Some people love this time of year, the changing of the leaves, Hallowe’en, pumpkin spice everything. We are moving swiftly towards fairy lights, seasons greetings and any excuse for a hot chocolate (with or without the Baileys). For some, shorter days feel ominous. It’s like the tolling of the bell, warning of more than just darker nights. People usually shrug it off. However, those who suffer with Seasonal Affective Disorder (SAD) struggle with the changing of the seasons.
This can happen in the summer months too but we are going to take a closer look at winter SAD. The condition can have a significant impact on a person’s mood, energy levels and overall well-being. We will delve into the science behind the symptoms and investigate helpful coping strategies.
If you have felt dismissed or fobbed off by family, friends, or the medical profession, this article is for you. I hope it gives you a starting point to help yourself.
Symptoms of SAD
The first thing to note is that SAD is not just feeling a bit down because summer has ended. Being thrown back into the normal routine of life is not a cause. Neither is it anxiety and stress over how you are going to afford Thanksgiving/Christmas. Or how to cope with family members at the most wonderful time of the year.
Winter SAD is not caused by events that occur in your life. However, they can add to the feeling of not being able to cope. It is a seasonal pattern that begins in Autumn and doesn’t let up until Spring.
The following symptoms can occur with varying severity:
- Persistent feelings of sadness or hopelessness
- Loss of interest in activities once enjoyed
- Changes in sleep patterns, such as oversleeping or insomnia
- Changes in appetite and weight, particularly cravings for carbohydrates
- Fatigue and low energy levels
- Difficulty concentrating or making decisions
- Irritability and increased sensitivity to stress
- Physical aches or pains, headaches or digestive problems that do not have a clear cause.
- Thoughts of death, suicide or suicide attempts.
- Social withdrawal or the need to “hibernate”
Causes of Seasonal Affective Disorder
As we learn more about the human brain and nervous system we are discovering factors that contribute to the development of the condition. We don’t have all the answers yet but some of the causes of SAD include:
- Reduced exposure to sunlight: The decrease in sunlight during the autumn and winter months can disrupt the body’s internal clock. This is known as the circadian rhythm. This disruption can lead to changes in mood and energy levels.
- Imbalance of neurotransmitters: Changes in the levels of certain neurotransmitters may play a role in the development of SAD. Serotonin and dopamine and melatonin are examples.
- Vitamin D deficiency
- Genetics: People with a family history of depression or SAD may face a higher risk. They might develop the condition themselves.
- Sleep disturbances that disrupt slow wave sleep
- Gender – women are more likely to suffer with SAD than men
Reduced Sunlight and the Circadian Rhythm
Humans, animals, and plants all have an internal clock called the circadian rhythm. It is a 24-hour cycle that naturally aligns with our day and night. The circadian rhythm affects our body’s response to environmental changes. It influences sleeping and waking patterns. It impacts core temperature and the immune system. The rhythm also affects hormonal balance and cognitive function.
Our rhythms are determined by environmental cues. These include meals, exercise, social interaction, and daily routines. Stress also plays a role. More importantly for SAD, exposure to light and dark is crucial.
If our exposure to sunlight alters significantly, it can throw off our circadian rhythms. This particularly affects melatonin production and core body temperature. It impacts alertness and continued low levels affects sleep and mood. This leads to cognitive disruption and poor mental health.
Serotonin
Serotonin is a chemical that sends signals between nerve cells in the brain and body. 95% of serotonin is found in your intestines. The remainder is made in the brain. The brain and stomach, or gut, are linked which allows the brain to influence your gut and vice versa. Serotonin is responsible for regulating digestion, body temperature, sleep, mood, memory.
The ability to make serotonin relies on an amino acid called tryptophan. However, this essential amino acid cannot be produced in the body. The only way to absorb it is through diet. Poor diet can reduce the absorption of this amino acid. This reduction then inhibits the body’s ability to create serotonin.
Melatonin
Melatonin is a hormone produced in the brain. Darkness stimulates the pineal gland to convert serotonin to melatonin. Exposure to light reduces production. Melatonin helps to control the circadian rhythm and your sleep/wake cycle. As night-time approaches, light levels begin to lower. Melatonin starts to increase about 2 hours before we go to sleep. This peaks about 3 hours after we fall asleep. It then decreases with the morning light.
Modern life means we spend more time indoors surrounded by artificial lighting and screens. This increase in artificial light and decrease in natural light affects our ability to produce the melatonin needed for our sleep/wake cycle.
So in the summer months our bodies produce less melatonin and in the winter months we produce more. Also as we get older our melatonin production levels decrease so we tend to sleep less.
Dopamine
You’ve probably heard of dopamine. Social media talks of dopamine hits and dopamine decor. It is often referred to as the “happy hormone”. When you do something that feels good we get a spike in dopamine. It also has a relationship with melatonin. In the day melatonin decreases and dopamine increases, at night it goes the other way.
Research points towards dopamine having any affect on our eyes responses to light, compromising our brain ‘reward’ pathways and overeating. This means that if we have low levels of dopamine our circadian rhythm may be affected. Overeating certain foods during the darker months may also be related to altered dopamine and our ability to feel pleasure. This has a knock on effect of not feeling great, eating to feel good then having a drop in the ‘happy’ effect leading to low mood.
Vitamin D Deficiency
When people talk of vitamin D deficiency they think of bones, teeth and muscles. We need it to regulate the calcium and phosphate in our bodies. This helps prevent bone deformities like rickets. It also assists in reducing bone pain and inflammation, and helps with cell growth.
Many people understand that the body needs sunlight to create Vitamin D and you can also find it in oily fish, egg yolks and red meat. Seasonal changes in sunlight and spending time indoors affect Vitamin D levels. Therefore, taking a supplement will help.
More recent research suggests that Vitamin D has a role in supporting mood and sleep/wake cycle. Observations in these studies indicate that those with depression/SAD have low levels of the vitamin in their system.
Genetics
Seasonal light changes impact our circadian rhythm and our ability to produce certain hormones. However, there have been more studies on how our genetics may make us predisposed to SAD.
People with a family history of depression have a higher risk of developing SAD. Research on identical and non-identical twins with SAD shows some results. Identical twins (identical genes) have a higher chance of both having SAD. Non-identical twins do not share the same genetic makeup therefore have a lower chance of both having SAD.
Further research also suggests that genes that are related to the circadian regulation. Those whose have a certain type of gene variant may be more vulnerable to depressive symptoms especially in winter months. Observations in people who have variants in their genes that affect serotonin transportation and melatonin regulation are also more vulnerable.
Slow Wave Sleep
Did you know that on average we sleep an hour longer during the winter months than the summer? Also our rapid eye movement, or REM (the most active stage of sleep), is 30 minutes longer in winter than autumn!
REM is regulated by our circadian clock. However, it isn’t the only stage in our sleep process that is affected by seasonal changes. Scientists have found that there is REM sleep and deep sleep (also known as Slow Wave Sleep).
Slow wave sleep is not driven by our circadian rhythms but is a homeostatic process. Homeostatis is our bodies way of adapting to external factors while maintaining constant internal conditions. It is how we have adapted and survived and how we continue to adapt and survive.
During slow wave sleep our body repairs itself, builds muscle and strengthens our immune systems. It also important for long term memory and processing new information. So the longer we are awake the more deep sleep is needed to recover.
Scientists still have a way to go to understand why more deep sleep is needed in the winter. However, it has been determined that people with disrupted slow wave sleep face higher risks. Age, breathing issues, depression, pain, and stress contribute to disruption. These factors increase the risk of having mood disorders as well as memory issues.
Gender
Unfortunately if you are female you are more likely to experience depression. Factors that increase this are biological, hormonal, genetic and social. A study in Sweden found that women are 1.5 times more likely to experience SAD symptoms than men. Women also react negatively to cold/short days, eat more in the winter and saw weight gain as a problem which added to low mood.
Women’s primary hormones are eostrogen and progesterone which also influence mood and neurotransmitters. Hormones fluctuate throughout the stages of a woman’s life (periods, pregnancy, menopause). These fluctuations can affect how they respond to seasonal light. These hormonal variations can influence melatonin levels and low eostrogen levels may lower serotonin uptake.
Circadian rhythms in women are being studied more closely with some research pointing to women having a shorter circadian period. This makes them more responsive to environmental light cues. So not only do women have hormonal disturbances but when there is less light they are susceptible to fatigue and mood disturbances. Being a woman isn’t easy!
There is also the social factors to take into account. Women often have unique stressors in life such as care-giving roles (children, elderly parents etc). These can can be difficult to balance with work, everyday life and expectations from society or community. These stressors increase vulnerability for depression. It must be taken into account that women are more likely than men to seek help for mental health issues . This means that the number of males with SAD maybe under represented.
Treating SAD
Unfortunately there is no cure for SAD. More scientific studies need to be carried out to fully understand how and why it affects certain groups of people. However there are strategies that can help manage the symptoms and improve overall well-being.
As with managing other mental health issues, these strategies aren’t new or ground-breaking. Consistency and time create results. Remember there are no quick fixes with well-being. Sometimes you must try a number of ways to get results for different situations. In doing this you build up your tool-box of coping strategies . When you have a number of tools at your disposal this will help improve your overall health.
Therapy
As a therapist I wholly support therapy as tool to help with SAD. It helps to talk though emotions, current issues and building a coping tool box through the darker months. As more research is being undertaken, it is clear that SAD has a physiological and genetic basis. This leads me to believe that SAD cannot be treated by talk therapy alone.
Talk therapy does help clients with feelings of being heard, positive mindset, and managing emotions . It also increases the clients ability to work through issues outside of the therapy room. From my research well-being during the autumn and winter months should be approached holistically. Ideally sessions around SAD should include talking about practical changes clients can make in their lives. Discussing diet, exercise, light therapy and signposting to the Doctor or other organisations would be beneficial.
Exposure to light
Light therapy has been the go-to for treating seasonal affective disorders. Treatment involves sitting in front of a light box for up to 2hrs in the morning from autumn to spring. The light box itself is much brighter than normal indoor lighting and filters out UV light . However, if you are taking light sensitive medication or have light sensitive conditions, discuss with your doctor first.
If you invest in a light box buy one that is at least a10,0000 lux . Lux is the term used to measure visible light. In the UK they range in price from £40 to £250 depending on the different functions. Which magazine has a recent online article that lists trusted SAD lamps which you can read here
With daylight savings occurring autumn and spring our bodies are not aligned with seasonality. The changing of the clocks can affect mood and sleep. Exposure to daylight, has a huge impact on our circadian rhythms as explained above. Neuroscientist, Andrew Huberman and Dr Samer Hatter discuss light effects on the Huberman Lab podcast. It is an interesting listen, you can find it here
The timing of exposure to natural light (or light therapy) is important. The best time of day to be exposed to light is within in the first 30 – 60 minutes of waking. This increases alertness, boosts mood, lowers stress and improves your quality of sleep.
Daily exposure to natural light should be for a minimum 15 minutes in the morning even on cloudy days. If this is not possible or you need more exposure then investing in a light box is ideal.
Exercise
Not a new concept but exercise is recognised as a mood booster. It has a positive impact on sleep and brain function. 30 minutes a day is what is recommended but that doesn’t mean you have to do it all at once. How about a 15 minute walk outside in the morning then again on your lunch break? That way you are exercising and getting light exposure!
When you have depression it can feel very difficult to motivate yourself especially during the winter months. It is tough to get out if you feel like you just want to hibernate. A physical condition might also limit your ability to exercise, making it hard to get outside.
The key here is to think of exercise as movement. We move every day in some fashion. Exercise doesn’t have to be exerting yourself (unless that is what you want to and can do). What movement you choose to do should be enjoyable and done as consistently as possible.
What ways can you move your body more than what you do when SAD hits? Could you just move more in your home? Perhaps do a chair based exercise video that is low impact. They aren’t just for the elderly! I have used these videos on days when I can’t do anything too physical but need to move. Do some gentle stretches, even housework is movement (though perhaps not enjoyable for some) or dance in your kitchen?
If you can get up and get out how about joining a group or a class . Go with a friend or to make a friend? Walking groups, a gardening club or just going window shopping with someone are all mood boosters with movement. All this counts and if you are getting natural light that is even better.
Diet
As always a healthy diet is important for our bodies to get all the nutrients, vitamins etc. As poor diet reduces the production of serotonin in the gut and limits the conversion of tryptophan to melatonin. It is important when managing depression to have a healthy gut.
The gut microbiome is affected by processed, high fat/refined sugar foods. To maintain a healthy microbiome that enables the absorption of nutrients and encourages a stronger gut/brain connection.
These include probiotics, prebiotic, eostrogen mimicking and tryptophan and fibre rich foods. The Infographic below details some foods that will aid your gut and boost your mood.
Probiotics can help restore your gut health by adding good bacteria. Yoghurts that contain live or active cultures are common in the supermarkets. Make sure you choose one that doesn’t have too much sugar. Fermented foods are also help with introducing microorganisms. I find these are an acquired taste but have come to enjoy Kefir yoghurt on my protein pancakes!
Prebiotics are the foods that feed our natural bacteria and help more to grow.
Trypotphan foods are essential as we cannot make this amino acid ourselves. If you are peri-menopausal or menopausal sources of tryptophan but also mimic eostrogen may be useful for helping with gut health, mood and sleep
Fibre is important to maintain a healthy gut and adults need roughly 30g a day. When introducing fibre, the key is to start slowly. If you eat too much you could find it causes bloating and wind and frequent trips to the toilet.
Affordability, access and choice.
But what if you don’t like, eat, can’t afford or have access to these types of foods? Research alternative foods that offer similar benefits . If you don’t don’t like certain foods but can’t find an alternative, experiment with with added flavours. I hate avocado so that gets whizzed up in a fruit/protein smoothie!
When it comes to affordability or access, pick one thing in your diet that you can access/afford and introduce. Don’t try to change your whole diet at once. If you can’t afford it or get it regularly, you will find it harder to stick to. You might resent the effort it takes to get it. For example change white bread to wholegrain, buy frozen vegetables if you can’t get fresh ( or won’t use it up before it goes off). Little changes will help.
Supplements
Vitamin D, B12 and folate, as well as iron are all important for energy levels which help with lethargic feelings during the autumn/winter seasons. If you can buy a good multivitamin especially if you have a poor diet.
If not a multivitamin, I would suggest a vitamin D supplement as it is difficult to get enough Vitamin D from diet alone. In the UK, the NHS recommend taking 10 mcg (you may see this written as 400IU) of Vitamin D3 daily.
If you have trouble with falling or staying asleep you may benefit from a melatonin supplement. Check with your Doctor before hand as some people cannot take this supplement with certain conditions and medications.
If you are taking any medication prescribed by a doctor or have underlying health conditions, please consult your doctor before taking any supplements or drastically changing your diet.
Antidepressants
If you are struggling with seasonal depression and it is affecting how you live your life, it may be that anti-depressants are helpful, at least in the short term. Reach out to your health professional to discuss what is happening to you.
Sleep hygiene
This is a topic that warrants it’s own blog post! Key points in sleep hygeine are:
- Daylight exposure, preferably within 30-60 mins of waking or using a SAD lamp.
- Not eating too late or drinking caffeinated or alcoholic drinks in the late afternoon/evening.
- Regular exercise of your choice
- Environment, make sure your bedroom is distraction free (keep screen time to a minimum two hours before bed). Try to keep the room quiet and dark, use earplugs and an eye mask if necessary. Also be aware of the temperature , too hot or cold can interrupt your sleep pattern.
- Routine. Having a bedtime routine is important in keeping our circadian rhythm regular. If you can go to bed and get up at the same time each day, even on weekends. Its best to do this gradually if you are not used to regular sleep/wake times.
- Naps. Napping can help. If like me you have an energy limiting condition, they can be useful. However it is best to keep these to short afternoon naps if you are generally healthy.
- Relaxation – as part of your routine, dedicate time before you sleep to wind down and relax. Once you are ready for bed, dim your lights and try out different methods of relaxation. This can be reading, meditation, listening to music, gentle stretching or even sex.
Conclusion
Doing the research for this article has really opened my eyes ! It has reinforced what I knew about the importance of light on our circadian rhythm. We need the right environmental factors and nourishment to strengthen our bodies and mind. We also need to invest in the time it takes to get restorative sleep patterns.
I have also realised that scientists and medical communities take this seriously. They are working towards more discoveries to help those who suffer.
It has highlighted the impact of modern life with screens on certain people’s ability to function. 24hrs living and processed foods are high contributing factors. Even more so in the autumn/ winter months. The methods above tare able to reduce depression and fatigue during the darker months. We just have to make lifestyle adjustments over time to feel better.
If you suffer with seasonal depression or depression in general, start making small changes now. Many people don’t get out in natural daylight as often as their body needs. If this is you, start now. Your body and mind will thank you in the future.
As a side note I also struggle with seasonal changes. This year, I have invested in a light box. I will keep you updated with my journey in another blog post.
