'Let there be light'

Winter can be a difficult time of year. It's cold and days are short, and heading off to work when it's still dark and returning home again in darkness doesn't help either. Thankfully there are things that help provide lighter moments and bring a smile to our face – Christmas decorations, carol concerts, parties, getting together with friends, and with family, well, usually that brings smiles – and other seasonal activities. Sometimes it's the excitement of an upcoming holiday, or just having a few days off that does the trick. When seasonal affective disorder (SAD) is around, however, even the good things struggle to raise a smile.

For an estimated one in fifty people in the UK winter is made harder because of SAD, a type of depression with a seasonal pattern, the commonest and most well-known being winter depression. Key to diagnosing SAD is its seasonal nature, and this is why it can take few years before someone is diagnosed and able to treat their SAD. Women are more likely to have SAD than men, and it's in the late teens, twenties and thirties that SAD usually first appears.

I remember a few years ago one of my patients with SAD coming to see me in advance of the winter, because she knew when her symptoms would start each year and liked to be prepared. She joked with me saying how she wasn't sure which she wanted this year – to comfort eat and sleep lots, or to take the antidepressants that work for her. Her symptoms included over-eating and over-sleeping which on the face of it she smiled wouldn't be such as bad thing if it didn't leave her more tired, with no energy, and having piled on the pounds, the knock-on effect being she felt more lethargic, down and miserable – a common scenario for those with SAD who may experience other symptoms too.

Possible symptoms of SAD:
Depressed mood and mood swings
Irritability
Tearfulness
Tiredness
Lack of energy
Lethargy
Reduced or increased sleep
Reduced or increased appetite
Anxiety
Loss of libido
Social contact avoidance

Light seems to be at the root of SAD, or rather a lack of it, which is why SAD becomes more likely the further a person lives from the Equator. Light stimulates a part of the brain called the hypothalamus, which helps to control sleep, appetite and mood. A lack of light upsets this control, and also causes more melatonin hormone – the hormone that makes us feel tired and ready for sleep – and less serotonin hormone, the 'feel happy' hormone, to be produced.

There are no prizes – apart from feeling your normal self again - for guessing that light therapy is one effective treatment for SAD. It involves sitting in front of an artificial light source which is at least five to ten times brighter than ordinary household bulbs. How long a person needs to sit in front of the light depends on its intensity. It's still possible to continue with other activities, for example reading, whilst using the light.

It's a good idea to make the most of daylight hours by spending time outdoors, especially if this involves being active since exercise releases endorphins, the body's feel-good chemicals. When indoors it's helpful to keep the environment well-lit and to sit near a window. The herb St John's Wort can also help successfully overcome SAD, as can talking-therapies and conventional antidepressants.

There's no need to feel embarrassed, ashamed, or guilty about feeling low during the winter months. SAD is a recognised health problem, and most importantly it can be effectively treated so someone can, in the words of my patient, 'be my normal self again'.

If you have any niggling health questions and would like to get in touch, then please drop me an email on DrRobHicks@aol.com
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