Tips for managing Seasonal Affective Disorder (SAD)

What is Seasonal Affective Disorder?

Seasonal Affective Disorder is a subtype of depression that recurs every year during the same season, usually around late autumn or winter, and which resolves later in the year when the seasons change. While many people can be prone to feeling a bit lower for some part of the winter, those who suffer from SAD have full blown symptoms of depression and also feel this way for typically about 4 months.

There is a subtype of SAD called ‘sub-syndromal SAD’ where the symptoms and duration may both be less severe although still be bad enough to make life difficult¹. This is also sometimes referred to as ‘winter blues’.

What are the symptoms of SAD?

The main symptoms of Seasonal Affective Disorder include:

• Depression
• Sleeping excessively with difficulty waking up in the morning
• Lethargy
• Increased appetite (in particular, craving carbs) and weight gain
• Irritability
• Reduced enjoyment of and interest in hobbies
• Guilt and feelings of worthlessness
• Withdrawing from friends and family
• Loss of libido

What are some tips for managing SAD?

While we don’t know exactly why SAD happens, the main theories involve the knock-on effects of low sunlight exposure on hormones that regulate sleep (melatonin) and mood (serotonin)². These tips help by addressing either the underlying lack of sunlight exposure, the effects it has on the other two hormones, or the depressive symptoms themselves.

Spending time outdoors

This may seem like a very simple solution, but it can be effective. By deliberately spending more time outdoors during daylight hours, you can increase the effect that even the weaker, winter sun has on your body, thereby avoiding or minimising the disruptions in production of melatonin and serotonin.

Light box

For those unable to spend time outside, treatment with a light box is another possible option that has been extensively researched^3,4. While there are different types of devices available, they all generally involve having indirect exposure of one’s eyes to light from a light box for a specified duration in the morning.

Light alarm

This is a special type of alarm clock that shines a light which becomes steadily brighter in the last 30 minutes or so of sleep. There is some evidence that it can help people feel less groggy and more alert in the mornings, and potentially feel as though they’ve had a better night’s sleep⁵. If your symptoms of SAD include excessive sleeping, difficulty getting up in the morning or lethargy, this may be a helpful tool for you.

Exercise

Exercise is one of the NHS-recommended lifestyle treatment for SAD⁶. There is evidence that it can be effective at reducing depressive symptoms compared to not exercising, for both people with seasonal and also those with non-seasonal (as in, typically year-round) depression⁷.

Diet

Interestingly, there is some low-level evidence from a small trial that both avoiding caffeine and avoiding sugar may help reduce symptoms of depression for certain groups of people⁸. There is also some evidence that certain B Vitamins (especially folate), and Vitamins D and E may be effective in improving depression⁸.

Medication

Taking medication during the winter season to boost your serotonin levels can be really helpful. There are different medication options available but the most commonly used type for SAD is SSRIs (selective serotonin reuptake inhibitors), such as fluoxetine and sertraline. These work by increasing the effectiveness of the serotonin that is already present in your brain. It is important to be assessed by a qualified medical doctor who can then prescribe this if appropriate as there are certain cases where it shouldn’t be used. Usually, this type of medication is prescribed by an NHS GP. If you have questions about whether or not this might be a good option for you, we’d be more than happy to talk through things with you.

Therapy

There is strong evidence that Cognitive Behavioural Therapy can not only help reduce symptoms of SAD in the short term, but it can also help to reduce the chances of relapse the following year².

Next steps

If you think you may have Seasonal Affective Disorder, it is generally a good idea to speak to a doctor before self-diagnosing. Sometimes other conditions can mimic SAD, such as an underactive thyroid disorder, or low Vitamin D. Getting some tests done looking at these conditions (amongst others) may be useful. These are tests that we can arrange here at CheckUp Health, or of course you can also speak to your NHS GP about this.

If you are experiencing severe low mood and are having thoughts of wanting to harm yourself or commit suicide, please reach out and speak to someone now. You can call 111 or your NHS GP, or you can also contact the Samaritans on their 24-hour helpline, 116 123, or visit samaritans.org. For more information about other options for urgent mental health support near you, please go to https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/.

Download the CheckUp Health app now and book a video or audio call with a private GP, daytime or evening, 7 days/week. Take control of your health.

References

1. https://patient.info/mental-health/seasonal-affective-disorder-leaflet
2. Management of seasonal affective disorder BMJ 2010; 340 :c2135 https://doi.org/10.1136/bmj.c2135
3. Nussbaumer-Streit B, Forneris CA, Morgan LC, Van Noord MG, Gaynes BN, Greenblatt A, Wipplinger J, Lux LJ, Winkler D, Gartlehner G. Light therapy for preventing seasonal affective disorder. Cochrane Database Syst Rev. 2019 Mar 18;3(3):CD011269. doi: 10.1002/14651858.CD011269.pub3. PMID: 30883670; PMCID: PMC6422319. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011269.pub3/full
4. Pail G, Huf W, Pjrek E, Winkler D, Willeit M, Praschak-Rieder N, Kasper S. Bright light therapy in the treatment of mood disorders. Neuropsychobiology. 2011;64(3):152-62. doi: 10.1159/000328950. Epub 2011 Jul 29. PMID: 21811085. https://www.karger.com/Article/Pdf/328950
5. Thompson, A., Jones, H., Gregson, W. et al. Effects of dawn simulation on markers of sleep inertia and post-waking performance in humans. Eur J Appl Physiol 114, 1049–1056 (2014). https://doi.org/10.1007/s00421-014-2831-z
6. https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/treatment/
7. Pinchasov BB, Shurgaja AM, Grischin OV, Putilov AA. Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light. Psychiatry Res. 2000 Apr 24;94(1):29-42. doi: 10.1016/s0165-1781(00)00138-4. PMID: 10788675.
8. Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help treatments for depression. MJA 2002;176:S84-96 https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.2002.tb04508.x