The SAD truth about those winter blues

Published on Tue 25 Sep 2007

The Daily Mail, 25th Sept 2007

More people than ever say they suffer from seasonal depression, but some experts now believe it's little more than hypochondria. So who's right?

When Eva Nahlik arrived back in Britain after living in the sweltering heat of Dubai for four years, she knew winter was going to be tough.

But she was completely unprepared for the dramatic transformation in her mood, energy levels and weight as the nights drew in.

From September until April, the 31-year-old felt sleepy all the time, started putting on weight and felt depressed.

'The first year after I arrived from Dubai, where there are 360 days of sunshine a year, the winter wasn't too bad,' says Eva, a personal assistant at a London telecommunications company.

'But the following year was terrible. It had been an awful summer as well, and when winter arrived it really hit me.

'Everything else in my life was perfect - I had a great job and relationship with my fiancé - but as the days got shorter, I started really craving sugar, and became depressed for no real reason. I also started putting on weight.'

In fact, Eva is one of more than a million Britons thought to suffer from seasonal affective disorder or SAD (another five million adults suffer from a milder form, 'winter blues'). This is a form of depression that occurs solely during the winter months and is thought to be caused by an imbalance of certain chemicals and hormones in the brain that are affected by sunlight.

This imbalance produces a wide range of symptoms, including a craving for carbohydrates, weight gain or loss, oversleeping, restlessness, loss of energy, lack of concentration and a depressive mood. These symptoms have to be experienced for three consecutive winters for SAD to be diagnosed.

Last week mental health experts warned that Britain could be heading for an 'epidemic' of winter blues this year following one of the most miserable summers in memory. The relentless rain and dark skies over the summer mean that many SAD sufferers are already feeling depressed.

Yet some experts now believe SAD is being overdiagnosed, and warn that many people who think they are suffering from it are actually experiencing a normal response to seasonal changes.

The term 'seasonal affective disorder' was first coined in 1984 by a South African doctor carrying out research on the higher rate of depression in the winter. However, the effect of the seasons on health has been observed for centuries. In 400BC, Hippocrates wrote that 'it is chiefly the changes in seasons which produce diseases'.

What makes SAD different from other forms of depression is that it recurs in winter and is linked to the reduction in the number of hours of sunshine and its intensity.

This makes it more common in countries 30 degrees north or south of the Equator. It's estimated that between two and three per cent of the adult population in these countries are seriously affected, and one in ten to a lesser degree.

It's thought to be caused partly by a lack of the brain chemical serotonin. This is responsible for regulating appetite and sleep, and people with SAD may have abnormally low levels of this chemical in winter.

They may also have more melatonin than normal — this brain chemical slows down the body clock and affects sleeping and mood patterns. People with SAD may respond to a decrease in light by secreting more melatonin, making them more sleepy.

Onset of SAD is most common in your 20s, and women are more likely to be affected than men. Doctors also think it may be hereditary.

According to Dr Natasha Bijlani, a consultant psychiatrist at the Priory Hospital in South-West London: 'It can be very debilitating, and in some cases patients need antidepressants to boost serotonin levels.'

In the most serious cases, patients who don't receive treatment are unable to function, and some have to give up work. Yet despite its identification 20 years ago, SAD is still not officially recognised as a specific disorder by the doctors' bible - the International Classification of Diseases (ICD) - although it is listed in the American version of the book.

Some experts believe this is simply because the current edition was written in 1992, when less was known about the condition. Others put it down to the fact that SAD is so difficult to measure.

Dr Peter Byrne, a consultant psychiatrist in Ealing, West London, says:

'I am not totally convinced about it as a standalone condition, and if it does exist, it affects no more than one in a thousand people.'

Some psychiatrists are even more resistant to the idea of SAD, says Dr John Eagles, a consultant psychiatrist at the Royal Cornhill Hospital, Aberdeen, who has been researching and treating SAD for more than ten years. They see SAD as 'a potentially misleading and harmful myth for people who seek illegitimate refuge in the sick role'.

This also raises questions about its treatment - specifically with antidepressants. GPs are handing out more of these than ever, and there are growing concerns that we are medicalising what is, for many, simply unhappiness.

Dr Bijlani has no doubt that SAD is a legitimate condition — she believes the reluctance to accept SAD as a recognised disorder is similar to the way chronic fatigue syndrome was initially viewed.

'Any condition that is psychological or psychiatric is prone to mistrust. People think in the back of their heads that these people are just making it up.'

'This is not a condition that someone can see. It is about how someone feels. Unless you are the doctor or a patient, it is open to misinterpretation.'

However, she and Dr Eagles are at pains to point out that SAD is different from the normal mild winter 'gloominess' more than half of all Britons feel, which, explains Dr Eagles, is merely 'normal seasonal fluctuation' in the physiological health of people living in our climate — the only treatment is to move somewhere sunnier.

The good news for genuine SAD sufferers is that sitting in front of a lightbox for about two hours a day will alleviate the symptoms for 80per cent of people. (If this doesn't work, it suggests the person may not be experiencing SAD but another form of depression.)

To be effective, the lightbox has to emit at least 2,500 lux (a measurement of the brightness of light - unlike watts, which refer to the power consumed to drive the light source). This is ten times brighter than domestic light.

However, lightboxes are not available on the NHS and cost between £100 and £250.

But Dr Byrne warns that while there is anecdotal evidence for its benefits, the treatment is still scientifically unproven. 'Most psychiatrists would say the growing interest in SAD is driven by manufacturers of light therapy treatments,' he adds.

Another option is antidepressants. Most doctors prescribe SSRIs (selective serotonin reuptake inhibitors), although there is little evidence to show they work for winter depression.

Other options include exercise, preferably outdoors during daylight, a healthy diet and counselling or cognitive behavioural therapy.

A lightbox has transformed Eva Nahlik's winters. 'After about three weeks - using it every day for two to three hours - I really noticed the difference,' she says.

'Even though it was the middle of winter I felt like there was hope, like you do when the days are getting longer.

'We brace ourselves for feeling down in winter because that is what we are used to. But it doesn't have to be like that.'

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