Seasonal affective disorder (SAD)
Two hundred years ago three quarters of the population worked outdoors in the natural light, a percentage which has dramatically dwindled over the years and currently stands at just 10 per cent. During the summer months whilst there are plenty of daylight hours, working inside does not seem to cause a problem for many individuals.
However, when the clocks change and daylight hours are dramatically reduced, the body's internal clock struggles to regulate itself when it is deficient of natural light. This process can often lead to the inset of seasonal affective disorder (SAD) or the winter blues as it is sometimes known.
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Who suffers from SAD?
SAD is a recognised medical condition which affects an estimated 7 per cent of the population every winter between September and April, in particular during December, January and February.
There are various levels of SAD but at its most severe it is a seriously disabling illness causing a variety of side effects such as sleep problems, overeating, depression, family and social problems, lethargy, physical complaints, behavioural problems and a general weakening of an individuals ability to function normally without medical treatment.
Many individuals in the UK (around 17 per cent) also suffer from a milder form of the condition which is known as subsyndromal SAD, a condition which brings about similar effects to those mentioned above, but on a lesser scale.
Because the UK and Ireland are situated in the higher latitudes of the northern hemisphere, we experience significant changes in the levels of light between summer and winter. This seasonal change in light combined with dark and gloomy weather, lifestyle and environmental factors all mean that more people than ever before are suffering with SAD. The onset of SAD is most common in individuals aged between 18 and 30 years old and though it does occur in both northern and southern hemispheres it is far less common in those living within 30 degrees of the Equator, where there are consistent and long daylight hours.
What are the causes of SAD?
Circadian rhythm imbalance
Circadian rhythm is the term used to describe physical, mental and behavioural changes which follow a 24 hour cycle, usually responding to light and darkness in an individuals environment.
Correctly timed rhythms work to regulate mood, sleep, wake, appetite, digestion and energy, all of which are usually timed on certain light cues such as the sun. When the body clock receives the right type of light, the body will produce active and energetic hormones ensuring that energy cycles are regulated. For example, when we wake during the winter without the signal of morning sunlight, the body will not produce the hormones we need to help us wake up and feel active and this can result in us feeling tired, moody and sluggish.
As it gets dark the pineal gland begins producing melatonin, a hormone which signals to our body clock that it is night time and time to sleep. In contrast to this, the sun rising in the morning sends a message to the pineal gland to stop producing the melatonin and thus we awake.
In a similar fashion, the production of the body's feel good hormone serotonin also takes its cues from natural light, which explains why dark winters results in lower serotonin production and subsequently higher levels of depression.
Scientific evidence also supports this notion as evidence has been found which proves serotonin levels increase with exposure to bright light, with researchers also finding that bright light makes a difference to brain chemistry.
What are the symptoms of SAD?
There are various symptoms which are indicative of SAD but generally a diagnosis can be made after three or more consecutive winters of symptoms, which may include a number of the following:
Often those suffering from SAD find any tension and stress in their lives much harder to deal with.
Overwhelming negative thoughts and feelings, a loss of self-esteem and feelings of loneliness and hopelessness which are different and more extreme compared to normal sadness are common among sufferers of SAD.
Fatigue is often so extreme and incapacitating that it prevents the sufferer from carrying out their everyday routine.
Loss of libido
A reduced sex drive and a lack of interest in physical contact is a common symptom.
It is not unusual for sufferers to crave foods which are either carbohydrate or sugar laden, often leading to a weight increase which in turn contributes to a loss of self esteem.
Reduced cognitive function
Ability to concentrate will often be affected as will memory.
Sleep issues are a huge problem with sufferers, who tend to either heavily oversleep or wake extremely early and struggle to stay awake during the day.
Sufferers may notice an increased level of irritability which will make social interactions difficult.
Sudden mood changes in spring
When the mornings and evenings begin to get lighter as Spring starts to set in, sufferers will more than likely notice a difference in their mood. This could be anything from agitation and restlessness through to short periods of hypomania.
What treatment options are available?
Antidepressant non-sedative SSRI drugs such as sertraline (Lustral), paroxetine (Seroxat) and fluoxetine (Prozac) are effective ways of reducing depressive symptoms of SAD and work well when used in combination with light therapy.
Though prescribed medication such as antidepressants have been found to be effective in many cases of SAD, in recent years the use of light therapy has emerged and has been found effective in up to 85 per cent of diagnosed cases.
A lack of light in the winter months is what causes an excess of melatonin and a depletion in our serotonin. However, a process which can rectify this mix up and alleviate any symptoms of SAD is exposure to a very bright light which emulates summertime levels of brightness.
Light therapy is a treatment which involves exposure to a very bright light for up to four hours every day. Ordinary domestic light bulbs are not strong enough to provide the recommended 2500 lux (technical measure of brightness) and instead a light box must be brought in which emulates the effects of a bright summers day (which can produce up to 100,000 lux).
Light therapy should begin in the Autumn time when sufferers begin to notice symptoms arising and throughout winter the light box should be used on a daily basis. Generally individuals will be required to sit two to three feet away from the light box which will allow the light to shine into their eyes, although users of boxes emitting over 10,000 can sit further away if they wish. Whilst in front of the box users can carry out normal activities such as working at a computer, reading, writing, eating etc.
The effects of treatment will usually be visible within three or four days and symptoms will further improve with continued use.
As it stands light boxes are not available on the NHS, though they are VAT free when bought from specialist retailers for medical purposes.
SAD can be an extremely debilitating condition to live with and unfortunately it leaves many individuals dreading the colder months. However, there are various treatments and therapies available which can help sufferers to have a more positive winter.
Talking treatments such as counselling, psychotherapy and cognitive behavioural therapy have been used by many an individual in a bid to help them discover any contributing factors which may be fueling their depression and they also work extremely well at tackling the cause of a problem from its root in a bid to prevent any future reoccurrence.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) has recently been praised as a highly successful method of treatment for SAD, after a report published in the journal Behaviour Issue found that just seven per cent of sufferers treated with CBT had a reoccurrence of symptoms compared to almost 37 per cent of those treated with light therapy.
The aptly named cognitive behavioural therapy is essentially a combination of both cognitive and behavioural therapies, and involves changing the way you think (cognitive) and the way in which you respond to certain thoughts (behaviour).
It is thought that this method works so well for the treatment of SAD because much of the focus is placed upon changing the way you think and behave so that a situation no longer makes you unhappy. The process of CBT involves focusing on current issues instead of investigating the root cause and more often than not will break problems down into more manageable sections which can be described as thoughts, emotions, physical feelings and actions all of which have the ability to influence one another (e.g the way you think about certain things can influence how you feel on an emotional and physical level and ultimately can affect your behaviour).
Cognitive behavioural therapy helps you to identify and understand negative patterns of behaviour so that eventually you can break the the negative cycle of altered thinking, feelings and behaviour and implement a more positive sequence.
CBT treatment will involve a number of sessions with a qualified therapist who will form an individual treatment plan tailored to your needs.
Counselling and psychodynamic psychotherapy
Because one of the most prominent side effects of SAD is depression, there are various talking therapies which are typically used to treat depression which sufferers find extremely useful. Counselling for instance gives individuals an opportunity to discuss their feeling openly in complete confidence. More specifically, psychodynamic psychotherapy involves sufferers discussing how they feel about both themselves and others as well as endeavouring to find out whether anything in your past is influencing how you feel today.
If you would like to find out more information about the various types of counselling and psychotherapy available please visit the types of therapy section of this site.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat seasonal affective disorder (SAD). However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments.
In terms of psychological treatments, NICE recommend that SAD be treated in the same way as depression, which may involve psychological treatments (like CBT) and/or medication. In regards to light therapy, NICE recommendations say patients should be aware that there is no substantiated evidence for it's effectiveness in the long term, however it does no harm and can be used as a complementary therapy.
Read the full NICE guidelines:
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