SAD INFORMATION SHEET

S.A.D.
Seasonal Affective Disorder
	Seasonal - changes with the seasons
	Affective - the way you display yourself to other people, the sort of face you put on
	Disorder - needs fixing
Winter Depression
The Winter Blues

WHAT IS SAD? 
SAD stands for Seasonal Affective Disorder.
Animals react to the changing season with changes in mood and behaviour and human beings are no exception. Most people find they eat and sleep slightly more in winter and dislike the dark mornings and short days. For some, however, symptoms are severe enough to disrupt their lives and to cause considerable distress. These people are suffering from SAD.

HOW DOES IT AFFECT PEOPLE?
Sufferers have to endure most of the following:
Sleep Problems - oversleeping but not refreshed, cannot out of bed, needing a nap in the afternoon
Overeating - carbohydrate craving leading to overweight 
Depression - despair, misery, guilt, anxiety, normal tasks become frustratingly difficult, hopelessness 
Family problems - avoiding company, irritability, loss of libido, loss of feeling 
Lethargy - too tired to cope, everything an effort 
Physical Symptoms - often joint pain or stomach problems, lowered resistance to infection
Behavioural problems - especially in young people 

The symptoms tend to start from around September each year, lasting until April but are at their worst in the darkest months.

WHO DOES IT AFFECT?
The standard figure says that around 2% of people in Northern Europe suffer
badly, with many more (10%) putting up with milder symptoms (sub-syndromal
SAD or the winter blues). Across the world the incidence increases with
distance from the equator, except where there is snow on the ground when it
becomes less common. More women than men are diagnosed as having SAD.
Children and adolescents are also vulnerable.

WHAT CAUSES IT? 
The problem stems from the lack of bright light in winter. Researchers have
proved that bright light makes a difference to the brain chemistry,
although the exact means by which sufferers are affected is not yet known.
It is not a psychosomatic or imaginary illness. Certainly bright light will
suppress the production of the hormone Melatonin by the Pineal Gland in the
brain.  It now seems likely that bright light also improves the levels of
the neurotransmitter Serotonin (5HT).  Very recently (September 1995) some
researchers have started to produce evidence that SAD sufferers have low
levels of Serotonin in Winter.  (No-one has found a way of sampling these
substances in the brain for obvious reasons, so the researchers have to
rely on inference and deduction for much of their work; however various
clever placebo controlled trials have been devised, which taken with the
obvious, and often dramatic effectiveness of treatment has satisfied anyone
who has taken a close look that this is a real phenomenon.) Melatonin taken
orally has the effect of making you drowsy.  Serotonin in effect transmits
the signals from one nerve ending in the brain to the next; Serotonin is
the substance affected by the new SSRI drugs (Prozac etc etc) These
substances and organs are connected to the "body clock" an area of the
brain which regulates sleeping, eating and many other functions which vary
on a daily rhythm, and some researchers believe that one aspect of the
problem is explained by the sufferer's body clock losing regulation and
drifting "out of sync".

WHAT TREATMENT IS THERE?
As the cause is lack of bright light, the treatment is to be in bright
light every day by using a light box or a similar bright light therapy
device. (Going to a brightly-lit climate, whether skiing or somewhere hot,
is indeed a cure). The preferred level of light is about as bright as a
spring morning on a clear day and for most people sitting in front of a
light box, allowing the light to reach the eyes, for between ? and ? hour
daily will be sufficient to alleviate the symptoms. The user does not have
to stare at the light, but can watch TV or read or similar, just allowing
the light to reach the eyes. For some people a "dawn simulator" (a light
which comes on gently in the morning, mimicking a natural sunrise) is a
suitable (and certainly a very civilised) solution. Drug treatments using
an SSRI drug are often helpful.  Alternative anti-depressant drugs are not
advised.  Finding the correct dose can take some time and persistence is
often called for.

IS THERE ANYTHING SPECIAL ABOUT THE LIGHT?
The light must be suitably bright. At least 2500lux (lux is the technical
measure of brightness) is needed, which is 5 times brighter than a well lit
office (a normal living room might be as low as 100lux); brighter lights up
to 10,000lux (about as bright as an early spring morning) work quicker.
2500lux is approximately the level of light needed to take a photograph
without using a flash (with an ordinary low cost camera and film). Contrary
to the old belief the light does not need to be special daylight, colour
matching or 'full spectrum' light; simply changing the lamps in a room to
these special types will not produce sufficient light.

SHOULD I TALK TO MY DOCTOR?
Of course.  There are a number of specialist NHS clinics in the UK, less in
other European territories.  North America has many therapists with
experience; members of SLTBR (Society for Light Treatment and Biorhythms
Research) are likely to have most knowledge.


Steve Hayes 100341.3413@compuserve.com 
further information
http://www.outsidein.co.uk/bodyclock
http://nyx10.ss.du.edu:8001/~lpuls/sadhome.html