How to combat seasonal affective disorder (SAD)

When the nights draw in and it becomes colder, it can be common for people to feel down. It’s the combination of being stuck inside, a lack of daylight and the undesirable weather that make the autumn and winter months mood-changing for many.

However, this seasonal change can cause more severe mental and emotional stress for some, and it can even have a negative impact on everyday life. 

Seasonal affective disorder (SAD)^[1] is commonly associated with low mood during the wintertime, but what is it? Is it a real disorder or just another name for the 'winter blues'? 

In this guide we're going to explore everything to do with seasonal affective disorder and what you can do to make those dark days a little bit brighter.

What is seasonal affective disorder (SAD) and is it real?

Seasonal affective disorder (also known as SAD) was first described as a mental health condition by Dr Norman E Rosenthal in a journal article in 1984 ^[2]. However, the Diagnostic Manual of Mental Disorders classed SAD as a type of depression rather than a unique mental illness.

SAD is a recurring, seasonal form of depression that people experience at the same time every year - most commonly in the winter months. Unlike the 'winter blues', it’s a lot more severe than just feeling a bit low.

SAD can be debilitating and cause a lack of energy, low mood and may prevent you from carrying out normal day-to-day activities. 

If you notice that you feel depressed at a similar time every year and it’s periodical, with long periods without depression, you may have seasonal affective disorder and you should seek advice from your GP.

How is seasonal affective disorder diagnosed?

As SAD can be similar to other types of depression, it can be a little tricky to diagnose, so it may take some time to identify if you have the condition. Your GP may ask you questions about:

• Your mood
• Your diet, sleep and lifestyle
• How your thought and behaviour changes during the year
• The severity of symptoms - how are they affecting your life?
• Family history of depression

The diagnostic criteria for seasonal affective disorder are symptoms of depression starting and ending within a specific season every year for at least two years, and not experiencing depression during other seasons.

It may be useful to keep a diary to track your mood and identify when your symptoms occur.

What does seasonal affective disorder feel like?

SAD has the same symptoms as depression, but rather than being present all of the time, you will experience them during a season. Symptoms of SAD include:

• Sleeping much more than usual
• Eating more than you normally do
• Frequently feeling 'low'
• Lack of interest in activities and hobbies you normally enjoy
• Low energy
• Lack of motivation
• Feeling hopeless or worthless
• Difficulty concentrating
• Social withdrawal
• Thoughts of death, harming yourself or suicide
• Reduced libido (sex drive)

SAD may affect your life by putting strains on your relationships due to isolating yourself, mood changes and a low sex drive.

You may also find it difficult to work due to difficulty concentrating and a lack of motivation. Seasonal affective disorder is commonly associated with feeling down and sluggish, but it can also make you feel anxious, irritable and stressed.

If you are frequently feeling stressed and anxious when struggling with SAD, you also may be more susceptible to tension headaches, as you may find it difficult to relax.

Why does seasonal affective disorder occur?

Since it was first formally described in the 1980s, there’s been quite a lot of research into SAD and how the condition is triggered.

One theory ^[3] is that the lack of sunlight could affect the body's hormones and chemicals in the brain. This change in hormones and chemicals could cause the hypothalamus (a structure in your brain which manages the balance of hormones) from working properly, which can disrupt your mood, sleep and appetite.

Another possible cause is the effect of a chemical called melatonin. Melatonin is a chemical that makes you feel sleepy and is produced by a small gland in the brain.

During the winter months some people create high levels of melatonin which can cause symptoms such as sleepiness and low energy levels that are associated with SAD.

Serotonin is a hormone that is commonly associated with depression, as low serotonin levels cause people to experience depressive symptoms.

Fewer hours of sunlight can cause less serotonin to be produced and therefore can cause seasonal affective disorder symptoms. Other causes that could potentially trigger them include:

• Circadian rhythm ^[4]: Your body uses light sources to time various bodily functions, so a lack of light in winter can disrupt this rhythm
• Genetic factors: A history of depression within your family could mean you are more likely to experience depression
• Childhood trauma
• Social factors, such as your relationships with your friends and family

Although SAD is commonly associated with winter it can, rarely, happen during other seasons, including summer. 

No matter when you experience these symptoms or whether you have noticed a pattern, you can seek help and advice from your GP to identify why you are experiencing depression and what treatments are available.

How to treat symptoms of seasonal affective disorder

There is no cure for SAD, but there are steps you can take to help manage your symptoms. The first step you can take is visiting your GP to discuss your symptoms and treatment.

It has been recommended by the National Institute for Clinical Excellence (NICE)^[5] to treat SAD in the same way as other types of depression. This means that treatments, such as antidepressants and talking therapies, can be used to help.

Common treatments for seasonal affective disorder include:

• Cognitive behavioural therapy (CBT) ^[6]
• Counselling ^[7]
• Antidepressants ^[8]
• Light therapy^[9]

What is the difference between cognitive behavioural therapy and counselling?

Cognitive behavioural therapy is a talking therapy that aims to change your thought processes and behaviour when faced with certain situations. 

It involves a number of sessions with a trained therapist who will talk through your symptoms and behaviour to create a programme to help you change your behaviour.

Counselling is another type of therapy that involves speaking to a trained counsellor about your problems and worries. It encourages you to open up about your feelings and emotions with the therapist who is there to listen and support your thoughts and concerns without judgement.

Unlike cognitive behavioural therapy, the aim is for you to gain a better understanding of your feelings and thought processes rather than a therapist telling you what to do.

The words 'therapy' and 'therapist' tend to conjure up mental images of sitting on a couch talking about your feelings whilst a person in a chair takes notes.

This can be the case in some circumstances, but technology and approaches to talking therapies have moved on and now therapy can take place in a variety of settings such as:

• 1-to-1 meetings face-to-face with a therapist
• Group meetings with other people who feel similarly to you
• Over the phone
• Online through live chats and websites
• Couples sessions if your symptoms are affecting your relationship

How can antidepressants help to manage SAD

Antidepressants are a type of medication that are used to manage depression symptoms and are also sometimes prescribed to treat severe symptoms of SAD.

The type of antidepressants that are usually prescribed by doctors for SAD are called selective serotonin reuptake inhibitors (SSRIs) ^[10].

They work by increasing levels of serotonin in the brain to lift your mood. However, they are not a magic tablet that can instantly make you feel better, as they can take between 4-6 weeks to take full effect.

It may also be recommended by your doctor to use a talking therapy, such as CBT, alongside using medication.

How does light therapy work?

Light therapy is a SAD treatment that has been used since the 1980s. It involves using a bright lamp (also known as SAD lamps, light boxes or daylight therapy lamps) which works by bringing more light into your environment during the day.

They come in different sizes and styles including desk lamps and bedside lamps.

SAD lamps tend to be around 20 times brighter than normal indoor lights and filter out harmful UV rays, so they are safe to use for most people.

It’s thought that light therapy works by simulating sunlight which encourages the brain to reduce the production of melatonin and increase the production of serotonin to prevent you from feeling sleepy and lift your mood.

Do SAD lamps actually work?

Although it’s a treatment that’s commonly associated with SAD, there is mixed evidence regarding the effectiveness of using SAD lamps. It’s based on the theory that a lack of light can affect the hormones and chemicals released in your brain.

It’s difficult to prove how effective SAD lamps are, but there is some evidence to suggest that they can work, especially when used first thing in the morning.

Don't suffer in silence

Mental illness can make life difficult. If you’re struggling with SAD or any other mental health condition, don't be afraid to speak to someone.

Whether it’s your GP, a counsellor, friend or family member, it’s so important to let somebody know how you feel so you don’t struggle alone. If you don't feel comfortable speaking to someone face-to-face or someone close to you, there are a range of helplines you can contact.

Samaritans helpline (available 24 hours a day, 365 days a year): call 116 123

Papyrus Hopeline (for those aged under 35 and struggling with suicidal thoughts): 0800 068 4141 (weekdays 10am-10pm, weekends 2pm-10pm and bank holidays 2pm–10pm)

Campaign Against Living Miserably (helpline for those who identify as male): 0800 58 58 58 (5pm–midnight every day)

Switchboard (helpline for those who identify as gay, lesbian, bisexual or transgender): 0300 330 0630 (10am–10pm every day)