Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a condition that people in far northern or far southern climates may suffer from during the reduced hours of daylight in the winter. It is also referred to as winter depression and affects people who feel normal during the summer but feel depressed during the winter months.
It has been estimated to affect up to one in ten adults in Northern Europe and the USA. However, the symptoms increase with latitude so that people living in Alaska suffer more than those living in Florida, and those in Sweden suffer more than those in Italy. Rates also increase with cloud cover, which may account for why one in five people living in Ireland are estimated to suffer with SAD. Women are more likely than men to suffer too and this is thought to be due to the seasonal fluctuations in reproductive and hormonal cycles that women experience.
Up to three times as many people in the more northerly countries are estimated to suffer with a milder form of SAD known as subsyndromal SAD (S-SAD) or the winter blues. At the other end of the scale, a significant proportion of sufferers require hospitalisation and up to one in five may go on to develop a bipolar or a manic-depressive disorder.
One exception to the increased rates of SAD with latitude appear to be the Icelandic people who suffer markedly less than their Scandinavian cousins. The diet of the Icelandic people is known for its high content of fish and it is thought that the docosahexaenoic acid (DHA) and/or the vitamin D it contains may account for their enhanced neurological function and resistance to depression.
What causes SAD?
In spite of being such a common and potentially serious problem, there is no agreement as to what causes SAD.
One theory is that SAD is a deficiency of the feel-good hormone, serotonin. Levels of serotonin are indirectly linked to those of the hormone, melatonin, which is produced by the pineal gland during the hours of darkness. Another 'hormone theory' is that SAD may be caused partially or wholly by increased production of cortisol by the adrenal glands during the winter.
Another theory is that SAD is caused by reduced blood vitamin D levels due to a seasonal lack of ultraviolet light exposure on the skin. The form of vitamin D the body produces is vitamin D3 or cholecalciferol and this is the most active form and can also be found in oily fish and animal products. In fact, vitamin D is not really a vitamin at all, its active form is actually a kind of steroid hormone. In addition to its important functions in aiding bone formation, it is recognised to promote the production and activation of the mood elevating neurotransmitters serotonin, dopamine and noradrenaline (norepinephrine).
Yet others think that SAD is not a disorder at all in the real sense, but a normal seasonal variation. Many animals hibernate in response to the cold weather and lack of food during the winter months. Some people think that SAD too may be hangover survival strategy acquired from a remote ancestor whereby activity decreases and sleep increases in order to conserve scarce food supplies.
Symptoms of SAD
Some SAD symptoms include:
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Feeling an unexplained sadness
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Feeling an unexplained depression
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Feeling lethargic
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Feeling fatigued
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Feelings of self-loathing
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An increased need for sleep
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Having little energy
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Finding it difficult to wake up in the morning or oversleeping
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Feeling sick in the morning
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Being overly sensitive and irritable
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A tendency to overeat - and especially a craving for carbohydrates, which may lead to weight gain
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Difficulty concentrating or completing tasks
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Withdrawal from friends, family and social activities
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Pessimistic feelings of hopelessness and
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Taking no pleasure in life
Seasonal Affective Disorder Treatments
Suggested treatments for SAD include:
Light therapy This involves placing a light box which emits a bright white 'full spectrum' light on your desk or kitchen table 30-60cm in front of your eyes and then glancing at the box regularly for 30-60 minutes ideally every morning. Although proven to help, many find the therapy tying and abandon it. For which reason you may find a light visor more convenient since you can move around and the visor has a battery pack that can attach to a belt. Improvements using light therapy are effective within a week and are cumulative.
Travel to a sunny destination Obvious, but effective. A skiing or beach holiday to somewhere bright and sunny will lift you out of your malaise.
Ionised-air administration The use of a negative air ioniser near to the bed has been found to provide a nearly 50% improvement in symptoms of SAD.
Exercise This may help to elevate mood and may be especially beneficial if conducted outdoors during daylight.
Increasing solar exposure Some manufacturers provide a computer-controlled heliostat to reflect sunlight into the windows of a home or office. Sunbeds too can be used to simulate natural light although most have been calibrated to produce mostly UVA which promotes tanning, rather than the UVB rays that are responsible for both burning and vitamin D synthesis in the skin.
Full spectrum light bulbs Replacing light bulbs in your office or rooms in which you spend the most time with full spectrum light bulbs may help.
Dawn/dusk simulation lights These are relatively inexpensive lights that slowly start to brighten prior to your set waking time so that your body has a chance to convert melatonin to serotonin prior to waking. These have been shown to be surprisingly effective - one study found an 83% better response when compared to other bright light therapies.
Timed melatonin supplementation Supplementing melatonin is thought to work by increasing brain levels of melatonin and possibly by suppressing the production of cortisol by the adrenal glands. Melatonin supplements are best taken in the late afternoon or at night to synchronise the daily cycle. Melatonin is available to purchase over the counter in the USA, but not in other countries.
High dosage vitamin D supplementation Some experts suggest supplementing doses of 3,500-7,000iu of vitamin D3 per day which the body converts to the active hormone (1,25-dihydroxycholecalciferol) in the liver and kidneys. Liquid vitamin D supplements are preferred by some.
St John's Wort supplementation This is well documented to help with depression and whilst effective on its own is even more effective when combined with light therapy.
5-hydroxytryptophan (5HTP) supplementation This is a naturally-occurring amino acid and precursor of the hormones serotonin and melatonin and aids the body's endogenous production of these hormones.
Fish oil supplementation Almost everyone is deficient in these oils and would benefit from supplementing them. Docosahexaenoic acid (DHA) in particular is thought to have a beneficial effect on mood and neurological function.
Eat oily fish You could take a tip from the Icelanders and include plenty of oily fish in your diet for both the vitamin D and omega oils this provides (Note: fish should be no bigger than your plate with the exception of salmon to avoid pollutants).
Flower remedies Several companies manufacture flower essences which relieve the symptoms of SAD on a subtle emotional level. Examples include Seasonal Affections by Findhorn Flower Essences, Flower Essence 92 from Bach and Lighten Up from the Alaskan Flower Essence range.
The important aspect of any therapy is to start before you need to and possibly to experiment with different therapies and supplements to see which ones - or which combinations - work for you.
Further resources
Click the relevant link for more information about Bach Flower Remedies in the UK or the US or to place an order.
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