‘Tis the season to be aware of SAD

Dr Anne Kehoe is a senior clinical psychologist and a chartered member of the Psychological Society of Ireland (PSI). Here she gives some timely information and advice about low mood in winter and Seasonal Affective Disorder (SAD).

In the past what we now describe as Seasonal Affective Disorder would have been known as the winter blues. Nowadays, when people refer to the winter blues they are often referring to a dip in mood that can occur in winter rather than the depressive levels of difficulty which can occur around seasonal change.

I think it’s particularly hard this year because people have had almost two years where they are more likely to have been isolated and less connected from a community perspective; and communities are often how we get through our difficult winters.

People often look forward so much to the Christmas period because what it represents is that connection to people you love; being together, fun, warmth, nice food. It’s a real marker to the winter to get us through that darker colder time.

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So the pandemic has been tricky. Celebrating things like Christmas brings a real connection, And that has been challenged, certainly last year anyway. So I think people are depleted even coming into this winter. It is difficult for anybody, never mind if you are struggling. It’s very challenging to see our way through all this. So the symptoms of seasonal change for people with SAD will be even more challenging.

SAD is a sub-type of depression. It is very similar to depression as we classically know it but it has a specifier or qualifier which is that it has a seasonal pattern. For example, people would notice key changes coming into winter or coming into spring. Diagnosing SAD you would be looking for a pattern. You’d be looking at the same criteria as depression but with a seasonal pattern for over two years.

Poor sleep

As the seasons change you could notice what we traditionally would see as the classic symptoms of depression such as: hopelessness, feeling worthless, withdrawing from people around you, feeling less energy, sometimes feeling agitated, poor sleep, appetite problems and anxiety.

Research suggests that there is a connection between the amount of daylight we get and SAD. If you look at a country like the USA, the rates of SAD will be much lower in Florida when compared to Alaska, where they have much less sunlight all year round. I've read supplementing with Vitamin D is recommended.

Seasonal changes cause a disruption in the sleep wake cycle, the circadian rhythm. Sunlight can play a role in the production of melatonin and serotonin, and some people are more sensitive to that.

Some changes in mood are very common around shortening days with less sunlight –nobody wants to really get up when it’s pitch dark out. However, if those symptoms are affecting your life to a degree that you think, “this is a thing”; and if it lasts a significant amount of time with that seasonal pattern, it’s good to seek advice. If you aren’t sure go to your GP and talk about it. Because sometimes people don’t know a lot about SAD and they might dismiss it, but it’s important to seek advice.

There are some very basic things that all of us should be doing in winter to help us survive what can be quite a dark time, like getting more sunlight, getting outdoors. Spending time outdoors in the daylight is very important. Communities far north like Finland will have much more of a culture of taking a winter vacation. It's a common practice to take a vacation to the sun. However, that's not always possible for people. Other people might use light therapy.

Be active whenever possible. Some people will need to really focus on ensuring a healthy diet and exercise because as often happens with depression you might not be motivated to do those things. But actually they might need specific attention.

And if that’s enough, that’s great. But you might need more because it’s very difficult to feel depressed. And it can be very confusing in particular to feel very depressed or very anxious around spring and summer because that’s not what people expect you to feel.

Talk therapy

Talk with your GP about what is needed. As with depression, if medication is seen as the right intervention it can be appropriate. Sometimes that’s enough, but often people might want a psychological therapy.

Talk therapy can be very important if someone is suffering from depression-like symptoms. So if you are withdrawn, feeling worthless, not sleeping or eating, or feeling agitated you may want talk therapy as a support to get you through that time.

It’s just so important not to be on your own with this. SAD is very real. It can have a huge impact on people’s lives. We are often shy to seek this kind of help, so start by talking to somebody that you know and trust. Get their perspective, see if they can help even in practical ways.

Connecting with others is good for our mood, knowing that those around us understand how we feel, and even if they don’t fully understand that they want to help, and that we are not alone in our feelings is so important.

Friends and family may not know exactly how best to help so try to tell them the practical things that they can do. Give them specific instructions about what does actually help and what doesn’t. People may have no idea what they are saying isn’t helpful or the simple little things they can do that will be helpful.

People may not be going to their GP with SAD symptoms because they don’t want to cause a fuss; things have been so stressful in healthcare for the last while. But do go to your GP. Go to your psychologist. Seek support.

There are things you can do about it, things that can help you get through this.