Seasonal Affective Disorder (SAD)

Feeling lethargic, tired and irritable? If you dread the coming of winter, you might be one of the many sufferers of a syndrome directly related to the weather. Laleh Lohrasbi explains the facts about SAD

Many years ago in London,  I came across an Egyptian  medical student. While I  was dreading the coming  of the British winter, for Mariam who  came from a country with midsummer  temperatures of around 45˚-50˚C, the  idea of cold and wet weather seemed  delightful and refreshing.  Mariam spent her first summer in  London enjoying the occasional shower,  breeze and warm sunshine. Soon the  cool breeze gave way to cold wind and  heavy rain. Day after day, the cloudy and  rainy weather became more frequent.  Finally a bitterly freezing winter arrived.  Mariam’s smile changed to a frown  and gradually to a sulk. She became  irritable and appeared to have lost  the motivation to get up and head for  college or work.A couple of friends realised her anxiety  and tried to take her mind off the  British weather by suggesting going  on a short trip up north. However, the  closer they got to Scotland, the more  depressed and blue she got. None of  the breathtaking views and landscapes  of Caledonia seemed to interest her.  She could not understand what was  happening.  Little did she know that the weather  was the culprit. In fact, she was  suffering from a disorder known as SAD  (Seasonal Affective Disorder).  The Office for National Statistics estimates  that seven per cent of the British  population is affected by SAD, with  around 17% of individuals suffering  from a milder form of this condition  known as Subsyndromal SAD which  has similar effects but on a milder scale.  Seasonal Affective Disorder is a mood  disorder that happens at the same time  each year. It is a type of depression that  has a seasonal pattern and that is why  it is also called winter depression or  winter blues.  Symptoms of this disorder usually  begin in autumn and get more severe  towards the winter, peaking in January  and February. The symptoms gradually  improve in spring. This disorder is  categorised as 1) Unipolar depression;  where the patient experiences depressive  symptoms, or 2) Bipolar depression;  when depressing periods (lows)  are followed by manic periods (highs)  where one feels happy, energetic and  much more sociable.  Symptoms of SAD are much the same  as those of depression and include  irritability and despair, lack of energy,  loss of concentration, increased appetite  and anxiety. However with bipolar  depression the patient may experience  periods of elevated mood, hyperactivity,  agitation, rapid thoughts and rapid  speech.  Although scientists know that SAD is  linked to the shorter days of the year  – when the body receives less exposure  to sunlight – its exact cause is still a  mystery. Most explanations revolve  around changes in hormone levels.  Hormonal changes  Hypothalamus is a gland in the brain  that when exposed to light regulates  many bodily activities, including sleep  and appetite. It also regulates the  circadian rhythms or the body’s internal  clock.

Exposure to light in the day  balances the amount of some internal  hormones including melatonin and  serotonin.  Melatonin is an internal hormone  produced by a small gland in the brain  called the pineal gland that regulates  sleep. In daylight, the pineal gland gets  a message from the hypothalamus to  stop producing melatonin but when  it becomes dark the pineal gland  begins to produce melatonin to induce  sleep.

What happened to Mariam, the  Egyptian student, was that during the  shorter and darker winter days, the  amount of melatonin produced in  her body increased and made her feel  drowsy, moodier and less energetic.  Serotonin is another internal hormone  that affects mood and sleep. The  amounts of Serotonin can increase with  the amount of daylight. The more we  are exposed to light, the more Serotonin  is produced. When the amount  of Serotonin is less than average the  symptoms of SAD appear.  Periods of exposure to light followed by  a period of darkness creates a hormonal  and behavioural rhythm in the body  called the circadian rhythm. Lack of  sunlight during the day may muddle up  this subtle timing. People who are living  far north or south of the equator are  more likely to be affected by SAD.  Patients such as Mariam are normally  recommended one of the treatments  mentioned below together with a  prescription of medicines.  Light Therapy  Light therapy is the first in line of  treatments. It is fast responding with  few side effects. Specially designed light  boxes with a very bright high lux light  are placed in front of the patient. The  patient sits in front of the light source  but not staring at the light directly.  This therapy is more effective if started  in early autumn before the symptoms  appear. The light coming from the light  box resembles sunlight and encourages  the brain to reduce the production of  Melatonin and increase the production  of Serotonin.  Sitting in front of a large high lux light  box (light intensity is measured by lux),  for 45 minutes a day and taking one  fluoxetine (Prozac, Sarafem) capsule  daily soon made Mariam feel better and  less gloomy.  Vitamin D Deficiency  Lack of Ultraviolet-B on the skin  (normally associated with sun exposure)  reduces the level of vitamin D.  Increasing the body’s intake of vitamin  D by taking supplements is an alternative  to bright light treatment.  Antidepressants  Drugs used for depression can also be  used for severe forms of SAD. Some  specific anti-depressants increase the  levels of serotonin in the brain and lift  one’s mood. It may take 4-6 weeks for  these drugs to take full effect.  Cognitive Behavioural Therapy  As with any other form of depression,  cognitive behavioural therapy  is an option which helps the patient  to reconsider h/her reaction to the  extreme mood swings.  Physical Exercise  This has been shown to be an effective  form of depression therapy, particularly  in addition to other treatments.  Adding twenty minutes of exercise to a  treatment usually helps the patient to  recover quicker.


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