Do you find yourself feeling down and drained in winter? If so, you could be experiencing Seasonal Affective Disorder, a mental health condition appearing in the winter and typically lasting until the spring.

Seasonal Affective Disorder (SAD) affects around 2 million people in the UK, and symptoms can last for up to 40 per cent of the year. During the winter and autumn months, many of us experience emotional and physical changes. These can include:

• Feeling sad, tearful, anxious, irritable, or agitated
• Difficulty concentrating
• A lack of energy
• Less interest in hobbies, work and relationships
• Not wanting to see people
• Wanting to eat more, especially ‘treat’ foods
• Weight gain
• Less commonly, appetite loss and weight loss
• Fatigue and brain fog

If this sounds familiar to you, you might be experiencing SAD. Although the condition can be distressing, simple measures can help improve symptoms. Your GP can help you determine if you have SAD, depression, or another condition. You might like to try calling the free Samaritans Mental Health line on 116 123. They can support you with any aspect of mental health, and no problem is too big or small. If your symptoms are severe, having a big impact on your life, or you are having thoughts of self-harm or suicide, contact your GP. If you need urgent help, call NHS 111, or 999 in an emergency.

Why Do I Have SAD?

Scientists do not fully understand what causes SAD. There do seem to be some things people with SAD have in common, although not everyone with SAD has all of them. Some features are:

• People with SAD may lack serotonin. This neurotransmitter works in the brain to help regulate mood.

Sunlight helps control serotonin levels, but in those with SAD, their body is too sensitive to the lack of sunlight in winter, causing serotonin levels to drop too low.

• People with SAD may also produce too much melatonin. This hormone maintains our sleep-wake cycle and causes us to feel sleepy at night. Too much melatonin can increase sleepiness and fatigue.

The sleep-wake cycle naturally changes with the seasons. For instance, you probably go to bed later and wake up earlier in summer because it is lighter. In people with SAD, problems with melatonin levels disrupt this normal daily cycle, and your body cannot adjust to the seasonal changes in day length, leading to sleep changes and fatigue in winter.

• People with SAD may lack vitamin D, which is made by our bodies when we are exposed to sunlight.

Because we don’t often get a lot of sun in the UK, and spending too much time in sunlight is not healthy, vitamin D deficits are common, especially during winter. Vitamin D deficiency can exacerbate the above problems, because vitamin D helps promote serotonin activity. Low levels of vitamin D are believed to cause low levels of serotonin and low mood.

• Negative thoughts and feelings about winter are common among people with SAD. It is unclear whether they ’cause’ SAD, or are an effect of ‘SAD’.

Most people with SAD hold negative feelings about winter. They may dread winter and feel winter is inherently unpleasant. Having ingrained negative thoughts about winter can make this time of year difficult as you expect it to be a depressing time of year.

How Is SAD Treated?

There are several effective treatments for managing SAD. Many of these treatments are also used in treating depression. Your GP can suggest treatments that are most suitable for you, although you can try light therapy and vitamin D supplements yourself for milder cases of SAD.

Light Therapy

Light therapy has been recognised as a treatment for SAD since the 1980s. You sit in front of a special light box each day for around 30-45 minutes each morning, from autumn to spring. The light makes up for the lack of sunshine in the darker months and can help ease your SAD symptoms.

The light box will filter out harmful UV light, so there is no risk of skin damage. It is a safe treatment for most people, and many find it extremely helpful. They are convenient to use and can be taken with you when travelling. The light boxes range in price, starting at around £20, and can easily be bought online. To make sure your light box will be bright enough to help, check the brightness is 10,000 lux or above. It should say on the box. You can find more information on light boxes here, alongside reviews.

Light boxes are safe for most people. However, people with eye diseases, or an increased sensitivity to sunlight (which can be caused by some medications), should seek medical advice first.

Vitamin D Supplements

People with SAD often have vitamin D deficiencies. Nutritional supplements of vitamin D can help improve symptoms. You can take a supplement from spring to autumn to boost your levels, which may relieve symptoms such as low mood and fatigue.

Although many people find vitamin D helps their symptoms, there is conflicting evidence on its effectiveness. Some studies have found vitamin D to be effective in treating SAD, but some results have suggested it does not help. Even so, taking vitamin D supplements in winter is likely to benefit other aspects of your health, and vitamin D deficiency has been linked to bone weakness. The NHS advises everybody to take a vitamin D supplement in the autumn and winter.

Vitamin D tablets are affordable and can be found in any supermarket, or online. They are around £2.30 for 90 tablets, which will last three months. Make sure you read the label carefully before taking supplements, as taking too much vitamin D over a long period of time can damage bones and organs. Vitamin D supplements are generally very safe and have no side effects. However, some medical conditions might mean you need a lower dose of vitamin D. Some medications may interact with supplements. Ask your GP or pharmacist for advice.

Antidepressants

SAD, like other forms of depression, is associated with disturbances in serotonin levels and activity. Antidepressant medications can help regulate serotonin, reducing feelings of depression and enhancing mood. A certain type of antidepressant, called SSRIs, are most often prescribed. They can be taken from autumn to spring to keep SAD symptoms at bay, and may be prescribed for more severe symptoms of SAD, and cases where trying light therapy has not worked.

There are many different types of SSRIs. Your healthcare professional will help you find the best one for you- you might need to try a few different ones until you find one that works well for you and does not cause side effects. They are generally safe if taken according to your doctor’s instructions, but you should watch out for side effects like tiredness and dizziness, which might make driving and operating machinery dangerous. Often, side effects are short-lived and get better after a few weeks. Some medications and conditions can interact with antidepressants, so make sure your physician knows about your health history.

Psychotherapy/’Talking Therapy’

Cognitive Behaviour Therapy (CBT) is a type of talking therapy aimed at helping people cope with difficult thoughts and situations. It is based on the idea that the way we think affects the way we feel. CBT has been used to help treat people with SAD. It is often conducted in sessions lasting 30-60 minutes (either individually or in a group), twice a week for six weeks. It focusses on replacing negative thoughts about winter (eg ‘winter is dark and makes me feel sad’) with more positive thoughts. When used for SAD, your CBT practitioner will also help you to identify and schedule pleasant activities, to help you feel more positive about winter.

CBT is very effective for improving symptoms of SAD, and depression in general. It is as effective as light box treatment, although CBT takes a little longer to work. Interestingly, the positive effects of CBT seem to last longer than the effects of light box therapy, so you likely will not need CBT each year. You will be able to draw on what you have learnt in the sessions and apply them to your everyday life whenever needed. Although CBT is most often performed by a professional, you can also use self-help books and online resources to learn how to apply it, so there is something to suit everyone, even if you are feel nervous seeing a therapist or counsellor.

Your GP can refer you for CBT therapy, or you can self refer here. CBT is free with the NHS, although waiting times can be long. You can seek private treatment, or check if your workplace, school or university offers CBT. Many will offer a mental health support service, and you can access CBT through them.

People experiencing low mood and anxiety can contact Guideposts’ Emotional Wellbeing Coaching service here. We can offer 1-to-1 telephone support sessions to help you manage these emotions.

Can I Prevent SAD?

SAD symptoms occur predictably at the same time each year, so many people wonder if they can start treatment in advance to prevent symptoms. You might wonder if starting light therapy or other treatments before the onset of autumn will stop your SAD symptoms developing.

However, there have been very few studies to research this. Of these studies, none have found evidence that starting light therapy or psychotherapy ahead of time can prevent the onset of symptoms. One type of antidepressant has been shown to prevent the onset of SAD, although this was associated with side effects.

Overall, SAD is very treatable, and most people will find a treatment that suits them. SAD is common, and it is possible that many people have SAD but simply assume their symptoms are normal. They may not realise that feeling down during the winter is avoidable, or that treatment is available. There are a variety of factors that seem to cause SAD, although not everybody will have all these factors. Remember to seek professional support if your symptoms are severe.