SAD, depression and ways to cope

How Seasonal Affective Disorder (SAD) is different from other forms of depression – and how to cope with SAD in a pandemic as seasons change.

Seasonal Affective Disorder is a form of depression, but it is different to other forms in three distinct ways, says Priory consultant psychiatrist Dr Natasha Bijlani.

Dr Bijlani spoke ahead of the clocks changing later this month (October), and as preparations are made for a second ‘Covid’ winter. Dealing with SAD in the middle of a pandemic can seem like a double burden when someone is already feeling isolated, lonely and anxious.

Working from home, and Covid concerns, may well increase the depressive aspects of SAD as staying indoors and avoiding venturing outdoors limits our exposure to natural light, says Dr Bijlani.

And while many won’t welcome the idea of winter, snow (if it does come) can actually help, she says, because it has the effect of reflecting what natural light there is.

Dr Bijlani says the difference between SAD and other forms of depression are distinct: “You can usually predict its onset according to the seasons, patients report sensitivity to environmental light, and they respond favourably to bright light therapy.”

SAD is a mental health condition, which affects up to 9% of the British population – with women believed to be up to 4 times more likely to be affected than men. It can have a significant and detrimental impact on a person’s quality of life and is largely a problem in parts of the world where the body’s natural daily rhythm is disturbed by dawn and dusk getting closer together in winter.

In the UK, this effect can be exacerbated when the clocks go back on October 31.

Dr Bijlani, of Priory’s Roehampton Hospital in south-west London, says: “It is well recognised that SAD may be related to changes in the amount of daylight during autumn and winter months, which can affect the levels of serotonin and melatonin in the brain that influence mood.

“During the night, the brain releases melatonin which contributes to making us feel drowsy and induces sleep. At daybreak, the effect of bright light, coupled with the natural rhythms of the brain, suppresses melatonin. In those susceptible to SAD, not being exposed to sufficient light, on dull winter days, can lead to the development of the symptoms of SAD.”

Last year was a particularly gruelling winter, with national lockdowns enforced at Christmas and again in early 2021. Some of those already suffering with SAD saw their symptoms exacerbated, fuelled by an increase in feelings of uncertainty and less opportunities to get out in search of sparse daylight hours. Whilst working from home afforded some people more flexibility, social isolation, no necessity to travel and the lack of a normal routine may have triggered the condition in those who were predisposed to SAD, or made a pre-existing condition worse or harder to manage.

Dr Bijlani says:

• For some people with mild symptoms, these can be alleviated by working in more brightly-lit areas, and keeping blinds wide open during the day
• People with “SAD” sometimes need four hours a day of special bright light at 10 times the intensity of ordinary lighting. It’s a very simple treatment, but when used regularly throughout the winter months, it can take away the worst of the feelings
• Make time for exercise outdoors such as cycling or regular walks. Make sure you are exercising outdoors where you are able, and eat well – foods that are rich in a variety of vitamins are helpful in warding off symptoms of depression. Exercising produces endorphins in the brain (which stimulate feelings of happiness), so try to take a walk at lunchtime, play a sport with family – be active in a way which you enjoy
• Be sociable where you can, even if that means remotely. Planning evenings or an afternoon talking with a friend, even if on the phone or Zoom, can be a really good way to give structure to your day and avoid loneliness and negative thoughts or feelings
• Don’t sleep in too late. Staying in bed too long will limit your exposure to light and excessive sleeping actually contributes towards lethargy
• Psychological treatment focusing around cognitive behaviour therapy – a talking therapy – can also be helpful. Priory Connect is an online video therapy which can be accessed from home.
• If problems persist and you are concerned about symptoms of depression, talk to your GP or contact the Priory. Doctors may also prescribe selective serotonin reuptake inhibitors (SSRIs)

My Possible Self is a free mental health app, with information provided by Priory mental health experts, which is available here https://www.mypossibleself.com/