What is seasonal affective disorder (SAD)?

Seasonal affective disorder (SAD) is a type of depression that you experience during particular seasons or times of year. Depression is a low mood that lasts for a long time, and affects your everyday life.

If you have SAD, you’ll experience depression during some seasons in particular, or because of certain types of weather.

“It’s like having your own portable black cloud.”

It’s common to be affected by changing seasons and weather, or to have times of year when you feel more or less comfortable. For example, you might find that your mood or energy levels drop when it gets colder or warmer, or notice changes in your sleeping or eating patterns.

But if your feelings are interfering with your day to day life, it could be a sign that you have depression – and if they keep coming back at the same time of year, doctors might call this seasonal affective disorder or ‘seasonal depression’.

“In the weeks before the clocks go back I start to feel sluggish and down, it’s harder to keep to my morning routine of going out for a walk before breakfast because it’s wet, cold and dark.”

What are the symptoms of SAD?

If you have SAD, you might experience some of the signs and symptoms below. But it’s different for different people, and can vary season to season, so you might also have other kinds of feelings which aren’t listed here:

  • Lack of energy
  • Finding it hard to concentrate
  • Not wanting to see people
  • Sleep problems, such as sleeping more or less than usual, difficulty waking up, or difficulty falling or staying asleep
  • Feeling sad, low, tearful, guilty or hopeless
  • Changes in your appetite, for example feeling more hungry or wanting more snacks
  • Being more prone to physical health problems, such as colds, infections or other illnesses
  • Losing interest in sex or physical contact
  • Suicidal feelings
  • Other symptoms of depression

If you also have other mental health problems, you might find that things get worse at times when you’re affected by SAD.

“I just can’t stay awake and the thought of having to go out, stay awake, make conversation. I just can’t do it.”

When might I have SAD?

SAD can affect you during any season or time of year. Some people experience it in summer, although less research has been conducted on this so you might find people are more aware of winter SAD.

You don’t need to wait to see a pattern before seeking support – it’s ok to ask for help at any time.

Our pages on treatment for SAD, treatment for depression and seeking help for a mental health problem  have more information.

“I close the curtains in the evening and wish it was dark so I could go to bed early but it’s broad daylight. I need to sleep and withdraw again from the world.”

Experiences of facing stigma

Lots of people have heard of SAD and depression in general, but this doesn’t mean that they understand what it’s like or how you’re affected. It doesn’t mean you ‘just feel a bit sad’, and there are many factors that can cause depression – for some people it develops without there being a specific reason.

It can be frustrating and upsetting if people don’t understand this, but it’s important to remember that you are not alone.

See Mind’s page on stigma and misconceptions for lots of ideas on how to deal with stigma.

What causes SAD?

The exact causes of SAD aren’t clear. It seems that the things we know can cause depression in general can lead to SAD, and research has also suggested that there are a few things that could contribute to the development of SAD in particular.

Depression can vary a lot between different people and you might have SAD due to a combination of factors, or there might not seem to be any specific reason.

On this page you can find information about possible causes of SAD:

Your brain sets your body clock by the hours of daylight. One theory is that if you experience SAD, this part of your brain isn’t working in the same way. This could mean your body clock slows down, leading to tiredness and depression.

Some researchers think this is because your sleep pattern (also known as your ‘sleep phase’) starts at a different time. This is sometimes described as having a delayed sleep phase.

SAD is thought to be more common in countries where there are greater changes in the weather and daylight hours during different seasons, including England and Wales. People who live near the equator for part of their lives and then move further away may also be especially vulnerable to getting SAD.

“The evening is endless and I would watch the clock and feel trapped in the dark.”

When it’s dark, your brain produces a hormone called melatonin which helps your body get ready for sleep. Some people with SAD seem to produce much higher levels of melatonin during winter (which is also what happens to animals when they hibernate).

The exact relationship between melatonin and SAD isn’t clear. Researchers have found that if you have high levels of melatonin and you’re exposed to bright light, your melatonin levels drop to a more usual amount. But this doesn’t seem to help with symptoms of depression.

“When winter comes and I feel the change in the seasons, I feel more drained and find it very hard to motivate myself into getting dressed or out of bed.”

We all have different experiences of particular seasons and types of weather. You might feel particularly uncomfortable in hotter or colder temperatures, which could contribute to you developing depression (or any existing depression worsening) at those times.

While more people are aware of SAD happening in winter, some people have more difficulty in warmer weather. Some studies have suggested a possible link between higher temperatures and poor mental health, but more research is needed to understand why.

“Sunshine and heat make me feel defensive, misanthropic, angry, anxious, resentful, impatient and turn my thoughts inwards. I don’t want to see anyone, go anywhere or do anything. Even bright, low winter light depresses me. I feel under siege.”

Whether or not you have symptoms of SAD, there might be some occasions or times of year you find especially difficult – for example, due to upsetting memories of abuse, bereavement, money problems, housing problems, loneliness or other mental health problems that get worse at particular times of year. Occasions like Christmas can also be particularly stressful, whether or not you have SAD in winter.

Coping with SAD

SAD affects everyone differently, and finding the way to cope best may take some time. Below are some ideas for where to start in finding ways of coping with SAD.

If SAD affects you during winter, there are particular things you could try that might help. You could:

  • Make the most of natural light. It might help to spend time in natural light, for example going for walks, spending time in parks or gardens, or simply sitting near a window. This seems to be helpful if you experience SAD in winter.
  • Plan ahead for winter. For example, try to make meals in advance and freeze them if you know you are likely to lack the energy to do this during the most difficult period.

“I try to get some natural light during the day just by being outside, maybe tidying up the garden or taking my dog for a walk. Exercise in natural light is really helpful but is not always possible.”

If SAD affects you during hot weather, there are particular things you could try that might help. You could:

  • Drink plenty of water so that you stay hydrated. See Mind’s page on food and mood for more information.
  • Look for ways to get shade, such as wearing wide-brimmed hats or sunglasses.
  • Visit indoor places. Staying inside all the time could make you feel isolated. It could help to try doing activities indoors, like visiting your local library or going to the cinema.
  • Plan ahead for summer. For example, try to avoid going outside at the hottest times of day where possible.

“I feel calmer and more relaxed when I have had a bath or a shower – no matter how quickly I am in there for. The same can be said for doing the washing up – it is a massive chore but I feel good when I can see the end result and also I find it takes my mind off the negative.”

It can be hard to reach out when you’re not feeling well, but it might help to share how you’re feeling. If you don’t feel you can talk to the people around you or you need additional support, you could contact a helpline such as:

  • SANEline – support for people experiencing a mental health problem or supporting someone else. You can call them on 0300 304 7000 (4.30pm–10.30pm every day).
  • Campaign Against Living Miserably (CALM) – support for anyone who wants to talk. You can call them on 0800 58 58 58 (5pm–midnight every day) or use their webchat service.
    For more options, see our page on helplines and listening services. Mind’s Infoline can also help you find services that can support you.
  • Samaritans – open 24 hours a day, 365 days a year to listen to anything that’s upsetting you. You can call 116 123 (free from any phone), email jo@samaritans.org or visit some branches in person. You can also call the Welsh Language Line on 0300 123 3011 (7pm–11pm every day).

“SAD is like a cold blanket that keeps depression and anxiety wrapped close to me. When I feel I can, I go outside and face the sun, close my eyes and focus on the light and warmth.”

You might find it helps to keep a note of your symptoms, including when they start and if particular things seem to trigger them, including changes in the weather. This could help you notice any patterns.

You could also make a note of things that feel helpful for you or which seem to make things worse. This can be helpful because SAD affects you at some times and not others, so you might not easily remember these details.

“I keep a daily diary and it’s helpful to look back over the years and see how each year I’ve felt the downward spiral starting.”

If you’ve noticed your symptoms follow a pattern, you may be able to work out when they’re most likely to start in the future. This may help you put things in place for those times.

For example you could:

  • Try to re-arrange stressful activities or events for another time
  • Plan relaxing activities that might help improve your mood
  • Plan ahead, such as stocking up on things you need or preparing early for special occasions such as Christmas
  • Try to make more spare time to rest or do things you enjoy
  • Create a self-care box

Some people find it helpful to fill a box with things that comfort them or help them to relax. You could try including your favourite book or film, a notebook and pen to write down your thoughts or notes of encouragement to yourself. This can be a useful tool as it can be very difficult to come up with ideas to help you when you’re feeling low.

“December is dark but the festive lights and cheerfulness are an antidote and I now put up my Christmas decorations really early (1st Dec) as a way of coping with my SAD symptoms and stretching out the ‘fairy-light antidote’ for a whole month. However, when all the festive cheer has gone, I find January and February really tough.”

Peer support brings together people who have had similar experiences. Some people find this very helpful.

To find peer support, you could:

If you’re seeking peer support on the internet, it’s important to look after your online wellbeing. For more information see our pages on online mental health and peer support.

“I have a dawn simulator alarm clock which lights up gradually to fill my space in the bedroom with a glow.”

  • Manage stress. It can help to think of ways to manage pressure and build your emotional resilience. See Mind’s pages on how to manage stress for more information.
  • Try some relaxation techniques. Learning to relax can help you look after your wellbeing when you are feeling stressed, anxious or busy. See Mind’s pages on relaxation for tips you could try, or information on mindfulness.
  • Spend time in nature. Being outside in green space can help you feel more in touch with your surroundings. See Mind’s pages on nature and mental health for more information.

“I get up early, wrap up warm, put on my pedometer and walk in the dark and enjoy the solitude … By the time people are up and about, I’m back home having walked a good few miles and feel so much better for it.”

Looking after your physical health can make a difference to how you feel emotionally. For example, it can help to:

  • Get the right amount of quality sleep. For lots of people who experience depression, sleeping too little or too much can be a daily problem. Getting good sleep can help to improve your mood and increase your energy levels. See Mind’s pages on coping with sleep problems for tips to help.
  • Think about your diet. Eating regularly and keeping your blood sugar stable can make a difference to your mood and energy levels. See Mind’s pages on food and mood for more tips.
  • Engage in physical activity. If you find exercise a challenge remember that even gentle activities like yoga, swimming or walking can be a big boost to your mood. See Mind’s pages on physical activity for more information.
  • Look after your hygiene. When you’re experiencing depression, it’s easy for hygiene to not feel like a priority. But small things, like taking a shower and getting fully dressed whether or not you’re going out of the house, can make a big difference to how you feel.
  • Avoid drugs and alcohol. While you might want to use drugs or alcohol to cope with any difficult feelings, in the long run they can make you feel worse. See Mind’s pages on the mental health effects of recreational drugs and alcohol for more information.

“My eyes, skin, throat and muscles ache. I find it difficult to concentrate. I can’t take in information or think things through to organise properly and my short-term memory is unreliable at that time of year. Evenings come as a relief. I feel my muscles relaxing as the sun goes down.”

What treatments can help?

Whether or not your depression seems to be seasonal, it’s ok to ask for help at any time – you don’t need to wait to see if there’s a pattern.

How can I access treatment?

The first step is usually to visit your GP. If you’re given a diagnosis of SAD, this will be based on whether your symptoms repeatedly follow a seasonal pattern, usually for two or more years – it doesn’t depend on the specific season or time of year when you’re affected.

Mind’s guide on seeking help for a mental health problem has information about talking to your doctor about your mental health, including what might happen at the appointment and making your voice heard.

“I was well into adulthood before I began to recognise a pattern. Initially I noticed that I often took more sick leave from my job in the winter months.”

The National Institute for Health and Care Excellence (NICE) guidelines say you should be offered the same types of treatments for SAD as for other types of depression, including talking therapies and/or medication. This is because there isn’t currently enough evidence to show whether or not particular treatments help with SAD.

You can read the full guidelines on the NICE website, including recommendations on treating SAD. This information uses the term ‘seasonal depression’ to describe SAD.

There are many different talking therapies that can be effective in treating depression. Mind’s pages on treatment for depression and talking therapy and counselling have more information on these treatments, and information on how to access them – including through the NHS, charities or privately.

“My energy levels fluctuated between autumn/winter and spring/summer. I absolutely dreaded the onset of darker days and felt that I was literally shutting down.”

You might be offered an antidepressant, either on its own or in combination with talking therapy. This will most commonly be a selective serotonin reuptake inhibitor (SSRI).

Our pages on treatment for depression and antidepressants have more information.

“Antidepressants have helped to put me in a place where I was more able to cope with counselling. This required a lot of hard work and I had to accept a completely different way of thinking.”

Medication really helps some people but isn’t right for others. Before deciding to take any drug, it’s important to make sure you have all the facts you need to make an informed choice.

See Mind’s pages on things to consider before taking medication and your right to refuse medication for more information.

Mind’s pages on coming off medication give guidance on how to come off medication safely.

Some people say they find it helpful to use a light box – a device that gives off strong white or blue light – or a lamp, or an alarm clock that simulates dawn. This is sometimes called light therapy.

The NHS doesn’t provide light therapy because there is currently insufficient evidence to show it works, although some people find it helpful. More research needs to be done to establish whether it is effective and why some people find it helpful and others don’t.

Light therapy might not be suitable for you if you’re also taking St John’s wort, as St John’s wort can make your skin more sensitive to light.

If you decide to try using a light box or lamp, you may wish to discuss this with your doctor who can advise on whether it’s suitable for you to try. If you have existing eye problems or you use a light box regularly, it’s also advisable to talk to an optician and to have regular eye check-ups.

“Using a light box wasn’t perfect but the change was tangible… a real shift and I began to cope better with the dark days and didn’t have the all encompassing desire to get back into bed and stay there.”

You might also decide to try other treatments alongside, or instead of, talking therapies or medication. These might include:

Your doctor may be able to refer you to some of these. You can also contact your local Mind to find out what they have available.

“I approached my GP and reported my symptoms but, as my antidepressant was increased, this just added another degree of sedation.”

What if I don’t feel better?

Your doctor should offer you regular appointments to check how you’re doing, and see how well any treatment is working for you. Different things work for different people, and if a particular medication or talking therapy doesn’t work for you, your doctor should be able to offer an alternative.

If you’ve tried a range of treatments and none of them have helped, your doctor might refer you for further support, for example from a community mental health team (CMHT).

For more suggestions, see our pages on seeking help for a mental health problem.

How can other people help?

If you are supporting a friend or relative who is experiencing SAD it can be hard to know what you can do to help. The following section has some suggestions of things you could try while also looking after your own wellbeing.

Lots of people can find it hard to open up about how they’re feeling. One of the most important things you can do is let the person you’re worried about know that you care and that it’s ok to talk about what they’re experiencing.

Supporting your friend or loved one to seek help can be really important. It can help to remind them that SAD is a recognised condition like many others and that they deserve help and support.

You can read Mind’s information on treatment and self-care, and encourage them to seek help from their GP. See our pages on how to support someone else to seek help for more information.

“I can see my family members with winter depression SAD shutting down through autumn, until in winter they are prone to afternoon naps, shutting themselves away alone in a room, and a lack of interest in anything.”

If you’ve not experienced SAD yourself, it can be hard to understand why your friend or family member can’t just ‘snap out of it’. Try not to blame them or put pressure on them to get better straight away – they are probably being very critical and harsh towards themselves already.

It’s common to describe certain types of weather as being good or bad, for example talking about ‘good weather’ or describing rainy days as ‘dreary’ or ‘miserable’. This could make someone with SAD feel criticised or alone, so it might really help if you consider how you talk about different types of weather.

“Their self-esteem is very low in the winter months, particularly November and December as the days get shorter.”

SAD can affect people in different ways, so it’s important to ask what things they would find most helpful, and what has or hasn’t helped them in the past. They may just want your emotional support or there may be specific practical things you could do that could help them cope.

Everyone will need different support, and the form this takes can change over time, so talk to your friend or family member about what help they might find useful and what they feel able to do themselves.

“I try and recruit my partner in making the main meal a couple of times a week and freeze leftovers to reduce pressure.”

If you have some idea when their symptoms are likely to start, you may want to plan things in advance that might help. For example, you could schedule time to offer practical help, plan activities to help them relax or just make sure people will be around to offer support.

It may also help to avoid planning any activities during that time that they might find particularly difficult, and to talk together about what demands they can cope with – for example, you might decide to avoid having guests during difficult times.

“I try to encourage my winter suffering family members to think ahead and get helpful things organised for during their difficult time (counselling, light boxes, planned events to look forward to etc) before winter starts, while they still have the energy and ability to do so.”

SAD can cause people to feel very isolated, for example if they don’t feel up to joining in with social activities or they struggle to find things they can do during difficult times.

It could help to suggest things they might find easier to do – for example, in the case of someone who feels worse in hot sunshine, doing indoor activities like watching a film together.

“I try to encourage them to get out of the house during daylight hours. They can forget that anything like that can be helpful.”

It can sometimes be really challenging to support someone, and it’s common to feel overwhelmed at times. It’s important to look after your own mental health too. For example:

  • Set boundaries and don’t take too much on. It is important to decide what your limits are and how much you are able to help them. If you become unwell yourself you won’t be able to offer as much support. See Mind’s pages on how to manage stress for more information.
  • Share your caring role with others, if you can. It’s often easier to support someone if you’re not doing it alone.
  • Talk to others about how you’re feeling. You may want to be careful about how much information you share about the person you’re supporting, but talking about your own feelings with someone you trust can help you feel supported too.
  • Find support for yourself. The organisations in useful contacts are there to support you too. It could also help to explore peer support and talking treatments.

“I found that as the day went on I would literally want to get into bed… it was an absolute struggle to stay up and be sociable just with my family and often I lost the battle.”

Resources

Useful Contacts

Mind

  • Mind’s helplines provide information and support by phone and email.
  • Local Minds offer face-to-face services across England and Wales. These services include talking therapies, peer support and advocacy.
  • Side by Side is our supportive online community for anyone experiencing a mental health problem.

Campaign Against Living Miserably (CALM)

Tel: 0800 58 58 58
thecalmzone.net
Provides listening services, information and support for anyone who needs to talk, including a web chat.

Depression UK

Depressionuk.org
Depression self-help organisation made up of individuals and local groups.

National Institute for Health and Care Excellence (NICE)

Nice.org.uk
Produces guidelines on best practice in healthcare.

NHS UK

Seasonal Affective Disorder (Overview) – NHS.uk
Information about health problems and treatments, including details of local NHS services in England.

Rethink Mental Illness

Tel: 0808 801 0525
Rethink.org
Provides support and information for anyone affected by mental health problems, including local support groups.

Samaritans

Tel: 116 123 (freephone)
Samaritans.org

Samaritans are open 24/7 for anyone who needs to talk. You can visit some Samaritans branches in person. Samaritans also have a Welsh Language Line on 0808 164 0123 (7pm–11pm every day).

Sane

Sane.org.uk
Offers emotional support and information for anyone affected by mental health problems.

Article Source: Mind UK.

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