Seasonal Affective Disorder

In today’s world it is easy to get caught up in the work/home routine and not spend much time outdoors. In summer in Australia we are lucky enough to come home in daylight and still have a few hours to spend in the garden, have a walk or enjoy a barbeque dinner so we still get to soak up that lovely vitamin D.

Winter is another story. We often leave home when it’s still dark in the morning and come back after sunset. Even those who do have access to natural daylight during winter can still be affected by cold and dreary days. It is not unusual to have less energy and to feel a bit down. The body’s internal clock can struggle to maintain its natural rhythm, especially after daylight saving finishes.

In some people, the disruption to their body clock and the effect on their mood can lead them into a form of depression known as Seasonal Affective Disorder (SAD) or the ‘Winter Blues’. This is recognised as a serious condition that may require treatment.

As with other forms of depression, it has varying levels of intensity. At its most severe it can be quite disabling and can produce a range of side effects including eating disorders, lethargy, and also noticeable changes in mood and behaviour. It can prevent a person from functioning normally without some form of professional help.

In countries more than roughly 30 degrees north of the equator during winter SAD can affect as many as 7% of the population – mainly younger women. In Australia and other mid southern hemisphere countries the condition is rare but it does exist. Studies have shown that night shift workers and others such as miners who work in little light are more at risk.

What are the causes of SAD?

When it’s cold and rainy is not hard to slip into a low, grumpy mood. However it is more the lack of light than the lower temperature that gets us down. We have a natural 24 hour cycle (called a Circadian rhythm) that governs many of our internal functions such as our digestion, energy levels and sleep cycles. All of these follow regular external cues - especially the light from the sun - and produce the appropriate chemical responses in the body at the appropriate time.

When we are exposed to the bright light of a sunny, spring morning our bodies’ energy hormones such as adrenalin get a big boost. We also receive a higher dose of the ‘feel good’ hormone serotonin so we are more likely to be in good spirits. Researchers have proven that brain chemistry does change and serotonin levels rise with increased exposure to bright light.

Conversely, on bleak winter mornings we are more likely to feel sluggish and moody as our bodies’ produce less energy. Then as it gets dark, the pineal gland produces more of the hormone melatonin which tells the body to wind down and prepare for sleep. Long, dark winters often result in decreased serotonin production and subsequently increased levels of depression. In people with SAD, these chemical messengers (neurotransmitters) get confused and it can be extremely difficult for a sufferer to overcome the condition without support and professional help.

How is it diagnosed?

SAD is difficult to diagnose as the symptoms are very similar to other forms of depression. To be confirmed, it needs to follow a pattern of occurring mainly in winter for a period of two or three consecutive years.

What are the symptoms of SAD?

Symptoms can be varied but the most common ones include:

Anxiety – Many sufferers find that they struggle with increased worry and tension.
Depression – Feelings of sadness, loneliness and hopelessness become more overwhelming and intense when compared to a person’s normal behaviour.
Fatigue – More than just tiredness, fatigue is debilitating and can prevent sufferers from carrying out even simple everyday tasks.
Loss of libido – People with depression often experience an overall feeling of detachment from the world around them and this extends to reduced interest in intimacy. Part of the change in body chemistry is a reduced sex drive.
Overeating – In a subconscious effort to feel better sufferers often crave comfort foods. As these are generally high in carbohydrates and sugars they can lead to weight gain. In addition, poor nutrition contributes to reduced energy which in turn reduces the likelihood of sufferers wanting to exercise. The weight gain also contributes to poor self-esteem.
Reduced cognitive function – Changes in brain chemistry also affect memory and the ability to concentrate.
Sleep issues – Many sufferers of SAD have huge problems with sleep. They may oversleep in the mornings or wake up early and find it hard to stay awake during the day.
Changes in social behaviour – Sufferers can become more withdrawn and less inclined to participate in their usual social activities. They may also become more moody and irritated with others.
Erratic mood changes in spring – As the days get lighter sufferers are more likely to experience sudden mood changes. In some cases this could be periods of agitation and restlessness while in others it could be more extreme and include short periods of manic behaviour. This seasonal symptom is a key indicator for diagnosis of SAD.

What treatment options are available?

Antidepressants

There are a number of antidepressant medications available to help people with SAD. They help to stabilise wayward neurotransmitters and subsequently moods and emotions. They can be used on their own or in conjunction with other forms of therapy.

Light therapy

The use of light therapy as a treatment for SADS has increased greatly in recent years and it has proven to be effective in up to 85% of cases.

A lack of exposure to bright light for a prolonged period causes the body to create too much melatonin and not enough serotonin. Ordinary household lights do not provide bright enough light to affect the body so to counteract this issue, those treated with light therapy are exposed to very bright light equivalent to a sunny summer’s day for up to 4 hours using a specially designed light box.

Ideally light therapy sessions should begin in autumn just as sufferers start to notice symptoms. Over winter the light box should be used daily with the person sitting around a metre or so from the light box (or further away if their box is more powerful). They should be facing the light but can carry out normal daily tasks such as eating, reading or working at a computer.

The effects of this non-invasive treatment will usually become noticeable with a few days and symptoms will continue to improve with ongoing use.

A counsellor or doctor will be able to help source a light box through a reputable medical supplier.

Other therapies

As one of the primary symptoms of SAD is depression many sufferers find that - in addition to medication and light therapy - they can also benefit greatly by participating in one of the many forms of talking therapies with an experienced counsellor. Treating the depression alongside the neurological imbalances increases their ability to overcome their condition.

Counselling sessions provide the person with a non-judgemental and safe environment in which they can freely discuss their innermost thoughts and feelings. The main premise behind these therapies is that behaviour is driven by subconscious thoughts, emotions and beliefs.

The counsellor will tailor a treatment plan to cater for the person’s circumstances and needs and will generally recommend a series of sessions over a period of weeks or months.

Psychodynamic therapy

In psychodynamic therapy the counsellor guides the person to explore these underlying thought patterns and to try and discover their origins. Once these have been established they can then be analysed to help shed light on current behaviour.

Cognitive behavioural therapy

Cognitive Behavioural Therapy (CBT) takes this approach one step further. When the problem beliefs or thought patterns are known and connections have been made to the present situation, the counsellor and sufferer can work together to come up with new, more constructive ways to respond to them. This approach is believed to be particularly effective for SAD sufferers as it helps them to change the way they deal with their situation so that it no longer makes them unhappy.

Studies have shown that while a recurrence of symptoms can happen for around 37% of sufferers treated with light therapy this number dropped to around 7% for those treated with CBT.

For more information on the various types of counselling and treatments available please visit the Therapy (crosslink to page) section of this site.

What should I look for in a mental health service provider?

There are a wide variety of people who offer mental health services. The generic term ‘Counsellor’ is used to describe various professionals such as psychologists, psychiatrists, social workers or occupational counsellors. Counsellors generally discuss your particular issues and work with you to find ways to address and overcome them. Most have undertaken years of study or additional professional development in their chosen fields however anybody can call themselves a ‘counsellor’. Also, some highly qualified counsellors may not necessarily have training in specific mental health conditions such as depression.

You may want to ask your counsellor about their type and level of qualifications or see if they are registered in Australia with a professional society or state body. Only certain kinds of practitioners can be registered with Medicare and process Medicare rebates, however most private health insurance companies in Australia have some provision for mental health care cover as part of their ‘extras’ packages.

Where can I find help near me?

Our directory lists hundreds of psychotherapists, psychologists, counsellors and other therapists from around Australia. These mental health experts offer counselling over the phone and online in addition to one-on-one consultations. Many also offer workshops and seminars.

Enter your postcode or suburb into our search box to see a comprehensive list of the health care professionals near you.