Seasonal Affective Disorders
Do you dread the words: "It’s autumn again"?
In Britain we enjoy talking about the weather, and I (and I am sure many others) listen intently to the weather forecast. We always seem to complain about the weather – it’s too hot, or too cold. Too wet, or too dry. Whilst it may be a favourite topic of conversation for many of us, for someone with Seasonal Affective Disorder (SAD) the changing weather – and more importantly, the changing seasons – can hold far more cause for concern.
With the onset of autumn the morning light starts to dwindle, the nights start to draw in, and the light intensity throughout the day diminishes.
Many of us relish autumn’s colours, with the prospect of cosy evenings indoors. Some even look forward to September’s return to work and school routines after the long summer holiday. There is the excitement of Christmas just around the corner, with all that the Festive Season has in store. However, a proportion of the British population has good reason to fear the months ahead.
For the sufferers of Seasonal Affective Disorder (SAD), there will be little pleasure to be derived from misty mornings, crisp leaves under foot and the prospect of curling up in front of a log fire.
Autumn is the time for SAD sufferers to take action to guard against the dark days ahead!
What is SAD?
It is normal to experience variations in mood as the seasons change. We tend to be more motivated in spring, and sleep more in winter. For some people, these changes are extreme. Seasonal Affective Disorder (SAD) is a mood disorder triggered by seasonal variations in daylight. The duration and quality of sunlight has a huge impact on many animals, with reproductive activity and hibernation linked to specific seasons. Similarly, man’s circadian rhythm (our biological clock) changes with the seasons, with many people becoming clinically depressed during the autumn and winter months. Typical symptoms resemble those associated with depression – lethargy, irritability, weight gain, generally feeling morose and a loss of normal sexual desire, but whereas depression is usually associated with a loss of appetite and disturbed sleep, Seasonal Affective Disorder (SAD) is typified by overeating, craving sugary or starchy foods and excessive sleepiness, known as 'atypical' symptoms. Although not diagnostic, this symptom constellation is common.
Although Seasonal Affective Disorder (SAD) is typically associated with depression in the 'dark' months, in some cases it is also associated with overactivity and mood elevation in the 'light' months of spring, suggesting a more 'bipolar' than 'unipolar' pattern. Whilst extremes of mood elevation rapidly present to professionals, a lower level of disinhibition (hypomania) is less likely to draw attention from professionals, but can still have a very negative effect on relationships - both at home and at work.
What causes SAD?
Nobody is absolutely sure, but there are some theories that do carry weight. The pineal gland in the brain receives input from nerves that are connected to the eye and secretes a hormone called melatonin, the production of which is markedly increased in the dark. Melatonin is generally involved in regulating the day/night cycle of hormonal activity in our body and specifically the sleep wake cycle. Melatonin levels are normally low in the day time when the light is bright and increase at night, peaking at about 2 or 3 am.
As well as responding to day/night cycles melatonin may also be responsible for the changes that some people experience when subject to changes in hours of daylight as well as the intensity of daylight that occurs with the seasons. One theory is that melatonin secretion surges during winter’s short, shadowy days, triggering the onset of SAD.
In support of this, the frequency, intensity and duration of Seasonal Affective Disorder (SAD) varies with latitude. The problem is greatest in areas furthest from the equator. Seasonal Affective Disorder (SAD) is especially common in people who have migrated from countries close to the equator (e.g. countries in Africa), and who have then settled in countries closer to the polar regions (e.g. Canada or England). To some extent the risk relates to the difference in winter lengths in these locations, once the impact of migration itself is accounted for.
How common is it?
A major research study published in the British Journal of Psychiatry in 2001 found that 2.4% of the general population in the area of the UK studied might be diagnosed with an episode of SAD, but the diagnosis is often missed. Symptoms begin in the autumn, climax during the winter and dissolve in the spring. Up to 80 per cent of those affected are female, with the 30s being the most common age of onset, but cases of childhood SAD have been reported and successfully treated. Additionally, there are a host of people affected by the Winter Blues for every one diagnosed with full-blown SAD.
Treatment
Sometimes, a medical illness or another psychiatric condition can present as depression, so it’s vital to have a thorough psychiatric assessment if you think you suffer from SAD.
One research study failed to show an increase in melatonin levels in SAD sufferers, but some studies show that patients with Seasonal Affective Disorder have a less pronounced melatonin cycle than people without SAD. Despite this uncertainty, exposure to bright light clearly benefits many sufferers, helping to re-establish a normal mood pattern.
Those with mild symptoms might find spending time outdoors during the day, or altering their homes or workplaces to receive more sunlight, sufficient to beat the blues, while light therapy, which suppresses melatonin secretion, is suitable for other sufferers.
Some medications including lithium, imipramine, chlorpromazine (Largactil) and trifluoperazine (Stelazine), used to treat depression and other psychiatric conditions may, however, increase the possibility of light therapy having a harmful effect on the eyes. If in doubt, seek the advice of an expert.
Antidepressant drugs can be highly effective in reducing or eliminating SAD symptoms. SSRIs (Selective Serotonin Reuptake Inhibitors) like fluoxetine (Prozac), paroxetine (Seroxat), citalopram (Cipramil), escitalopram (Cipralex) and sertraline (Lustral) have been effective in treating SAD. This has lead to the hypothesis that the melatonin hormone affects serotonin levels in certain parts of the brain.
Psychotherapy can encourage SAD sufferers to re-frame their depressive assumptions and negative expectations and encourage them to create positive thought patterns and actions.
It is vital that the treatment is tailored to suit each individual patient, because no two cases of SAD are exactly alike. Many patients prefer to take a pill because for them it is quicker, easier and more effective than light therapy, while others need light therapy, psychotherapy or a combination of two or even three of the options (light therapy, medication and psychotherapy).
I would urge those who suffer from SAD to start treatment before the condition becomes overwhelming – to take preventative action that might make the next winter a time to look forward to!
NOTE:
It is important that the information presented here is intended as general information and is NOT an alternative to a detailed discussion with the professionals in charge of a patient’s care.
This is to some extent based on an article written by Dr Assin for a local newspaper in 2003