Monday 26 February 2018

Dear Dr Grant: How can I keep depression at bay over long, dark winter?

SAD (Seasonal Affective Disorder) is when a major depressive episode begins in early winter
SAD (Seasonal Affective Disorder) is when a major depressive episode begins in early winter

Dr Jennifer Grant is a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dear Doctor Grant, 

I know the evenings are still bright but I have a history of depression and I always get nervous around this time of year as I worry that the autumn and winter will herald a major dip in my mood. It doesn't happen every year and it's not exclusive to winter - but I have been more prone during this time of year as opposed to summer. I just wonder if you can tell me what I might think about doing now to help keep my mood steady.

A: Considering you have a history of depression you likely have suffered from some or all of the following symptoms; pervasive low mood, loss of interest in doing things, fatigue, sleep disturbance often with early morning wakening, feelings of guilt or hopelessness and a change in your weight or appetite. These symptoms are all too common and unfortunately some people can delay seeking help. So I applaud your willingness to try to target these symptoms before they become overpowering.

The history you give is not typical for seasonal affective disorder (SAD) as you mentioned your low mood is not exclusive to winter. SAD is when a major depressive episode begins in early winter and, if left untreated, generally remits during the following spring. These episodes are often characterised by increased sleep, increased appetite, and weight gain (symptoms that can also be found in depression).

One effective strategy is to try cognitive behavioural therapy (CBT). This is a non-pharmacological treatment that can be adapted for SAD and involves twice-weekly sessions with a clinical psychologist or counsellor. Pharmacotherapy includes antidepressant tablets that have been proven to work very well in the right circumstances.

More simple techniques include regular exercise (brisk walking, running, or cycling) or resistance training (weight lifting) three to five times per week for 45 to 60 minutes per session. Relaxation techniques such as yoga or mindfulness can also assist in the management of depression or SAD. Going to bed early, not watching TV or using digital devices with blue light in the bedroom, daily walks outdoors, enhanced indoor lighting and waking from sleep with a light timed to come on in the bedroom will also help you combat your low mood. Don't be afraid to seek help (as you have done in the past) if these techniques are just not enough.

Herald

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