist and the therapist has knowledge and experience of working with SAD.
Anti-depressants are often prescribed to treat depression but the evidence that they are effective in the treatment of SAD is limited. If you do try anti-depressants, remember that they can take up to four to six weeks to take full effect, so they are best taken at the start of the season before symptoms begin.
Always remember that for SAD, as with most mental health issues, there is no one size fits all treatment approach. Different things work for different people, but for many people active self-care makes all the difference.
Sorcha says “My SAD does still recur – it sneaks up on me, and before I know it I am in a funk. Now I get out my lightbox as the hour goes back in October, and I start using it even if I am still feeling OK. I review my diet and make sure I take my vitamin D. I prioritise outdoor exercise over the gym when the weather is good, and regularly meet a friend for a walk. All these things help, but I have to make sure I keep them up, or my motivation goes. I am always relieved as the days lengthen in the Spring, and my mood takes less hands on management.”
MyMind Centre for Mental Wellbeing has centres in Dublin, Cork and Limerick and provide multilingual counselling and psychotherapy services. Fees are based upon employment status, offering the unemployed or students affordable services. Revenue generated from full fee clients is reinvested, enabling us to provide services to all. Clients self-refer and appointments are within 72 hours. Call 076 680 1060 or email email@example.com
Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The Heart and Soul of Change: Delivering What Works in Therapy (pp. 23–55).
Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., … Nemeroff, C. B. (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(4), 656–662. https://doi.org/10.1176/appi.ajp.162.4.656
Rohan, K. J., Meyerhoff, J., Ho, S.-Y., Evans, M., Postolache, T. T., & Vacek, P. M. (2015). Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder. American Journal of Psychiatry, 173(3), 244–251. https://doi.org/10.1176/appi.ajp.2015.15060773
Stewart, A. E., Roecklein, K. A., Tanner, S., & Kimlin, M. G. (2014). Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder. Medical Hypotheses, 83(5), 517–525. https://doi.org/10.1016/j.mehy.2014.09.010
Syed, E. U., Wasay, M., & Awan, S. (2013). Vitamin B12 Supplementation in Treating Major Depressive Disorder: A Randomized Controlled Trial. The Open Neurology Journal, 7, 44–48. https://doi.org/10.2174/1874205X01307010044