DR NORMAN ROSENTHAL: How not to get seasonal affective disorder

How not to get seasonal affective disorder: DR NORMAN ROSENTHAL – the pioneering psychiatrist who first discovered SAD – reveals how to avoid the blues this winter

Dr Norman Rosenthal reveals how to avoid Seasonal Affective Disorder

It’s dark when we get up and – for many – still dark when we get to work. We sit indoors for much of the day. Even a trip to the sandwich shop at lunchtime seems a chore in chilly weather.

This morning, at 2am, the clocks went back.

It meant an extra hour in bed. But from tomorrow it’ll be dusk, if not night, by the time we are travelling home. Suddenly it’s as if we never see the sun at all.

So it’s not surprising that many of us get the winter blues – a general sense of being a bit below par, less productive, and wanting to hide away. For hundreds of thousands of Britons, though, the dark, cold winter months are even more difficult to cope with.

The change in season also brings with it gradual, creeping depression – a condition known as seasonal affective disorder, or SAD. It doesn’t usually come on overnight. First, getting out of bed may become a struggle. Then fatigue sets in. Comfort food beckons – sweet and stodge – and with that comes weight gain and a further lack of motivation.

Over time, the low mood can get worse – guilt, anxiety and a desire to be alone may creep in. As one sufferer I know put it: ‘I feel like all my systems have been turned off in the winter… I’m leaden, and heavy. The fatigue is agony. I have to drag myself from one place to the next.’

At worst, patients may feel suicidal. So, needless to say, it’s a serious condition. But while there is no cure for SAD, there are things you can do – starting today – to help. With a little determination, and by following my simple step-by-step guide, you can stop it from blighting your life.

It wasn’t taken seriously… my thesis was taken as a joke

It was back in the mid-1980s when I first suggested there was a specific type of depression that was triggered by the lack of light in winter. I was working at the National Institute of Mental Health in Bethesda, Maryland, in the US at the time. My thesis was met with a deal of scepticism in the medical community. Although some people supported this new diagnosis, others were dismissive – contemptuous, even. Some colleagues even thought SAD was a joke.

Professionally, it was a little galling. More importantly, for a very long time, sufferers found it hard to get taken seriously. Thankfully, more than three decades on, things are different. SAD has won mainstream acceptance and treatment is available on the NHS. One in five Britons are believed to suffer to some extent.

According to a recent YouGov poll, symptoms are acute for eight per cent of people. Women are 40 per cent more likely to be affected than men. We don’t know for sure why some people are affected, but we think it’s due to combination of genetics, our biology – such as hormones and age – light and stress.

While there is no cure for SAD, there are things you can do – starting today – to help (stock image)

I noticed I felt slow mentally in winter

In South Africa, where I grew up, winters were never particularly grim. But on the East Coast of the US, the shifts in weather between seasons was extreme: summers often blistering hot, and winters freezing.

Both my wife and I felt slower mentally during the darker months. At the time, emerging research suggested that light didn’t just help us see – it had biological effects.

One major discovery was the hormone melatonin, which is integral in regulating our sleeping and waking cycles. Melatonin is secreted by the pineal gland, which is tucked beneath the mid-line of the brain.

Its activity is regulated by special light receptors in the eyes. Darkness signals the gland to begin secreting melatonin into the bloodstream, making us feel drowsy. Light, as the sun rises, is detected by the eyes, and halts production.

But the chemical messenger does so much more than put us to sleep. In animals, it governs reproductive cycles. It even governs antler growth in reindeer.

I wondered: did light have other effects in humans? Around this time, I encountered another scientist who suffered mood changes in the darker winter months – but much more severely than I did. So we decided to carry out an experiment: to see if light therapy could make a difference to his mental health.

It’s not just the ‘worried well’

Light therapy – basically, sitting near a source of very bright light, known as a light box – is the cornerstone of SAD treatment. But back in the 1980s, no such thing existed. So we rigged together the first prototype, made from a fluorescent ceiling light. These emit what is known as white light – which is similar to the light emitted by the sun.

Is it the winter blues …or full-blown SAD? 

The following are core symptoms of SAD. They develop as the seasons change from summer to autumn and winter:

• REDUCED energy
• INCREASED eating, including carb cravings
• DISTURBED sleep
• LOWER sex drive
• THINKING problems, such as difficulty concentrating
• MOOD problems, particularly depression.

If you have some of these symptoms during autumn and winter, and find them problematic, you may well have SAD or subsyndromal SAD. 

It is common to suffer from SAD alongside other mental health problems, including non-seasonal depression, premenstrual syndrome and eating disorders. 

Whether or not this is the case, you might benefit from the treatments described on these pages, and in my book Winter Blues. 

However, it’s always wise to consult your GP if you feel unwell, so they can rule out other causes such as thyroid gland problems and chronic viral illnesses.

My colleagues Thomas Wehr, Alfred Lewy and I gave our volunteer – the scientist suffering from seasonal mood changes – three hours in front of the box before dawn, and three after dusk.

This simulated the length of a day in summer, in terms of hours of light. Within three days, he began to feel better – dramatically so.

Over the following years, we gathered evidence and treated more patients suffering from what became known as SAD.

Many sceptics initially argued that we were dealing with ‘the worried well’ – people who felt a little down during winter, but had nothing wrong with them. But gradually, the diagnosis of SAD became accepted worldwide.

There is also what we call subsyndromal SAD, sometimes known as winter blues: when you feel less productive in winter, but not so much that you’d need medical help.Symptoms can vary in severity from one year to the next, and exist along a spectrum. One year a patient might have full-blown SAD and then a less debilitating manifestation the next year.

We know now these conditions are common – particularly in places such as England and Scotland. SAD is seen less in sunnier climes, affecting, for instance, just 1.5 per cent of people in Florida.

And more needs to be done to raise awareness and alleviate suffering caused by short, dark days.

In a recent study of more than 1,000 people with SAD, participants suffered, on average, 13 winter depressions before receiving any treatment. Alongside light therapy, we have a wealth of other strategies to tackle the problem – from lifestyle changes, to medication.

The key is to start taking steps as the seasons change. That means, if you think you’re a SAD sufferer, you need to take action today.

And here is what I advise…

From today, as the clocks go back…

Most people with SAD benefit from light therapy. Indeed, studies suggest it is as effective as antidepressants are for non-seasonal depression. That’s why I don’t think it’s necessary, in most cases, to jump straight to medication.

Many SAD patients will need to start light therapy during October: once the clocks go back, the longer evenings can be a burden.

Ideally, you should have a diagnosis before starting treatment, so your progress can be monitored by your doctor. But if your symptoms are mild, it may be worth giving light therapy a go for up to two weeks, to see if it helps.

To do so, you’ll need a light box.

They cost from about £75 from companies such as Lumie (lumie.co.uk) and from SAD.org.uk, which also gives advice on buying.

The illuminated surface should be at least 1ft square – smaller boxes have not been proven to be effective. Brightness – or rather, intensity – of bulbs are measured in a unit called lux. The average room light is about 300 to 500 lux.

The amount of light coming from the sun, just as it crests the horizon on a cloudless day, is about 10,000 lux – and the bulbs in many light boxes emit this intensity of light.

They should be no less than 2,500 lux and boxes that emit lower levels need to be used for longer.

You don’t have to stare at it. Just facing it with your eyes open is enough. You can catch up on paperwork or make phone calls as you do – in fact, I’m sitting in front of mine as I write this.

For some people five to ten minutes of light therapy, once or twice a day, is all that’s needed.

Just one day of light therapy… and I felt like my old self again 

Neina Sheldon, 36, is a copywriter and marketing consultant from Greenside

Neina Sheldon, 36, above, describes having SAD as ‘being like Tigger and Eeyore in one person’.

During the summer, the writer from Greenside, near Gateshead, feels ‘my normal self, upbeat, energetic, motivated and working like the clappers’.

But from late September onward, things change dramatically. ‘It’s like I’m a different person,’ she says. ‘It starts with feeling tired all the time, and then the low mood kicks in.

‘I’m pessimistic, have no motivation to do anything, and I become irritable and snappy.’

Neina’s symptoms first began in her teens – yet it was just put down to ‘hormones’ at the time. It wasn’t until her early 20s that she visited her GP.

‘I said, “I know this sounds weird, but I feel like I’m two different people in summer and winter.”

‘He asked me if I’d heard of SAD, which I hadn’t.’

On her doctor’s recommendation, Neina purchased a light box.

She says the effect was dramatic. ‘It was amazing, like flicking a switch. On day one, after sitting with it for 30 minutes, I had more energy.’

I suggest starting with 20 minutes, and increase as needed – or decrease if you feel a bit wired, which can happen.

People typically end up using the box – of 10,000 lux – for between 30 and 90 minutes, broken up into two daily sessions. If you experience side effects such as headaches, eye-strain, irritability or anxiety, insomnia or nausea, decrease the time in front of your box.

Some light boxes emit blue light – but there are fears they could damage the eyes, whereas all evidence shows that white light is safe in this regard. There is also no evidence that blue is any better than white light.

Most people feel the effects of light therapy within two to four days of starting treatment. However, it’s worth persevering for a week or two to give the therapy a fair try. Some feel a shift in mood after just one session.

I also recommend people with SAD get a device called a dawn simulator. They’re like alarm clocks with bulbs (much less intense than a light box) that gradually lighten at a set time, to gently wake you.

Morning walks… and meditation 

Light therapy isn’t the only thing to do this month. I suggest starting a programme of morning walks – or even jogs – to take advantage of the morning sunlight. Get outdoors, and look up at the sky (although, obviously, never directly at the sun). Even on the cloudiest of days, there is light.

Some studies suggest combining exercise and light therapy is particularly potent, so building this into your routine is key.

Join a local walking or running group, or just ask your partner or a friend along. Do whatever it takes to resist the temptation of being a couch potato.

People with SAD often have a voracious appetite for carbohydrate-rich foods, such as bread, potatoes, pasta and rice – not to mention sweet treats.

One theory is that carbs boost the effect of serotonin, a brain chemical linked to mood – which runs low in people with SAD. Stress can also trigger over-eating. Patients often say eating carbohydrates comforts them, ‘energises’ or makes them feel good – but this is usually short-lived. And in the long-term, this sort of eating leads to weight gain. I suggest a carbohydrate-restricted diet.

Minimise bread and pasta and try substituting toast and cornflakes at breakfast with something protein-rich such as eggs, or porridge oats, which are slower to digest.

To counter stress, I am a huge advocate of meditation. I first started to meditate more than a decade ago and found it rapidly made me feel calmer and more able to cope.

I also lost about 8lb over a few months – I think due to the reduction in stress-driven eating.

Some types of meditation involve repeating a mantra or sound, while others involve focusing the attention on breathing or body sensations. Visit uk.tm.org for more information.

Don’t be afraid of therapy or drugs  

Some people, despite their best efforts, will not respond to the above measures. Fortunately, SAD can be treated in other ways – for example, medication or psychotherapy.

Cognitive behavioural therapy, or CBT, is probably the best option. In fact, research by Dr Kelly Rohan at the University of Vermont suggests it might be effective alone – even without light therapy – and it may prevent future bouts of SAD.

The therapy involves identifying unhelpful thoughts, emotions and behaviours and finding new, more helpful ways of thinking. Your GP should be able to get you a referral, as it’s NHS recommended.

If you are very depressed, CBT can be difficult and there are alternatives that may be offered.

Starting antidepressants in the autumn, before the onset of symptoms, has been shown in some patients to prevent depression from occurring.

The drugs can often be tapered and stopped in the spring. So there is a lot you can do now to prepare for the dark months ahead.

During this time, avoid extra stress by postponing new projects until spring. Once your symptoms are under control, you might even be able to enjoy small things this winter – seeing a friend or simply curling up in front of the fire with a book.

As I wander the streets of my neighbourhood, I always marvel at how different the gardens look from last summer.

The air has a bracing quality. And remember, by the time the seasons change again, you’ll be ready for a new challenge.

• Winter Blues: Everything You Need To Know To Beat Seasonal Affective Disorder by Norman E Rosenthal, £13.99, is published by Guilford Press. normanrosenthal.com

…but clocks going back may prevent heart attack  

By Pat Hagan for the Mail on Sunday 

An extra hour in bed isn’t the only benefit of the clocks going back this weekend. Those additional 60 minutes sleep could, in fact, have a profound impact on your health.

If you’re one of the seven million Britons with heart disease, it could prove life-saving. A recent study by University of Colorado scientists showed that in the two to three days immediately after the autumn time switch, the number of potentially fatal heart attacks drops by roughly 20 per cent.

And when the clocks jump forward an hour in the spring, heart attack rates jump 25 per cent almost immediately.

Why? It’s all to do with the power of sleep. ‘Most of us can get away with a few late nights but any more than that and you start running up a sleep debt,’ says Dr Neil Stanley, a member of the British Sleep Society and author of the book How To Sleep Well. ‘If you are repeatedly deprived of your full quota of sleep – seven to eight hours a night for most of us – for more than about four weeks, it can become a chronic condition that could threaten your health.’

An extra hour in bed isn’t the only benefit of the clocks going back this weekend (stock image)

Growing evidence shows the greatest toll is on your heart.

Last year, a study of 460,000 Britons found that even those without family history of heart disease, who were perfectly fit and healthy, dramatically increased their risk of a heart attack by sacrificing sleep.

Those averaging fewer than six hours a night were a fifth more likely to have a heart attack than those getting seven or eight hours. If they slept five hours or fewer, the risks increased by more than 50 per cent.

Professor Melvin Lobo, a heart disease specialist at Bart’s NHS Health Trust in London, adds: ‘It’s not just the time you spend in bed – it’s the quality of the sleep that counts.’

According to experts, poor sleep can trigger a cocktail of other common problems, causing the risk of heart attack to soar. ‘Being exhausted during the day and awake at night can raise levels of hormones that drive up blood pressure,’ says Professor Naveed Sattar, from Glasgow University’s Institute of Cardiovascular and Medical Sciences.

Sleep deprivation also upsets the balance of vital hormones in the body that control appetite.

Studies show that eating late at night – up to two hours before bed – upsets the internal body clock, or circadian rhythm, which, in turn, disrupts our metabolism. The body is less efficient at processing food for energy, causing spikes in blood sugar and blood pressure. Both of these are known risk factors for heart attacks.

Too little sleep can also harden your arteries. Sleeping six hours nightly was shown, in studies by University of Chicago researchers, to make participants three times more likely to develop fatty deposits in the blood vessels over a five-year period, compared to those who consistently slept for at least eight hours.

But a daytime snooze won’t help matters. According to recent Chinese research, catching up with shut-eye during the day won’t undo the damage caused by restless nights.

Further research published in the journal Current Biology in February this year showed that a weekend lie-in is unlikely to help, either.

Ultimately, the best defence against sleep-related health problems is simple: a few early nights. Studies consistently show that being early to bed not only protects you from heart disease, but also respiratory illness, psychological disorders and even – according to some studies – early death. So, consider setting a bedtime. Your heart – and overall health – will be better off.

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