As the nights draw in earlier and the harsher, colder weather takes hold, many people in the UK will be starting to feel the effects of ‘Winter depression’, also known as Seasonal Affective Disorder.
For those living with the condition, this year these feelings may be all the more pronounced. With much of the world in the grips of a pandemic, and the country at present observing a national lockdown, the winter months may be even more challenging.
Earlier this year, Treated.com’s Jackson Hall spoke to the man who ‘discovered’ Seasonal Affective Disorder, Norman E. Rosenthal, M.D., to discuss the condition in more detail.
But before we get to that, here is some insight from Dr Daniel Atkinson on what COVID-19 means for Seasonal Affective Disorder, and what you can do to try and limit the symptoms.
Will COVID-19 make SAD symptoms even harder to deal with?
As we know, the highly contagious nature of coronavirus has necessitated strict rules around socialising and gathering in public places. This does impose limits on the activities we would normally do that help to make us feel better, emotionally and mentally.
‘While I and many other doctors would agree that the current restrictions are needed to help us keep the virus under control, there’s certainly a need to be mindful of the effect that this form of preventative behaviour has.’ comments Dr Atkinson.
‘December is a social month for many of us. For those who spend time with friends and family as a release from a difficult job or living alone for example, socialising is something we look forward to. Not having that can without doubt make SAD harder to deal with.’
‘There’s also the added stress factor of the coronavirus situation as a whole. From a healthcare perspective, we’re heading into Winter in a much better position than we were in last March, as we know more about how the virus transmits, how to treat it, and the additional good news that came out recently about the Pfizer vaccine. But we are still likely in for a tough couple of months, and a lot of people are going to be feeling more anxious as a result.’
‘It could be said that for those who normally do get anxious Christmas anyway, because of strained relations with family members for example, this year there isn’t that added pressure to deal with if we can’t visit our families in person. But in a lot of cases, this relief might be counteracted by more negative feelings of isolation.’
‘I think most people would agree that this year, overall COVID-19 will have an amplifying effect on Winter depression.’
Dr Daniel Atkinson on coping with Seasonal Affective Disorder
- Talk to your support network. With COVID around at the moment it may not be easy, but try not to isolate yourself too much from your family and friends. If you’re able to arrange regular calls with them, and talk through any anxieties you have, it will help you to feel connected and engaged.
- Get outside during the day. Even though it may be colder and the sun may not be out, getting some fresh air during daylight hours is likely to have a positive effect on your mental wellbeing.
- Try to get some exercise. Whether it’s running outside, walking or doing a workout at home, exercise helps to increase endorphin levels and this will help to raise your mood.
- Break routines. If you feel yourself getting into a rut of doing the same thing everyday, mix it up. Try taking up a new hobby that you can do indoors, or explore something creative. New activities help to stimulate the mind and the goal of achieving something you haven’t before will give you something to focus your attention on.
- Get some sleep. It can be easy to slip into feeling low if you’re feeling constantly tired, so getting the recommended 7-9 hours a night is important. Because daylight hours are in short supply, try to be regular with your sleeping habits, going to bed early so you can get up early, and making the most of the lighter conditions.
- Eat healthily and stay hydrated. A balanced diet and plenty of water is always a good idea but is especially important in helping you feel positive.
‘For many, 2020 will feel like a lost year, with little achieved, whether it’s personally or professionally.’ Dr Atkinson adds. ‘Probably the most useful way to look at it, is that 2020 has been a challenging one for almost everyone - and has been more about survival than upward progress.’
‘So certainly if you’re ending the year in the more or less the same position you started it, and managed to stay healthy, you have to look at that as an achievement.’
The Story of Seasonal Affective Disorder (SAD)
For hundreds of years, the weather and the seasons have been used throughout literature to convey themes centred around emotion. The summer, feelings of happiness, optimism and hope, whereas winter is often used to connote negative emotions - as if the writers of old predicted there may be some correlation between the seasons and mood.
But it wasn’t until 1984 that this correlation between mood and season, coined Seasonal Affective Disorder (SAD), was first described and studied by Dr. Norman Rosenthal.
Norman E. Rosenthal, M.D. is the world-renowned researcher and psychiatrist who led the team that first described Seasonal Affective Disorder (SAD) and pioneered light therapy to treat it.
How was Seasonal Affective Disorder discovered?
Rosenthal grew up in Johannesburg, South Africa. When he moved to New York at the age of 26, he was struck by how much longer the days lasted. Because of the equatorial contrast between the two places, New York City provided him with, what felt like, more hours in the day.
His creative streak, productivity and energy levels spiked. He was able to take on more tasks, reach more deadlines and complete more work.
However, he would be struck once more when the clocks changed in late October - the first time he would witness it in New York.
He left work the following Monday and found the world engulfed in darkness. Now, he felt apprehensive about his work, his energy levels decreased and his overall mental well-being diminished. It lasted for the entire winter.
But this wasn’t enough for Rosenthal to make any assumptions. “You have to go through a few cycles before you can see a pattern,” he explains. “Then I came to the NIMH, the National Institute for Mental Health, where they were studying rhythms and mood and light. And then I met Herb Kern, a scientist who had experienced it to a greater extent [than myself].”
Herb Kern was the first person to be studied in relation to Seasonal Affective Disorder, a little before Rosenthal first coined the term. Kern was a research engineer who had experienced similar symptoms to Rosenthal, and detailed this all in 15 years’ worth of personal journals. “It was fascinating.” Rosenthal recalls.
They began to experiment with light therapy on Kern - the idea of incorporating artificial light into a person’s daily routine as to recreate the absence of natural light. “He came out of the depression pretty promptly,” Rosenthal recollects, “but could it be a placebo effect? Could he have persuaded himself? Just because he wanted to feel better? One never knows. So we needed to have the ability to study it in groups.”
Studies on Seasonal Affective Disorder
This led to Rosenthal meeting with a journalist for the New York Times who decided to publish an article about the work they were undertaking. This moment, in the story of Seasonal Affective Disorder, would prove pivotal.
“When I saw the numbers of people who responded to that article - thousands - I think we calculated approximately 3000. [It] was huge.” Thus was the start of the large group research Rosenthal had hoped for.
But it wasn’t smooth sailing moving forward. There was some reluctance among some of his colleagues to really acknowledge the idea that the seasons could impact mood. “I think it may have been Schopenhauer who said that all truth or discovery goes through three stages. At first it is ridiculed. Then it is violently opposed. And then finally it is declared obvious. That’s the sort of phenomenon that I experienced.”
“I thought they were wrong!” he asserts, “I think that for millions of people it really does constitute a major handicap. A real impediment to creativity, productivity and quality of life.”
Rosenthal and his team started experimenting with light therapy in greater numbers, and the results were deeply encouraging, if not ground-breaking. The vast majority of people saw a decrease in their symptoms. Like Kern, effectively the first person to truly be studied in relation to SAD, light therapy proved itself to be an incredibly powerful remedy.
Eventually, Rosenthal’s research was accepted among the psychiatric community. Not only is SAD a real, diagnosable medical condition, but light therapy is now an accepted and widely prescribed treatment. It is to Rosenthal that we owe much of our contemporary understanding surrounding this condition.
“I’m sitting in front of my light box right now,” he tells me, “I have gone for an extensive walk already today, I meditate regularly, I remain very, very active. If I weren’t doing all of these things I would be really low. I think the good news for me is that I do everything that I recommend to others. And, as a consequence, my winters are pretty good.”
What we know about Seasonal Affective Disorder today
It was in the mid-1980s that Rosenthal conducted his groundbreaking research surrounding Seasonal Affective Disorder. More than 30 years on, the condition has become widely accepted and is regarded as a common phenomenon. “Certainly in the United Kingdom,” he tells me, “you have very cloudy weather and you’re very far north, so you have a lot of those problems.”
Continued research and understanding has allowed for more people suffering to come forward. It has allowed both patients and medical professionals alike to differentiate between SAD and other, more generalised mental health conditions, This, in turn, has led to more appropriate treatment.
It’s difficult to put a precise figure on just how many people suffer with SAD. It will differ from nation to nation, and can depend largely on geographical location in relation to the equator.
In 2014, a poll conducted by YouGov and the Weather Channel revealed that 29% of the UK population suffer, to a degree, with SAD. While polls are not always trustworthy, it is true to say that a significant number of people, in the millions, suffer with the condition.
Treated.com spoke with one such person called Brian, who has been suffering with Seasonal Affective Disorder for roughly eight years. “I noticed my mood shifted during the winter months, and knew it was something I wanted to address because of how great I felt the rest of the year.”
On his symptoms, Brian told us that he’s “affected mostly when the days get shorter and there’s only about 8.5-9 hours of sunlight. The winter months also have that bitter cold that sends a chill to one’s core.”
He continues, “my symptoms definitely get worse as it gets colder and the days get shorter. I experience trouble sleeping, hopelessness/depression, and the loss of interest in activities I would otherwise enjoy.
I experience mild irritability, appetite changes, difficulty concentrating, and a general “bummed out” feeling for the duration of late-Autumn to the end of winter - regardless of environment and weather.”
Brian uses a number of different treatments. A combination of eating well, exercise, hormonal supplements, psychotherapy and light therapy help him to live a relatively normal life. “I wouldn’t say I’m completely cured, but I no longer shut myself indoors and experience the intense emotional and physical symptoms of SAD from mid-October to early February.”
“Today, I’m very open about my experiences and mental health, because I truly believe talking about it is the only way you’re going to get better.” He goes on to suggest to others who may have SAD may find exercise beneficial, as well as eating healthily and getting enough sleep.
“In addition, there’s no shame in making an appointment with your doctor or a mental health professional to explore other options like medication or Cognitive Behavioural Therapy.”
How SAD may feature in our future
Seasonal Affective Disorder affects, and will continue to affect, more people into the new year and new decade. If, as some predict, winters are going to become increasingly harsh, this could impact those suffering with the debilitating symptoms of SAD.
It is still a medical condition that requires more attention and research, but fortunately is something we partially understand moving forward.
“Given our current understanding,” comments Dr Danel Atkinson, GP Clinical Lead at Treated.com, “Seasonal affective disorder is something which can only be recognised, or diagnosed, if someone has undergone specific symptoms several years in a row. Two years at the very minimum.
This doesn’t mean that it can’t be confronted if it’s the first time you’re experiencing the symptoms, it just means it’s slightly premature at that stage to diagnose SAD. Regardless of the season, if you’re experiencing any of the following symptoms and it’s interfering with your ability to live a normal life - you should speak with your doctor.
SAD brings with it a very particular set of symptoms. They are usually consistent from person to person. But some may experience certain symptoms more severely, others more moderately.
They include a persistent low mood, lack of pleasure derived from activities, relationships and sex, irritability, feeling overly sleepy, feelings of despair or worthlessness, irregular eating habits and decreased productivity and creativity.”
If your doctor does conclude or diagnose SAD, they may suggest any number of treatments. Initially, if they suspect it centres around the cause, they might suggest natural changes to your diet and exercise habits.
They might also recommend some forms of antidepressants or hormonal supplements. As Dr Rosenthal describes, they might also prescribe light therapy (though certain doctors may have differing opinions on which treatment is best suited).
Lastly, they may refer you to a talking therapist. Typically in cases of SAD, Cognitive Behavioural Therapy is said to be of the most benefit. CBT involves the recognition of what bad thought processes/patterns look like and how to combat those thoughts with logic and counter-arguments.
For millions of people, Seasonal Affective Disorder is a debilitating, sometimes not easily diagnosed mental health condition.
Treatment will vary depending on the person, but “whatever is working should be continued,” Dr Rosenthal says, he concludes that “the good news is that anything that can work for people who are more seriously affected, is also going to work for those who are more mildly affected.”