Written by Dr. Mark Winwood
Dr Mark Winwood is a leading figure in the mental health field and AXA Health’s Consultant Psychologist.
Do you feel low during the winter months? You’re not alone. In fact many of us feel the winter blues. For some of us, however, the symptoms are more persistent and more serious. This persistent sadness and exhaustion associated with seasonal changes has been recognised as a diagnosable type of depression, called Seasonal Affective Disorder (SAD). According to the Royal College of Psychiatrists, approximately 3% of us will be so seriously affected by SAD that it will interfere with our everyday lives.
Symptoms can start as early as August and are at their worst from November to February, usually resolving by April. SAD can be caused by a lack of light during winter when days are shorter with less sunshine, and the sun is not as bright. However, other conditions which reduce light levels can bring on the symptoms of SAD at any time of the year, for example, prolonged periods of dull weather in summer, or low levels of light at home or at work.
Dr Mark Winwood, Clinical Lead for Mental Health Services at AXA Health answers your questions about SAD, how to recognise the symptoms and some of the things you can do to boost your mood during the winter.
Q. Over the past few weeks I have been tired and emotional a lot more than usual. I think it is down to the weather and the dark mornings. What can I do?
Many people feel that they suffer with loss of energy and feel more emotional during the winter months. However, there are many things that we can do to help with this – a few ideas are:
- Exercise – it can be hard to feel motivated to keep active as the nights draw in but just 20 minutes of brisk walking, jogging, cycling or housework that raises your heartrate can really help you feel more energetic and happier.
- Get daylight – natural daylight supports our circadian rhythm and help us sleep at night. So even if you seem to go to work when it’s dark and go home when it’s dark – get out in the lunch hour – even better use it as a time to do your daily exercise.
- Sleep – get plenty of good quality sleep – it essential for positive mental and physical wellbeing. Cut down on stimulants such as caffeine and alcohol as they can disrupt our body clocks and impact the quality of our sleep.
- Stay connected – make dates for social time with friends and family – always have something to look forward to.
- Explore your stress triggers – write them down and share with a close friend. Maybe you can look at these experiences in a different way.
- Eat well – you may feel like eating lots of comfort food – these tend to be high in processed sugars which impact your energy and your mood. Remember your 5 a day and get loads of fresh fruit and veg.
- Hydrate yourself – water can really help.
- If your symptoms persist or get worse please go to see your GP who may recommend a course of treatment to help. Talking therapies and practical solutions such as light- boxes are among the options available.
Q. I often feel down on dark/dreary days... I've heard a lightbox could help. Is this true? Also why does it cause me to feel low when the weather is worse?
Light boxes (which simulate sunshine) have been shown to be effective in over 80% of diagnosed cases of SAD. Most modern light boxes emit an intensity of 10,000 lux and treatment will take 30 mins – 1 hour a day. By way of comparison, the intensity of a bright summer day can be 100,000 lux. Treatment usually starts to work within 3 to 4 days.
But before you go down this route it’s worth trying out some the suggestions in the answer above. Not only are they free but they’ll help boost your mood and improve your overall wellbeing while you’re at it!
The NHS also recommends:
- Lifestyle changes – Try to get as much daylight as possible, exercise, and try to manage stress.
- Cognitive Behavioural Therapy (CBT)
- Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs)
In answer to the second part of your question, there are lots of reasons why we might feel low in the winter, but it could be a simple lack of daylight. We now live much more of our lives indoors and so see less sunlight than we may have done in the past. It is thought that a lack of such light affects how serotonin (an important neuro-chemical) works in the brain and that this can make us more likely to become depressed.
Q. Other than the sun what are good sources of serotonin?
Other good ways of helping your body to stimulate serotonin production are exercise and good diet. This means pushing away the leftover cake and eating sensible carbs to stimulate serotonin. Sweets and simple carbs, like white rice and white bread, quickly raise blood sugar, flood you with insulin, and then you tend to feel low. Eating wisely also means watching the caffeine, which suppresses serotonin.
The foods to have on hand if you tend to feel low in winter include:
- Oatmeal (original)
- Egg whites for omelettes
- Peanut butter
- Prewashed veggies
- Whole grain crackers and bread
- Lean turkey/chicken
- Cottage cheese
Q. Most people seem to be affected by the cold/winter... Can SAD be triggered by the heat/summer? I tend to get hot and bothered a lot, and I'm never so happy to see the sun arrive.
SAD is typically used to describe feelings of depression as the days get shorter and colder. But some people get reverse symptoms – the onset of summer triggers their depression symptoms. This usually happens for individuals who live closer to the equator. Symptoms of summer depression (which is also categorised as SAD) include loss of appetite, trouble sleeping, weight loss, and anxiety.
There are a number of reasons this may happen, such as schedule changes (having a routine is a good way of managing your mood – in the summer months this can be ambushed by kids holidays etc...), body-image issues (summer clothes are more revealing), financial concerns (the expense of holidays etc..) or just because you find the heat oppressive.
So to answer your question 'yes' SAD can happen in the winter and summer!
Q. What are the symptoms of SAD and how do they differ from depression?
SAD is a type of depression with a particular pattern – it starts and stops regularly with the seasons each year. It is sometimes known as recurrent winter depression because the symptoms are typically more apparent and tend to be more severe during the winter.(although as we’ve seen this isn’t always the case). SAD is classified as a diagnosable depressive disorder.
Most of the symptoms of SAD are the same as those of non-seasonal depression. These include:
- A persistent low mood
- Lack of energy
- Loss of pleasure or interest in normal everyday activities
- Feelings of despair, guilt and worthlessness
- Seeing other people less
- Less interest in sex.
But the symptoms of SAD are slightly different. In non-seasonal depression, people commonly (but not always) sleep less and eat less. In SAD, they usually sleep more and eat more.
If you have SAD, you may find it very difficult to wake up in the morning and can often feel sleepy during the day. You may crave chocolate and high carbohydrate foods, such as white bread or sugary foods. If you have SAD, you probably won't be doing as much physically, so it's easy to put on weight. Finally, unlike other forms of depression symptoms subside when the season changes.
For some people, these symptoms can be severe and have a significant impact on their day-to-day activities.
There are number of things you can do to try and improve your mood and energy levels (see answer above), but if the feelings persist or get worse as winter develops please visit your GP to discuss possible treatments and support.
Q. Are there any known links between comfort eating and SAD – are people more likely to eat more if they're spending more time indoors/feeling depressed?
One of the most common symptoms of SAD is eating more and usually foods that are high in processed carbohydrates. There’s additional likelihood for weight gain because people tend to stay inside more when it is dark and the weather is bad. They also tend to be less active and do less exercise.
I would certainly recommend increasing outdoor exercise, particularly during day-light hours. Also eat plenty of fresh vegetables and high protein foods which can help boost your resistance to low mood during the winter months.
Q. I love going for runs and staying physically active but in the winter months it is such a drag. Do you have any tips for working out inside in the warm during the winter months?
It’s hard to feel motivated to go outside and exercise in the winter. However there are many advantages of doing so, especially if you can get outside in daylight. Access to daylight in the winter months can be beneficial for both your physical and mental health. It has also been demonstrated that there is wellbeing advantage of just being outside in the fresh air with access to nature. Individuals who regularly access green spaces or environments close to water report higher levels of wellbeing.
However, if going outside is not possible, then rather than not exercising, I’ve found a website that has some great ideas: 20-awesome-indoor-workouts-try-winters-over.
Do you have a question about SAD or another health concern? Our team of Health at Hand nurses is available 24/7
SAD – NHS Factsheet