Autumn leaves mark onset of blues

Mental Health Nursing,  Nov 2003  by Barraclough, Carly Marie

• E-mail
• Print
• Link

The onset of autumn, Keats' 'season of mists and mellow fruitfulness', is no such poetic delight for an estimated half a million of the UK population. To them, it marks the start of a long haul to the songs of spring. Shorter, sunless days herald a drift into a seasonal pattern of depressive mood disorder, or 'seasonal affective disorder' (SAD). Carly Marie Barraclough reports

Research commissioned by MIND last year provides an interesting snap shot of the impact that the winter months have on the mental health of the nation. Of the 1060 adults (aged 16 and above) questioned as part of the survey, 35 per cent said they feel more depressed or anxious at that time of year, (40 per cent of this proportion were single people compared with 29 per cent, couples). Forty five per cent feel like 'hibernating', (50 per cent of women compared to 41 per cent of men). Moreover, 25 per cent of 16 to 24 year-olds questioned said they tend to drink more alcohol in winter with 53 per cent of 16 to 24 year-olds saying that they eat more. Previous MIND research, as part of the MIND Week Survey 2000, corroborates these figures and also reveals that December and January are the bleakest months, followed by February and November.

More recently, a research study published in The British Journal of Psychiatry (Michalak E et al, 2003) was carried out with the aim of determining the association between demographic/psychosocial factors and increased reported seasonal patterns of mood disorder ('seasonally') and SAD in a community sample in the UK. The results found that an association between seasonality, negative life events (such as illness or unemployment) and social support could be made. The findings also showed that it was only gender - being a woman - that was predictive of actually being diagnosed with SAD.

The 'winter blues' is a fairly common phenomenon - a dislike of dark mornings and a tendency to eat and/or sleep more - but for those that suffer in the extreme form, SAD is a disturbing, depressive illness that can prevent them functioning normally without continuous interventions and treatment. The symptoms of SAD cover a range of behavioural, physical and medical presentations and those affected will show a combination of these in varying degrees.

In addition to these symptoms, a study carried out by Eagles et al (2002), looked at the uptake of health care services for patients diagnosed with SAD. The study was able to conclude that patients with SAD are heavy users of health care services and presented with a wider variety of symptoms than the 'non-seasonal' controls, received more prescriptions, with more investigations and referrals to secondary care. Data of specific symptoms presented over a five-year period more often by patients with SAD than the controls (adding to the table of symptoms, left) includes pain, panic and palpitations.

Treatment for SAD can range from common sense, self-help advice to light therapy, using a range of specially developed products.

MIND, which has produced a booklet Understanding seasonal affective disorder, gives several tips to help those with milder forms of SAD. Keeping up your 'light quota', by getting outdoors to make good use of the small amounts of light can be beneficial as can paying attention to general physical and mental health - while leaving any major tasks for a later date. Establishing a good balance of exercise and nutrition can help and going on holiday - if possible - can ease symptoms, although some people may find they become worse on returning to the UK.

Light therapy has been proved effective in diagnosed cases of SAD (Wileman et al, 2001). For most people, using a light therapy device for between half to three-quarters of an hour daily - in order to replicate daylight - will be sufficient to alleviate the symptoms. Treatment is usually effective within three to four days and the benefits continue providing the light therapy is used every day.

Ordinary light bulbs and fittings are not strong enough - they generally emit an intensity of 200 to 500 lux, whereas the intensity of a bright day in summer can be 100,000 lux. Light therapy can come in the form of light boxes, which can be used at a normal working distance, allowing light to shine directly through the eyes. Other sufferers may find a natural alarm clock helpful. These mimic a natural sunrise allowing the user to wake up with gradually increasing light so the body gets going even before they are fully conscious, and the user wakes up feeling alert and positive. The clock can also be used at night to fade down at night, giving the body a signal to wind down.

Some 'traditional' antidepressant drugs, such as tricyclic, the SAD Association argues, are not especially helpful when treating SAD as they can exacerbate the sleepiness and lethargy that are the symptoms of the disorder, although non-sedative drugs that influence levels of serotonin, such as Prozac may help - especially when combined with light therapy or another self-help treatment.