Tue, Sep-03-13, 07:38
The happy news about Seasonal Affective Disorder
From The Times
3 September, 2013
The happy news about Seasonal Affective Disorder
Millions claim to have Seasonal Affective Disorder but new research suggests figures are exaggerated
When Beverley Bunting moved from sunny Australia to wintry Southport, Merseyside, she quickly began to fall into despair. She also put on a stone and a half, thanks to a new craving for sweets. “I used to get winter cravings for chocolate and biscuits,” she says. “I wondered what was the matter with me. I felt miserable. I was tired all the time. In the summers, I felt fine.”
For years, Bunting blamed the problem on her busy life — “I had a lovely young family, but bringing up three children in winter could be such a strain.”
Four decades on, Bunting 60, believes the dread that accompanied the end of summer was not due to child-rearing but was Seasonal Affective Disorder, or SAD. She says she is a serious sufferer of SAD, like millions of people in the UK. Her life improved only after her husband bought her an early version of a light-box which mimicked full-spectrum daylight. Instantly, she says, her dark winter moods dissipated. “I hadn’t made the link to the seasons before,” she adds. “No one really knew about SAD then. Nowadays everyone knows about it.”
Awareness of SAD has grown phenomenally. Last February, the Seasonal Affective Disorder Association (SADA) reported that more people than ever were complaining of crippling bouts of the condition. Yet some experts believe that mild versions of SAD symptoms — negative thoughts, oversleeping, fatigue, irritability, cravings for carbs and sweet foods, and feelings of guilt and low self-esteem — may be simply an inclination to feel grumpy at dark mornings and grim weather rather than a clinical illness.
The idea is supported by research at Oregon State University in America, which claims clinically diagnosable SAD is rare and that the issue has become exaggerated. A study of almost 800 people, published by the Journal of Affective Disorders , concluded that neither the time of year nor the weather greatly influenced symptoms of clinical depression in most people. “We may not have as much fun in winter”, says David Kerr, who led the study, “but that’s not the same as real clinical depression.”
Kerr’s team asked its subjects to report the depressive symptoms they could remember over several years. Nine in ten people reported seasonal changes in mood and almost three in ten said these were a problem, but by comparing the reports with weather records, including intensity of sunlight, the study found that cold, grey weather was far less significant than expected. Dr Kerr said his findings do not rule out the existence of clinically diagnosed SAD but show that people may be overestimating the effect the seasons have.
SAD quickly took hold of the public imagination — and perhaps that snappy acronym is partly responsible. It was created by Norman Rosenthal , who identified the clinical problem in 1985. Rosenthal, a South African psychiatrist and scientist at the US National Institute of Mental Health, also pioneered the use of light therapy to treat the condition. He then publicised the disorder with bestselling books such as Winter Blues: Seasonal Affective Disorder — What it is and How to Overcome It.
As a follow-up, Rosenthal also publicised “spring fever”. In 1989, he claimed that this involves “sex drives and energy levels surging for many people”. It didn’t catch on in the way that SAD has.
Few people seem to consider spring fever a debilitating problem requiring clinical assistance. Nor is spring fever likely to create a new therapeutic industry, unlike SAD.
Beverley Bunting’s literal “light-bulb moment” came because her husband, a pharmacist, was becoming disturbed by the increasing number of people being sent to him by GPs clutching prescriptions for antidepressants for SAD. When the Buntings found that a light-box could alleviate Beverley’s symptoms, they started a business, renting similar gadgets to people with the winter blues. The company, SAD Shop, still does good business — despite a welter of competitors joining the market — selling light boxes for up to £800 each.
“We started with only six different light boxes. That was all that was available,” Bunting says. “Now there are hundreds on the market.” The Scandinavians have taken to light therapy and they produce beautiful light boxes that are treated as home furnishings. “For the vast majority of people, light boxes are a therapy that has no side-effects,” she adds. “Unfortunately for some people who suffer migraines, it can bring on the headaches.”
There are controversies: a scientific row has broken out over one invention, the Valkee, a Finnish-made headset that shines a bright light into the wearer’s ears. It sells in the UK for £165. The makers say that a pilot study at the University of Oulu shows that light in the ear canals can illuminate regions of the brain and ward off the effects of SAD. They claim the Valkee, when used for only six to 12 minutes a day, gives users greater energy and fewer mood swings.
The gadget was the subject last year of MOT, Finland’s equivalent of the BBC’s Panorama, which said the Valkee performed no better than a placebo in clinical tests. The device also won the 2012 HuuHaa (flim-flam) award from a panel of Finnish sceptical scientists, who claim that evidence to back the makers’ claims is lacking. The makers, however, say their gadget has proper scientific underpinnings.
There are also questions over the prevalence of the disorder. SADA claims that 7 per cent of Britons are affected by SAD. However, Chetna Kang, an expert on depressive disorders at the Royal College of Psychiatrists, argues that the figure is about 3 per cent. This is still substantial, meaning that about two million people are sufferers.
There are several reasons why SAD may be over-diagnosed (or indeed, self-diagnosed). Kang explains: “People often have winter blues that is not actually clinical depression,” she says. “In the winter, it is natural for it to feel harder to get up in the morning. SAD has been given a lot of publicity so it is popular to blame such feelings upon it.”
Kang says that Britain has no separate category for SAD when a diagnosis is made, and it is put in the same bracket as recurrent depressive disorders. “There may be some atypical symptoms with SAD,” she says. “In depression people usually suffer from poor sleep and low appetite, but with SAD people may sleep and eat a lot more. It is almost like the body going into a state of hibernation.”
She says l ight boxes can be effective, “but if your condition is indeed severe enough to be diagnosed as SAD, then a course of antidepressants, such as sertraline, can be appropriate”. She adds: “Cognitive behavioural therapy (CBT) can also help, particularly for getting people out of negative thinking which can perpetuate the depression.” Most of all, she says, we should do our best to be exposed to daylight in the winter.
Such advice should be adopted by everyone, whether or not they believe they suffer from SAD. Natural sunlight is thought to affect everyone’s health and studies have shown that rates of kidney cancer, non-Hodgkin’s lymphoma and prostate cancer are all lower in men whose jobs keep them out of doors. Natural light can also reduce the prevalence and symptoms of multiple sclerosis, too, according to the Proceedings of the National Academy of Sciences.
Beverley Bunting is one person who will not be surprised to learn that a lack of sunlight may be related to obesity. An Aberdeen University study of 3,100 women in the northeast of Scotland, where one in five people is overweight, found that the clinically obese have 10 per cent less vitamin D than those of healthy size. “The link is significant,” says Helen Macdonald, of Aberdeen University. “We think that obese people are not getting enough sunshine.”