Understanding seasonal affective disorder (SAD)

Seasonal affective disorder, or SAD, affects millions of people and is four times more likely to affect women than men. Presenting symptoms, either severe or mild, include;

• low mood
• changes in appetite
• sleep disturbances
• a lack of motivation to socialise or engage in activities
• isolation
• loneliness

It most commonly occurs (or is likely to be reported to present itself) during winter months, although there could be variations on this. For some, it can start manifesting in autumn and progress into winter; for others, symptoms might occur in summer. In such cases, it is called SAD in reverse. There are also transitional periods of spring and autumn to consider when it comes to mental health and general well-being and this particular disorder. It is the time in-between winter and summer that some may find difficult and unsettling. With some mental health conditions, symptoms intensify during spring and autumn, presenting either as depressive episodes or manic ones.

The most common association with SAD is people’s low tolerance towards diminishing daylight in the environment and changes in climate. It is a lack of sunlight/day time hours, and generally gloomy weather conditions, that can bring on symptoms of SAD. If we look at SAD in-reverse, symptoms would be intensified by too much daylight and long days, as well as heat that can often be intolerable. For many tiredness in winter is common, and sleep can be disturbed by way of sleeping too much or not sleeping enough. In the summer, for many, the heat and shorter nights can make it difficult to sleep and can affect mood, weight, energy levels, and a desire to socialise and be out generally, which are all of the activities that promote physical and emotional well-being.

Let’s look at whether the presentation of SAD is purely due to changes in climate and environment, or if there could be more to it. There is some research available on the disorder, with some interesting and conclusive results, as well as areas where more research might be needed.

For people suffering from SAD, differences between seasons would be presented as extremes, swinging from deep depression to something close to mania, whether it is from winter to summer or summer to winter. Anticipation and yearning for warm weather and sun can be intense for those suffering through the winter months. On the other end of the spectrum, with the darker part of the year approaching, it can feel like the end of the world is upon us, and there is a sense of not being able to cope. There is a little balance in that way of viewing seasonal changes, and often transitional periods are ignored and not fully experienced, which leads to living in polarities of experiences. With summer depression, the approaching cooler temperatures and darker nights can bring much-needed relief.

What are alternative ways of looking at the nature of SAD and how it manifests? Could other factors play into this condition that could lead us to ways of working with it?

Personality types

Many personality models point towards two types: introverts and extroverts. Extroverted people enjoy socialising, being around other people, being active, travelling, and engaging in outdoor activities. Such types process their experiences generally through interacting with the outside world. They obtain energy externally. If you think of this type of personality in terms of nature symbols, that would be the sun; e.g. introverted people prefer solitude and need to withdraw from social interactions to recharge themselves. They process things away from the external world, and their internal world is often rich and complex. They are creative, reflective, and enjoy space to themselves. Those are the moon types, if you like, preferring quiet and darkness.

A natural inclination for extroverted personalities would then be towards summer, a time for socialising that provides opportunities to stay up late, engaging in various activities. Winter doesn’t provide that set-up, and in fact, most of it is taken away by a lack of light and opportunity to be 'out there'. SAD for extroverted types could be a common and usual presentation in winter.

For introverted types, it is in reverse, with winter being a much-welcomed season to withdraw and reflect. Winter would be a period when introverted types are at their most creative and productive. Darkness benefits them; something that summer doesn’t offer. Introverted types get tired in the light/heat, which results in a lack of sleep and rest and has a spiralling effect on mood, productivity, and motivation.

A spiritual perspective

Transpersonal psychotherapists work with the idea of the 'whole' within a person’s psyche. The idea is that everyone has light and dark sides to their personality, and it is how it should be. There is no one just 'light' and no one just 'dark', and it is not that one is good and the other is bad, it is about both being part of the whole and worthy of our attention, compassion, awareness, and acceptance. Seasons and nature can help us greatly to understand ourselves if we observe changes in nature and think of how it relates to us. If we work with becoming aware of the cycles in nature, we can begin to recognise our cycles, which then leads to self-awareness. It is possible to work with SAD in a way of personal preferences for light or darkness and see if one or the other dominates or is out of balance. It is recognising a possibility of imbalance in how we view the world and ourselves which then leads to the symptoms we experience.

You can also work with shadow/unconscious material, things that we would rather not see or acknowledge and therefore banishing it to the darkness, as well as exploring the qualities, considered as a 'light' side of a personality; things that we like about ourselves. The aim is to accept the 'darkness' and 'light' as equally valuable parts of the whole. Once the work with shadow material is underway, a perception of winter (the darker part of the year) might be seen as a period that can offer positive and rich experience. Some people might have a problem with light, i.e. denying their own 'goodness', therefore 'being exposed' in light would be painful, and they are much more comfortable in darker places. Psychotherapy can help with exploration and building awareness around these issues.

Looking at the past

Many of us can be unaware of the cycles that present themselves with each season, i.e. we are unconscious of what is happening to us. We only know that one or the other doesn’t feel good. Psychotherapy can help with bringing awareness to feelings and patterns of behaviour by going back in time. Attitudes towards winter, summer, or any other season can stem from places we are unaware of. SAD can be connected to significant dates, important anniversaries, and traumatic events, such as childbirth, death, abusive experience, or childhood trauma.

Symptoms often manifest in the body, e.g. increased appetite or lack of energy, and aches and pains, because the body holds emotions and memories, and with each cycle recognises the time of year.

For many, family gatherings (like Christmas) would trigger a memory or a pattern that is no longer working for them, but we might not know how to get out of it. We find ourselves stuck in time, so to speak. With each approaching winter, there will be a sense of doom and a burden of obligation where boundaries might be loose around family members. The darkness of winter or having too much light in summer can also draw us into a lonely and quiet place where we are forced into our thoughts and feelings even more, which can be difficult. Winter can feel like a loss, a grieving period in itself, and if a significant event might have happened during winter or summer for you, symptoms of SAD would intensify. Working in therapy and discovering patterns and processing, perhaps, areas that didn’t have any attention before, like difficult family dynamics and learning to build healthy boundaries or working through unprocessed grief experience, might help dilute dark and heavy experiences that come on every year. Psychotherapy can help with the exploration of all of the above and become aware of the cycles that occur every year.

• Awareness helps with coping and provides choices you can learn to make before symptoms occur.
• Acceptance and understanding SAD as a stage that passes can also bring relief.
• Finding personal freedom in choosing what works for you.
• Putting things in place in advance, e.g. going on holiday away from family instead of feeling the pressure to perform.
• Building boundaries and finding your voice.
• Saying 'no' to things you don’t want to do and saying 'yes' to yourself instead.

What to do if you think you have SAD

• Explore your life experiences in therapy.
• Consult your doctor if your symptoms are severe, get an appropriate assessment, diagnose, and put a treatment plan in place that is suitable to you.
• Going out in the sun every day, or even standing by the window during light hours during winter, as well as retreating to a cool, shady place in the summer if your SAD is in reverse.
• Try meditation and visualisations to bring about the desired effect. There are many available.
• Evaluate your experience as a whole and see benefits in both, light and dark, as well as periods of transition.

Read more about SAD on Happiful, Ask the Experts: What is SAD? and 10 ways to overcome seasonal depression.