Seasonal affective disorder

Researchers think that a lack of sunlight might stop a part of the brain called the hypothalamus from working properly. This affects:

• The production of melatonin. Melatonin is a hormone that makes you feel sleepy, and in people with SAD, your body may produce it in higher than normal levels.
• The production of serotonin. Serotonin is a hormone that affects your mood, appetite and sleep. A lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression.
• Your body's internal clock (circadian rhythm). Your body uses sunlight to time various important functions, such as when you wake up. Lower light levels during the winter may disrupt your body clock and lead to symptoms of SAD.

It's possible that some people are more vulnerable to SAD because of genes inherited from their whānau/family.

You may have SAD if during the winter months you:

• Have a low mood most of the time. You may experience this as feeling sad, low, flat or numb.
• Lose interest and pleasure in things you normally enjoy.
• Feel guilt or worthlessness.
• Sleep and eat more or less than usual.
• Don’t feel like seeing your friends and family.
• Have trouble concentrating.
• Notice that you move and think more slowly than normal.
• Think about dying.

If you have symptoms of SAD, it’s important to see your doctor before they get worse. Your doctor will ask you about your mood, sleep, eating, thoughts you’ve been having and whether you’ve had depression before. They may also recommend some blood tests. Because it is common for people who have had depression to get it again, it can take a few years for you and your doctor to work out if your symptoms are seasonal.

Your doctor will probably recommend antidepressant medication, psychological therapy or a combination of both. If your symptoms are more severe, they may also recommend light therapy. 

Psychological therapy

Cognitive Behavioural Therapy (CBT) is a type of talking therapy that helps you to use activities and thoughts to improve your mood. Research shows that CBT is an effective treatment for SAD. Ask your doctor to refer you to a psychologist or counsellor who is trained in the use of this effective therapy. Most New Zealand trained clinical psychologists are trained in CBT. You can search for a clinical psychologist(external link) near you.

Otherwise, you can use an online therapy programme like Beating the Blues or Just a Thought to beat SAD.

Light therapy

In light therapy, you sit by a special lamp called a light box for about 30 minutes to an hour each morning, shortly after waking, so that you're exposed to bright light. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

The recommended light boxes have filters that remove harmful ultraviolet (UV) rays, so there's no risk of skin or eye damage for most people. Research shows that light therapy is an effective treatment for SAD. 

When light therapy has been found to help, most people notice an improvement in their symptoms within a week or so. Ask your doctor about whether light therapy is an option for you and how to get a light box.

Another type of light therapy is called dawn stimulation. It involves a special kind of light that gradually brightens your room, mimicking the light at sunrise. This has also been found to work well for SAD.

Medicines

Antidepressants are often prescribed to treat depression, and they may also sometimes be used to treat severe cases of SAD. 

There are many different types of antidepressants, but the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, citalopram, escitalopram or paroxetine are preferred for treating SAD. They increase the level of the hormone serotonin in your brain, which can help lift your mood.

If you're prescribed antidepressants, you should be aware that:

• it can take up to 4 to 6 weeks for the medication to take full effect
• you may have to try different medications before you find one that works well for you and has the fewest side effects
• you should take the medication as prescribed and continue taking it until advised to gradually stop by your doctor
• some antidepressants have side effects and may interact with other types of medication you're taking.

Once you know that your symptoms of depression follow a seasonal pattern, you can use medication to prevent further bouts in winter. Research shows that the medication Bupropion is the most effective for preventing SAD before it kicks in during the winter months. Read more about antidepressants.

• spend time outside each day, especially early in the day
• keep moving, as exercise boosts your mood
• eat well, as healthy eating improves your energy and your outlook on life
• stick to a good  sleep routine by using these sleep tips 
• stay in touch with those closest to you
• find enjoyable things to do that don’t depend on good weather
• do an evidence based online depression therapy programme like Beating the Blues(external link) or Just a Thought(external link)
• get support (see below).

Read more tips for managing SAD.

Apps reviewed by Healthify

You may find it useful to look at some Mental health and wellbeing apps.

In the summer months, develop habits that you can carry over even in winter that make sure you spend time outside in daylight each day, particularly in the first half of the day. This could be to exercise outside when you get up in the morning, walk part of the way to work, go for a walk at lunchtime or have lunch outside wherever possible. On the weekend, keep up a regular outdoor activity, such as sport, gardening, going for a bike ride with a friend or playing in the park with your children. Bupropion is the only medication found to reliably prevent SAD.

Join a support group(external link) 
Find a counsellor or therapist(external link) 
Get help online at www.depression.org.nz(external link) or www.SPARX.org.nz(external link) 
Phone a helpline:

• Lifeline 0800 543 354 or (09) 5222 999 within Auckland
• Free counselling 1737 
• Suicide Crisis helpline 0508 828 865 (0508 TAUTOKO)
• Healthline 0800 611 116
• Samaritans – 0800 726 666
• Depression helpline – 0800 111 757 or free text 4202 (to talk to a trained counsellor about how you are feeling or to ask any questions).