Seasonal Affective Disorder's acronym describes the condition accurately - SAD. Someone affected by seasonal affective disorder feels sad to the point of depression. A mood disorder, SAD is mostly associated with a lack of light and therefore associated with the dark days of winter. However, there's another version of SAD which has a spring onset and is known as summer depression rather than winter depression.
The person who first discovered seasonal affective disorder is Norman E. Rosenthal, a South African psychiatrist who researched mood disorders among other conditions, while studying in the US. Two of his books about mood disorder caused by seasonal changes were issued in quick succession in 1989, with a third book called 'Winter Blues' shooting to fame in 2005.
His ground breaking research has helped identify this disorder which he himself experienced through drastic mood changes after moving from South Africa to the north east of the US and experiencing the sudden change of light levels. He and his research team experimented with the use of light therapy and published a research paper on the subject in 1984.
Light therapy is based on the understanding that the light levels outdoors on a sunny day are 500-1,000 times brighter than artificial indoor light, and therefore alternatives to outdoor light can help counteract the gloom and doom experienced by people affected by a seasonal lack of light.
A&H spoke to Dr. Anton Grech, a leading psychiatrist, senior lecturer in psychiatry at the University of Malta and Senior Research Fellow, BCMHR-Cambridge University.
As a psychiatrist do you find that SAD is common in Malta?
SAD is quite common in Malta, but it is less common than in Nordic countries. The reason is that in Malta the seasonal changes in intensity and length of daylight are not that drastic.
How does SAD manifest and are patients aware of its existence?
SAD manifests itself by depressive episodes triggered by the change of seasons, mostly in the beginning of winter. Patients suffer from a combination of the following: low mood, lack of energy, no motivation, very negative thinking, low self esteem, loss of self confidence, inability to experience joy, anxiety, lack of sleep or poor sleep.
In severe cases, a person experiences suicidal thoughts. Persons suffering from this condition and those close to them are aware of these changes. But most do not realize that these are symptoms of depression and think that there is something physically wrong with them or that they are just tired.
How is SAD treated and, if left untreated, can it become chronic?
The treatment of SAD consists of a combination of medication and psychotherapy. Since there is a strong physiological element in its cause, medication has a very prominent role. It is very important to treat SAD so that it does not become chronic depression. Some people need preventive treatment before the change of season.
Who is most affected, by age, social status, and occupation?
There is no particular class or profession that is affected more than another. All age groups can be affected equally.
SAD SYMPTOMS
Seasonal affective disorder symptoms usually appear when days get short and the weather's dull, in late autumn and early winter. More rarely, symptoms can occur in spring and summer, rather than in autumn and winter. Initially, symptoms are mild and worsen progressively over the season.
SAD is a sub-category of major depression and shares many of the symptoms such as:
- feeling depressed, hopeless or worthless most of the time;
- losing interest in activities you normally enjoy;
- feeling sluggish and fatigued without having done much;
- feeling agitated and unable to concentrate;
- difficulty falling asleep and remaining asleep for a whole night;
- changes in weight and appetite.
Autumn / winter SAD symptoms also include:
- oversleeping;
- craving carbohydrates;
- unusual weight gain;
- feeling tired all the time, and 'heavy' limbed;
- feeling irritable and unable to get along with others;
- feeling extra-sensitive to rejection.
Spring / summer SAD symptoms include:
- insomnia;
- feeling agitated and anxious;
- poor appetite and weight loss.
When to see a doctor
Feeling down occasionally is normal. It's part of the experience we call life. Feeling down for days at a time with no obvious cause or explanation is another matter. If you don't feel able to live normally or motivated to do things you normally enjoy doing, or if your sleep pattern and appetite have changed unusually, it's time to see a doctor about possible depression, especially if you're feeling hopeless or thinking about suicide.
Diagnosing seasonal affective disorder
Visit your GP if you have the symptoms of seasonal affective disorder (SAD). Effective treatments are available if you're diagnosed with the condition.
Your GP may carry out a psychological assessment to check your mental health. During the assessment, you may be asked questions about:
- your mood
- your lifestyle
- your eating patterns
- your sleeping patterns
- any seasonal changes in your thoughts and behaviour
- whether there's anything in your personal history that may contribute to a depressive disorder, such as child abuse
- whether there's anything in your family history that may contribute to a depressive disorder, such as a family history ofdepression
Your GP may also carry out a brief physical examination to check for any other possible causes of your symptoms.
7 WAYS TO MANAGE SAD
1. Take vitamin D, which is typically known as the sunshine vitamin. Vitamin D insufficiency affects almost 50% of the population worldwide. An estimated one billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency (VDD).
2. Increase your intake of Omega-3 since this helps keep your brain well supplied with healthy levels of feel-good neuro-transmitters.
3. Exercise for at least 30 minutes every day, at least five times a week
4. Expose yourself to outdoor light. Sit at a sunny window to read. Cover up and walk outdoors, even if it's cold. Take a walk in the countryside, do some gardening, hang the washing outdoors to dry. Don't worry if it's cloudy. Diffused outdoor cloud light is better than no outdoor light.
5. If you work indoors, try to situate yourself in natural light and surround yourself with warm colours. Remove barriers to natural light, and help diffuse natural light in your workspace by placing mirrors strategically.
6. Make an effort to keep to a consistent sleep schedule. Go to bed and get up at the same time every day.
7. Eat healthy food, preferably fresh. Avoid fats and sugars and processed meals.