|
|
||
S.A.D.Seasonal
Affective Disorder
(SAD syndrome, Seasonal Adjustment Disorder, Seasonal Affected Disorder or just SAD Disorder. Also the terms Winter Depression or Winter Blues are also sometimes used, especially when describing the milder types of SAD).
Animals react to the changing seasons with changes in mood, metabolism and behaviour and human beings are just the same. Most people find they eat and sleep slightly more in winter and dislike the dark mornings and short days. For some, however, symptoms are severe enough to disrupt their lives and to cause considerable distress. These people are suffering from SAD. SAD (Seasonal Affective Disorder) is a type of winter depression that affects an estimated half a million people every Winter between September and April, in particular during December, January and February. It is caused by a biochemical imbalance in the hypothalamus due to the shortening of daylight hours and the lack of sunlight in winter. For many people SAD is a seriously disabling illness, preventing them from functioning normally without continuous medical treatment. For others, it is a mild but debilitating condition causing discomfort but not severe suffering. We call this subsyndromal SAD or 'winter blues.' Seasonal affective disorderIntroductionSeasonal Affective Disorder (SAD) is a type of depression or mood disorder with a seasonal pattern. The most common form of SAD is also called winter depression or winter blues, because symptoms are worst in the winter months. They tend to start from around September, are worse when the days are shortest (in December, January and February) and improve in the spring. There is also a summer version of seasonal affective disorder, but this is far less common and has different symptoms. Sufferers have to endure most of the following:
Seasonal affective disorderSymptomsSAD can be a disabling illness. Without treatment, people with SAD can find it difficult to live a normal life. Sub-syndromal SAD or 'winter blues' is a milder condition, but it can still have a major effect on how people feel and act. Symptoms of SAD include:
Feelings of depression, hopelessness, or despair; and Stress and anxiety. A small number of people also experience a short period of hyperactivity in the spring. The standard figure says that around 2% of people in Northern Europe suffer badly, with many more (10%) putting up with milder symptoms (sub-syndromal SAD or the Winter Blues). Across the world the incidence increases with distance from the equator, except where there is snow on the ground, when it becomes less common. More women than men are diagnosed as having SAD. Children and adolescents are also vulnerable. Around 1 in 50 people in the UK have SAD. It is more common in women than in men and most commonly starts between the ages of 18 and 40. Up to 1 in 8 people in the UK experience milder symptoms of winter blues (sub-syndromal SAD). Studies around the world have shown that SAD becomes more common the further you are away from the equator. This suggests that SAD is linked to the change in the number of daylight hours through the year. The problem stems from the lack of bright light in winter. Researchers have proved that bright light makes a difference to the brain chemistry, although the exact means by which sufferers are affected is not yet known. The cause of SAD is not fully understood, but is thought to be linked to reduced exposure to light during the winter months. Researchers have shown that bright light makes a difference to brain chemistry, but it is not clear exactly what the effect is. One theory is that light stimulates a part of the brain called the hypothalamus, which controls mood, appetite, and sleep. In people with SAD, lack of light and a problem with certain brain chemicals prevents the hypothalamus from working properly. Melatonin, a sleep-related hormone released in the brain, has also been linked to SAD. This hormone is thought to cause symptoms of depression and is produced at increased levels in the dark. SAD may also have a genetic cause. It has been shown that you are more likely to develop SAD if you have a close relative who has it. Amount of sunlight SAD may be related to changes in the amount of daylight during the autumn and winter. The amount of sunlight affects the levels of certain chemicals and hormones in the brain. A chemical called serotonin plays a role in 'lifting' the mood. It is thought that people with SAD may have abnormally low levels of chemicals such as serotonin in winter.(3) A hormone called melatonin 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 than people without SAD.(3) However, drug treatments designed to suppress the secretion of melatonin do not stop the symptoms of SAD so this is not the only factor. Genetics Research has shown that if you have a close relative with SAD, you are more likely to develop it.(1,2) Low serotonin levels Neurotransmitters carry the messages to the brain. There are several neurotransmitters involved in SAD, but the main one is serotonin. Levels of serotonin have been found to be lower in depressed people, in winter. It’s thought that this neurotransmitter might not work properly in people with SAD. Low melatonin levels After reaching the hypothalamus, nerve impulses travel to a tiny organ behind it called the pineal gland. While it’s dark, the gland produces the hormone melatonin, which makes us sleep. Light stops melatonin production, so we wake up. People with SAD have been found to produce much higher melatonin levels in winter than those who don’t have SAD symptoms, but their summer levels are normal. When treated with bright light, melatonin levels drop to normal. However, suppressing melatonin doesn’t cure the symptoms, so this factor isn’t likely to be the sole cause of SAD. Disrupted body clock Another possibility is a problem affecting the nerve pathways in the brain. A faulty suprachiasmatic nucleus (SCN) along one of these routes could slow the body’s clock (circadian rhythm), causing lethargy and depression. The delayed circadian rhythms can be ‘reset’ with bright light in the morning, and this alleviates the symptoms of SAD. However, light treatment seems to work whatever the time of day it’s used, so this can’t be the only explanation. As the cause is lack of bright light, the treatment is to be in bright light every day by using a light box or a similar bright light therapy device. (Going to a brightly-lit climate, whether skiing or somewhere hot, is indeed a cure). The preferred level of light is about as bright as a spring morning on a clear day and for most people sitting in front of a light box, allowing the light to reach the eyes, for between 15 and 45 minutes daily will be sufficient to alleviate the symptoms. The user does not have to stare at the light, but can watch TV or read or similar, just allowing the light to reach the eyes. Light therapy FAQ Is anything special about the light? The light must be suitably bright. At least 2500lux (lux is the technical measure of brightness) is needed, which is five times brighter than a well-lit office (a normal living room might be as low as 100lux); brighter lights up to 10,000lux work quicker. The lightbox must deliver the lux at a sensible distance, so you don't have to be sat too close to it. Contrary to the old belief the light does not need to be special daylight, colour matching or 'full spectrum' light; simply changing the lamps in a room to these special types will not produce sufficient light. Light therapy has been shown to be effective in up to 85 per cent of diagnosed cases. That is, exposure, for up to four hours per day (average 1-2 hours) to very bright light, at least ten times the intensity of ordinary domestic lighting. Ordinary light bulbs and fittings are not strong enough. Average domestic or office lighting emits an intensity of 200-500 lux but the minimum dose, necessary to treat SAD is 2500 lux, The intensity of a bright summer day can be 100,000 lux! Light treatment should be used daily in Winter (and dull periods in summer) starting in early Autumn when the first symptoms appear. It consists of sitting two to three feet away from a specially designed light box, usually on a table, allowing the light to shine directly through the eyes. The user can carry out normal activity such as reading, working, eating and knitting while stationary in front of the box. It is not necessary to stare at the light although it has been proved safe. Treatment is usually effective within three or four days and the effect continues provided it is used every day. Tinted lenses, or any device that blocks the light to the retina of the eye, should not be worn, Some light boxes emit higher intensity of light, up to 10,000 lux, which can cut treatment time down to half an hour a day. Light boxes are not available on the NHS and have to be bought from specialist retailers; they are now free of VAT and start at less than £100. Antidepressant drugs Traditional antidepressant drugs such as tricyclics are not usually helpful for SAD as they exacerbate the sleepiness and lethargy that are symptoms of the illness. The non-sedative SSRI drugs such as sertraline (Lustral), paroxetine (Seroxat) and fluoxetine (Prozac) are effective in alleviating the depressive symptoms of SAD and combine well with light therapy. Other psychotropic drugs e.g. lithium, benzodiazepines have not proved widely useful in the treatment of SAD. Daily exposure to as much natural daylight as possible, especially at midday, should help. Psychotherapy and Counselling Psychotherapy, counselling or any complementary therapy which helps the sufferer to relax, accept their illness and cope with its limitations are extremely useful. Complementary therapies that have a relaxing effect, such as massage and acupuncture, may also be helpful. The herbal remedy St Johns Wort is thought to be helpful in relieving some of the symptoms of SAD - but you should always consult your GP or pharmacist before taking it, as it can interfere with other drugs such as the contraceptive pill.
Diet
Diet can greatly improve SAD because the aforementioned serotonin is
made from amino acids called tryptophan. this means you effectively can
boost your levels of this serotonin by eating tryptophan rich foods.
The best natural sources of tryptophan can be found in fish, turkey,
chicken, bananas, milk, eggs, nuts, and avocados.(Taking extra vitamin 12 can also be of help, as can monitoring levels of zinc and potassium). What else can I do to help myself?
We know that being outdoors throughout the winter isn’t a cure, because
many farmers and outdoor workers have SAD. But, it’s still worth making
the most of the available light. Go outdoors in natural daylight as
much as possible, especially at midday and on bright days. Inside the
home, choose pale colours that reflect light from outside. Sit near
windows, when you can.Try to avoid putting yourself under stress. Pay attention to the messages that your mind and body are sending you that winter is a time to take it easier and go into hibernation. Even if you can’t curl up in bed and sleep for six months, you can simplify your life in winter. Be ruthless about which tasks can be left until summer, especially major upheavals, such as changing jobs, moving home, extra housework and decorating or repairs. Plan ahead for the winter. Buy Christmas presents, stock up store cupboards and give parties in the summer, when you want to. You need to keep active during the winter, but with routine stress-free activities that don’t require too much concentration or drain your energy. There’s plenty of evidence to show how good physical activity is for mental wellbeing, and for helping with problems such as depression. One research study showed that a daily one-hour walk, in the middle of the day, could be as helpful as light treatment for coping with the winter blues. A healthy diet is also important, and you should try to balance the SAD craving for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables. Some people find that taking extra vitamin B12 is helpful. Pamper yourself physically with a massage, or learn how relaxation exercises can help you unwind. ( Look into the benefits of complementary medicine as an option. St John’s wort is a popular herbal remedy available over the counter in the UK. There is some evidence that it is an effective treatment for mild to moderate depression. This would be appropriate for the winter blues, although not for severe SAD. (Some people have reported positive benefits, but others have found it causes long-term, negative side effects, including over-sensitivity to light, which prevents them using light therapy. It is possible that it may react with antidepressants. The UK Government Committee on the Safety of Medicines warns people not to use St John’s wort when taking certain other prescription or non-prescription medicines, including oral contraceptives.) There is only one permanent cure for SAD, and that is to live within 30 degrees of the equator. Failing that, think about taking a holiday in sunny places during the winter. Southern Spain and the Canary Islands would both be good options. Or go skiing and benefit from the extra brightness of light reflected off the snow. One word of caution; some people with SAD have become much worse on returning to the UK gloom after very bright sunshine in places such as Africa. It seems that the contrast in light levels can do more harm than good sometimes, so consult your doctor or the SADAssociation if you have any doubts. Think about joining a support group, or setting one up locally. Sharing your experience with others who know what it’s like is very therapeutic. Knowing that you are not alone and that help is available can make SAD much more bearable. Get as much support as possible from your family and friends. Tell them about the condition, so they know what to expect and how to help. Find a supportive GP. How can family and friends help? It’s not always easy to live with someone who has SAD. It’s like being with two different people, one who is lively, cheerful and energetic, during the summer, and the other who is sleepy, morose and irritable, during the winter. In summer, he or she can be hard to keep up with; in winter, you won’t get much response from him or her. Try to accept that your friend or family member feels awful. They aren’t being lazy, or not making an effort. They sleep because they have to; they can’t help it. Being hostile about it or teasing them is likely to make things worse. Having SAD is no joke; it’s been described as feeling half dead, half your life. Sometimes, it can drive people to suicide. Offer practical assistance, if you can. It’s important to get treatment and other matters organised during the summer, because once winter comes, someone with SAD soon finds apathy taking hold. As soon as you notice signs of lethargy, encourage the person to start their treatment programme and to stick with it. If they are using light treatment, build it into daily life. If the person needs an hour’s light before going to work or school, make sure other chores or responsibilities don’t interfere. Help them to pace themselves, and be sensitive about making too many demands on them (such as inviting a houseful of guests to stay). In the long run, it’s in nobody’s interest if they become more stressed. It can be very upsetting when someone is constantly irritable and seems unwilling to give or accept love. Relationships can be strained to breaking point if one partner feels it’s all too one-sided. Hard though it might be to imagine or understand, being depressed can be emotionally paralyzing. Someone in the grip of it may be unable to feel happy, caring and loving in the usual way. Whatever it may seem, they are not deliberately rejecting you. They may be desperate for love and care, and yet not able to accept it, when it’s offered. Be patient, but insist they get treatment. You can then both look forward to better times. mind.org.uk advice: A GP is a good first point of contact. He or she will ask about your day-to-day life and symptoms. One bout of the "winter blues" doesn't automatically mean you have SAD. But, if you have regular symptoms over at least two consecutive years in autumn/winter which clear in the spring, the diagnosis may be SAD.(1,2) Your doctor may also want to rule out other forms of depression. It can sometimes be quite difficult to tell the difference between SAD and other types of depression. It may not be immediately obvious that the symptoms are linked to changes in the seasons, as people with non-seasonal depression can also have repeated cycles of symptoms worsening and improving, but for different reasons. It is therefore important to try to spot the pattern of symptoms always appearing in the winter months, and disappearing in the summer on their own, not as a result of treatment. It usually takes at least two years to show this pattern clearly. Institute for Complementary Medicine (ICM) PO Box 194, London SE16 7QZ tel. 020 7237 5165 web: www.icmedicine.co.uk Outside In (Cambridge) Ltd. Unit 31, Scotland Road Estate, Dry Drayton, Cambridge CB3 8AT tel. 01954 211 955 web: www.outsidein.co.uk SADAssociation PO Box 989 Steyning BN44 3HG England http://www.sada.org.uk Registered charity: No. 800917 sad-lighting.co.uk Unit 12 Beech Close Wootton Oxfordshire http://www.sad-lighting.co.uk OX13 6DQ References http://hcd2.bupa.co.uk 1 Seasonal affective disorder. NHS Direct Health Encyclopaedia. www.nhsdirect.nhs.uk accessed 24 November 2005. 2 Seasonal affective disorder (SAD). UK Department of Health. PRODIGY. www.prodigy.nhs.uk accessed 24 November 2005. 3 Understanding seasonal affective disorder. Mind. www.mind.org.uk accessed 24 November 2005. See also Mental Health day the news Oh Nuts Happiness Nutrigenomics and tailor-made diets |
||
| meditations |
top |
|