Every winter, in particular during December, January and February, sometimes even as early as September and through to April, around 7% of the UK population and 6.1% in USA, are affected by SAD, whereas in some Nordic countries like Scandinavia and Iceland the occurrence is unexpectedly low.

This is caused by a chemical imbalance in the hypothalamus due to the lack of sunlight in winter and the shortening of daylight hours and is repeated year after year.

For many people this can be a seriously disabling illness, that prevents them from functioning normally without on going medical treatment. For others, it is a less severe, but still, debilitating condition causing discomfort and suffering, this is what is known as Subsyndromal SAD or 'winter blues.' It is thought that another 17% of the UK population have this milder condition.

Symptoms of Seasonal Affective Disorder may consist of: tendency to oversleep, difficulty waking up in the morning, to overreaction, a craving for carbohydrates, leading to weight gain, a lack of energy, difficulty with concentrating, and completing tasks, and a loss of interest in friends, family, and social contacts.

To sum up, symptoms of Seasonal Affective Disorder can be some or all of the following:

• Depression
• Sleep Problems
• Lethargy
• Over Eating
• Loss of Concentration
• Social Problems
• Anxiety
• Loss of Libido
• Mood Changes

All of this leads to the depression, and lack of pleasure which characterize a person suffering from Seasonal
Affective Disorder.

There have been various causes proposed for the occurrence of Seasonal Affective Disorder, one possibility is that Seasonal Affective Disorder is related to a lack of serotonin, another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland.

This gland produces the melatonin hormone in small quantities and then releases it into the blood stream. The release is triggered by periods of darkness or reduced sunshine, if higher than normal levels of melatonin are being released into the blood stream, then the amount of good quality sleep can be affected.

The 'winter blues' experienced by both Seasonal Affective Disorder and Subsyndromal Seasonal Affective Disorder sufferers can usually be lessened or extinguished by increased outdoor activity, particularly on sunny days, resulting in increased exposure to sun light. There are well documented connections between human moods, and energy levels, and the different seasons, even in healthy individuals. It has been suggested that Seasonal Affective Disorder is a remnant of a hibernation response in some remote ancestor, and if this interpretation is correct, Seasonal Affective Disorder would not be a dysfunction or disorder, as most psychiatrists assume, but a normal and expected response to the seasonal changes. Women tend to be more likely to be affected by Seasonal Affective Disorder than men.

Most sufferers experience some kind of major depressive disorder, but as many as 20% may go on to develop a manic-depressive disorder such as bipolar disorder.

It is very important to discriminate between the change in mood associated with recovery from the winter depression and a manic episode because there are important differences in the treatments.

Treatments?
There are several different treatments for the classic seasonal affective disorder, including bright light therapy, medication, Negative air ionization, and cognitive-behavioural therapy, a psychotherapeutic approach.

Bright light therapy has been shown to be effective in up to 85 per cent of diagnosed cases, and usually involves the use of a light-box.

Ordinary light bulbs and fittings are not suitable. The average domestic or office lighting usually emits an intensity of 200-500 lux, as opposed to the minimum dose necessary to treat SAD, of 2500 lux, The intensity of a bright summer day can be as much as 100,000 lux.

Bright light treatment should be used every day throughout winter, and even during prolonged dull periods in summer time. This normally means starting in early autumn or when the first symptoms appear, and it means sitting two to three feet away from a light box, which would usually be on a table, and allowing the light to shine directly into the eyes.

Normal activity such as reading, working, eating and knitting while stationary in front of the box, can be carried out, as it is not necessary to stare directly at the light.

Treatment usually takes effect within the first three or four days and then continues, provided it is used daily. Tinted lenses, should not be worn or any other device that blocks the light to the retina of the eye.

Some light boxes can emit higher intensity of light, some as high as 10,000 lux, which can reduce the treatment time needed to half an hour a day.

Light boxes have to be bought from specialist retailers, they are not available on the NHS, but they are free of VAT when used for medical purposes.

Negative air ionization, involves releasing charged particles into the air of the sleep environment, and has been found effective with as much as a 47.9% improvement when the negative ions are of sufficient density.

There are various medications useful in the treatment of SAD, which one is used depends on each individual case and their specific needs. Psychotherapy, counselling or any complementary therapy that helps the sufferer to relax, accept their illness and to cope with its limitations are extremely useful.

My personal observations on information and support for sufferers of Seasonal Affective Disorder who may not be fully aware of their problem and do not recognize the symptoms and are therefore missing out on the treatment that they could have.

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