SAD seems to develop from inadequate bright light during the winter months. It is thought to be caused by a biochemical imbalance in the hypothalamus, the part of the brain which controls mood, appetite, sleep, temperature and sex drive. When light enters the eye, it stimulates nerve impulses to travel to the hypothalamus, but if less light enters the eye or there is a fault in the nerve pathway, hypothalamus activity is affected and so are the functions it controls.
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Light therapy has been proved effective in up to 85 per cent of diagnosed cases. Light therapy involves spending up to four hours per day exposed to light that is at least ten times the intensity of domestic lighting. You can sit in front of a special 'light' box, allowing the light to reach your eyes. The light box should be used in dull periods in summer and daily from early autumn when symptoms first appear. You don't need to stare at the light and can just glance at it from time to time while your reading, working or eating. Treatment is usually effective within three to four days and the effect continues if it is used every day. Evidence also points to the value of dawn simulation devices that gradually mimic the progressive presence of dawn prior to a person’s waking.
Light boxes and dawn simulators are not available on the NHS and cost between £60 and £400 from specialist retailers. You should try light treatment before buying - several companies offer a home trial or hire scheme - see the list of organisations. In addition to light therapy, research is being carried out into the positive effect of negative ions which are found in high concentration at the seashore and in lower concentration indoors in Winter.
Antidepressant drugs may be prescribed for people with severe SAD, although more traditional antidepressants may increase feelings of sleepiness and lethargy. Newer drugs have been found to be more helpful and can be combined with light treatment.
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Accept that you don't cope as well in winter and try and organise your life accordingly. Prioritise what needs to be done at home and work and try to do the minimum during winter - leaving any major projects until the summer. Also use the spring and summer months to plan ahead - stocking up the freezer, buying Christmas presents and socialising. Make the most of the natural light that's available by getting out of doors, decorate your home in light colours and aim to be near windows in shops, cafes and your work place.
Try to continue doing the things you enjoy and if possible, consider taking a holiday to somewhere bright and sunny in January or February but remember that some people have felt much worse on returning to the UK gloom after spending time in very bright sunshine.
Exercise and good nutrition are known to have a positive impact on mental health and well-being, try to make sure you exercise regularly and eat a balanced diet that includes lots of fresh fruit and veg and keep alcohol intake to a sensible level. More information about our exercise campaign and our food and mental health campaign.
Remember that there is an end in sight, but if your symptoms continue for two weeks or more and are having an effect on your ability to function normally see your GP.
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It can sometimes be difficult living with a person with SAD, but you need to accept that they really do feel awful during the winter months. Realise that they have no control over their behaviour and never imply that they are lazy or aren't trying hard enough. Help your friend or family member to get as much done during the summer and encourage them to use their light or other treatment at the first signs of lethargy. Be sensitive to their needs and don't force them to do things they are really not up to. Above all, be patient and caring and look forward to better times in the spring.
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Written in 2000
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