Patricia Casey: 'It's that time of year when dark days mirror how we're feeling'
The clocks have gone back and the evenings are shorter. Most of us are bemoaning the gloom of the long nights, especially when contrasted with the beautiful, balmy summer evenings of 2018. And it is from now on that those with seasonal affective disorder (SAD) will also experience their sadness - a type of depressive illness which evolutionary biologists say is analogous to the winter hibernation of some animals.
The comparison may be appropriate since SAD, if not treated, remits spontaneously when spring approaches, similar to the emergence of animals after their long sleep. The problem for humans engaged in hibernation is that we have to feed families, care for our loved ones, work and keep a home.
So the impact of several months inactivity in winter, when we are most needed to protect the very lives of those around us, is grave. There is also the risk of suicide during the depressed phase. It is for these reasons that SAD is treated rather than being left to resolve naturally.
The term was first used in 1984 at a seminar held at the US National Institute of Mental Health in Bethesda, Maryland, although the symptoms were first mentioned in scientific literature in the late 1800s by Emil Kraepelin, the man who "discovered" schizophrenia. The term SAD was used in a paper discussed at the 1984 meeting, which included some sufferers. The lead author of the paper was psychiatrist Norman Rosenthal. A South African, he moved to the US and he and his wife noticed the profound effect that the seasonal changes had on their mood compared to in their native country. He suffered with this condition.
This seminal paper presented all the research that led to the identification and naming of the condition, as well as its causes. These included changes to the body's daily biological rhythms (circadian rhythms) and the role of melatonin, known as the timekeeper hormone. It also discussed the role of artificial light therapy and medication. Little in this original understanding has changed since then.
Light therapy is the favoured treatment of many, as it appears more natural, although it does involve sitting in front of the lamp for 30 to 120 minutes each day, with best results reported from morning exposure. The lamp must be designed specially for this treatment; UV or tanning lamps are ineffective. Walking in the morning, resulting in exposure to the early sunlight, may also assist. Some use antidepressants as an adjunct to this during the winter months.
It is also possible to institute antidepressants a few weeks prior to the usual onset of the person's depression to prevent recurrence. In my professional experience this strategy can be very helpful and minimise, or even eliminate, the need for light therapy. Talking therapies may help.
SAD must be distinguished from the common winter-blues that many of us are experiencing just now. SAD is characterised by severely depressed mood, inertia, sleepiness and over-eating. Like all those with depressive illness, suicidal thoughts may be present and suicide is a risk during the symptomatic period.
There are still questions asked by some psychiatrists about the reality of SAD and whether it differs from other subtypes of major depression. This has led to SAD activism by those with the disorder.
Witness seminars continue to be held to discuss the personal stories and the ongoing scientific exploration into those with winter depression. Queen Mary's Hospital, London, is one such venue where luminaries such as Rosenthal still attend to give testimony, personal and scientific, to the reality of SAD.