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26 October, 2016

What is Seasonal Affective Disorder (SAD) and what can we do about it?

Contrary to popular belief most mental health problems are neither long standing nor permanent. Mental health difficulties are typically episodic and they are most often transient. While they usually arise in the context of significant stress it seems that for some people one of these stresses may simply be the arrival of the autumn and winter months.

RTE Radio 1 - Today With Sean O'Rourke - What is Seasonal Affective Disorder

Seasonal Affective Disorder (or SAD for short) is a recurring depressive disorder also known as “The Winter Blues”. SAD is a problem of recurring episodic depression characteristically associated with the arrival of the autumn/winter months but typically relieved with the onset of spring.

Estimates vary but there is no doubt that SAD is a common problem. Significant winter depressions are thought to occur in three out of every one hundred of the population. Twice as many women as men experience SAD and the commonest onset ages are in the early 20’s and 30’s.

Episodes of SAD are typically depressing and they can last many weeks, with a person experiencing many common depressive features, such as a reduction in mood or energy, a loss of joy or concentration, and also a loss of appetite or even over-eating.

Of course these features may be seen with any depression but with SAD these depressive symptoms arise either new “out of the blue” or coincident in addition to other symptoms already being experienced by someone with anxiety or depression. In other words SAD may be a recurring isolated and discrete problem or an additional and coexisting one.

There is no known cause for SAD but as ever with mental health diagnoses theories about causes are plentiful. These theories are generally psychological and/or social but in the case of SAD the most compelling theories relate to the detrimental influence on the brain of loss of sunlight in our environment. It seems likely that the reduction in the number of daylight hours has something to do with the onset of SAD. A chemical messenger in the brain called Melatonin fluctuates with exposure to light. This hormone arises from the Hypothalamus and this is an area of the brain known to be associated with the regulation of mood, appetite and energy.

However fluctuations in melatonin induced by darkness do not entirely explain things. For example in countries where there is an even greater seasonal reduction of day light hours (such as in Scandinavia) there is no greater incidence of SAD. To my mind there has to be more to SAD than Melatonin, but as yet we just don't know. The subjective influence of other seasonal stresses is probably also a factor.

Mental health problems like SAD are not on the increase. It may simply be that we are more aware of them. Still overall levels of mental health distress do appear to be increasing in other areas. The trends are worrying. Recent evidence from the UK has revealed a near four fold increase in certain stress related common mental health disorders. There has been a substantial increase in post traumatic stress disorder, particularly in young women, and also a large increase in self-harm and suicidal behaviours.

SAD or seasonal depressive disorders do not not appear to be precipitated by the stresses or traumas of life. SAD is a form of mental suffering that is very challenging. For me this tells us something important about mental health and wellbeing. There is no single cause of mental health difficulty (just as there is no single definition of mental wellbeing). We are human and so all these things have psychological, biological, social and spiritual aspects to them, and probably lots more besides!

So what can we do about getting SAD. Well, as ever, it is always better to start by talking about it. Share the problem. A problem shared is a problem halved as they say. Nothing is resolved in secret. Of course the usual advice applies. Talk to a loved one, a family friend, a partner, a family physician, but most of all tell someone. These conversations don't have to be about blame, but they can help to explain, and that can give great relief.

Mild degrees of distressing symptoms can also be relieved by taking small practical steps. These include fostering greater self-care, taking more exercise, eating better and seeking out greater sources of positive life-affirming company. In that way SAD may be like any other mild depression.

More severe cases where symptoms are persistent and pervasive and where low mood is associated with multiple consequences such as impaired concentration, loss of weight or suicidal thoughts, may indicate a need for more active treatment.

The melatonin theory has led to the development of “light” as a therapy. It is possible to buy lights known as “light boxes” that emit constant beams of northern light (that is to say these boxes emit specific wave lengths without potential harmful UV bands). These are available commercially and for some they are very helpful. Most of those who benefit do so within a week of using about 30 minutes or so of therapy usually in the morning and every day. Some manufactures offer a light box for a trial period and it’s wise to take up such an offer before parting with lots of expense. If it’s not going to work for you it can be returned at no loss.

Other people benefit from Cognitive Behaviour Therapy (CBT). This helps to reframe the SAD experience and helps people to re-engage with the world and the future despite the SAD struggle. Others may require medication and as with any depressive episode requiring medication it’s best to discuss this with your doctor and to consider all the benefits and the risks. For SAD most physicians would start with a medication from the Serotonin family. What ever approach is taken, whether it is a single measure or a combination, it is essential to persist until recovery is achieved and to persist in recovery for as long as it takes to prevent relapse.

Many of us fear the arrival of the winter months. This is understandable given the return of the long dark evenings and the hazards of floods and inclement weather. Perhaps this year will be different. Lets hope that this year we will all take time to soothe ourselves and so to re-build our reserves of wellbeing.

Of course there is a natural inclination to hibernate at these times, but this Autumn/Winter we might take a wellness approach. We might look beyond ourselves and to each other for wellness. Perhaps this year we will make winter a season to be collective and to be warm, joining together within our neighbourhoods and families, whatever their size or shape, to enjoy each others company, in our clubs and our communities, wherever we may be.

So this winter as we share time with each other we may be well and remain so. But as we do, let us spare a thought for those of us with less resources, those without a secure home and without sustained companionship, for those whose resilience has been dented by loss of friendship or positive values. Let us speak up for mental wellbeing wherever we can. Remember mental wellbeing is for every one, especially this winter.

If you would like more information or support on this or any other mental health issue why not call our free Walk in My Shoes information and

support line at St. Patricks Mental Health Services on (01) 249 3333 or our youth support line on (01) 2493 555.

There is also helpful information on SAD from the HSE

The Royal College of Psychiatrists provide helpful notes about SAD

There is some helpful information to be had at the Seasonal Affective Disorder Association on Light boxes

Background information on the rise of stress-related mental health disorders in the UK is summarised by Professor Sir Simon Wessley (President of the RCPsych) in recent article in the Huff Post called “Behind the scenes are worrying trends for women mental health”