ࡱ> `b_q` jSbjbjqPqP .d::jKdddddddx    $Dxv"jlLv.Dr$!!!!!!!$#hH&l"d"dd0"%%% dd!%!%%: ,dd!`   !F"0v" .''!!'d!((h%T "" v"xxx <xxx<xxxdddddd Understanding Seasonal Affective Disorder Why do we have seasonal mood changes? Most of us feel better when the sun is shining more cheerful and energetic. On grey, gloomy days, especially in winter, we tend to feel less enthusiastic, more inclined to stay indoors or even in bed, to do less work, to socialise less and to eat more. The reason for this is the change in the quality and quantity of light. As winter approaches, there are fewer daylight hours and so, by December, we often get up in the dark and come home from work or school in darkness. Whats more, the shorter winter days dont have the same light intensity that we get in summer. The cycle of light and dark determines our sleeping and waking patterns. Until the widespread use of electric light, people used to wake and get up with the dawn light and sleep when it became dark. In winter, people would sleep longer and be less active. Nowadays, we tend to override these natural rhythms and manipulate the hours of light and darkness to suit our sophisticated lifestyle. Many night-shift workers and jet-lagged air travellers suffer from disrupting their body clocks in this way. The effects of light Some people seem to be more affected than others by lack of daylight. When light hits the back of the eye (the retina), messages are passed to the part of the brain (the hypothalamus) that rules sleep, appetite, sex drive, temperature, mood and activity. If theres not enough light, these functions are likely to slow down and gradually stop, like a car that is running out of fuel. Some people seem to need a lot more light than others to keep them on the road, and these are the people who develop seasonal affective disorder (SAD), to a greater or lesser extent. What are the effects of SAD? People with SAD experience seasonal changes of mood and behaviour. The most common mood change is depression, a so-called affective disorder. Symptoms may start emerging between September and November and continue until March, April or even May. Around 20 per cent of cases are fairly mild, and are known as the winter blues, or sub-syndromal SAD, occurring mainly during December, January and February. But between two and five per cent of cases have severe SAD and cant function in winter without continuous treatment. Many find it difficult to study or hold down a job during this season, because they feel lethargic or sleepy and find it difficult to concentrate. Their relationships are put under strain, and even break up, because they become irritable, unloving and so less lovable. Nine out of ten people report that they eat and sleep more in winter and that long stretches of grey skies make them more down in the dumps. This is all perfectly natural. But for those with SAD, the symptoms are more severe, and happen regularly, each winter, following a seasonal pattern. The symptoms go away in spring, either suddenly (with a short period of hyperactivity) or gradually, depending on the amount of sunlight in the spring and early summer. Unfortunately, SAD is often misdiagnosed or overlooked. Once someone has experienced two or three winters of symptoms, they can be said to be suffering from SAD. The symptoms are many and varied, and people can experience any of the following common effects: Lethargy or fatigue: lacking in energy and being unable to carry out your normal daily routine. Sleep problems: oversleeping, finding it hard to stay awake during the day, sometimes havingdisturbed nights and early morning waking. Depression (including postnatal depression): feeling sad, low, weepy, guilty, a failure;sometimes hopeless and despairing, sometimes apathetic and feeling nothing. Mood changes: in some people, bursts of over activity and cheerfulness (known as hypomania) in spring and autumn. Overeating: craving carbohydrates and putting on weight (which may increase negative feelings). Bulimia: eating large amounts of food and then vomiting. Social problems: irritability (especially among children), and not wanting to see people; abusive behaviour. Concentration problems: difficulty thinking straight, making decisions or concentrating. Anxiety: tenseness and inability to cope with everyday stresses; panic attacks. Loss of libido: not being interested in sex or physical contact. Alcohol and drug abuse. Feeling under the weather. Most people with SAD have a lowered immune system during the winter, and are more likely to get constant colds, infections and other illnesses. Period problems. The symptoms of the winter blues (sub-syndromal SAD), the milder version, are similar but they are less severe and last for a shorter period than full-blown SAD. Typically, they might include tiredness, lethargy, sleeping and eating problems. What causes SAD? The exact causes of SAD are still unclear. Scientists and doctors worldwide have been researching SAD since the early 1980s, and there are several different theories as to what causes it and where the problem lies. They centre on the way that light triggers messages to the hypothalamus in the brain. Low serotonin levels Neurotransmitters carry the messages to the brain. There are several neurotransmitters involved in SAD, but the main one is serotonin. Levels of serotonin have been found to be lower in depressed people, in winter. Its thought that this neurotransmitter might not work properly in people with SAD. Low melatonin levels After reaching the hypothalamus, nerve impulses travel to a tiny organ behind it called the pineal gland. While its dark, the gland produces the hormone melatonin, which makes us sleep. Light stops melatonin production, so we wake up. People with SAD have been found to produce much higher melatonin levels in winter than those who dont have SAD symptoms, but their summer levels are normal. When treated with bright light, melatonin levels drop to normal. However, suppressing melatonin doesnt cure the symptoms, so this factor isnt likely to be the sole cause of SAD. Disrupted body clock Another possibility is a problem affecting the nerve pathways in the brain. A faulty suprachiasmatic nucleus (SCN) along one of these routes could slow the bodys clock (circadian rhythm), causing lethargy and depression. The delayed circadian rhythms can be reset with bright light in the morning, and this alleviates the symptoms of SAD. However, light treatment seems to work whatever the time of day its used, so this cant be the only explanation. Who gets SAD? Its extremely rare to find people with symptoms of SAD living within 30 degrees of the equator, where daylight hours are long and extremely bright. But it can affect people anywhere else in the northern and southern hemispheres from Scandinavia, in the North, throughout Europe, in most of North America and North Asia, and as far as the southern parts of Australia and South America. Some people even get SAD in summer, during dull periods. Problems with diagnosis People who have lived near the tropics for part of their lives and then immigrate to this country are more vulnerable to SAD symptoms. There is a view that people from different cultural backgrounds, whose symptoms show up differently, are sometimes misdiagnosed and wrongly told they have schizophrenia or manic depression. SAD can begin at any age, most commonly between 18 and 30, with more people developing it before the age of 21 than after. No-one really knows what triggers it, but in a survey of people with SAD, it was linked to events such as childbirth, hysterectomy or other hormonal upheavals. Of those who took part in the survey, 14 per cent said it had been triggered by a major loss or bereavement and 11 per cent by serious illness, both of which are common triggers of depression. Its thought that twice as many women as men have SAD, but its difficult to get an accurate picture. Characteristically, men find it harder to admit to depressive symptoms and are more likely to try to find relief in alcohol and drugs than to go to the doctor. But more men are now recognising their symptoms and seeking treatment. SAD and postnatal depression Its been suggested that postnatal depression may be SAD, brought on by the considerable stress of having a baby. If you already suffer from SAD, and are hoping to start a family, spring is probably the best time to have a baby. Children Children with SAD tend to be irritable, badly behaved and sleepy (finding it difficult to wake up or stay awake), and this may earn them the labels lazy or difficult. If SAD is the cause, and goes undiagnosed, it can have a very negative effect on a childs life and on their future. What sort of treatment is there? Many people make their own diagnosis and treat themselves, but it may be a good idea to talk to your GP about your symptoms and how youre dealing with it. Ideally, any treatment (including light treatment) should be medically supervised, either by a GP or a SAD clinic. Unfortunately, there are only a few NHS clinics in this country, and you may have to wait a long time for an appointment. Bright light therapy Bright light is the most effective treatment for most people. Light therapy (phototherapy) helps about 80 per cent of people, usually within three to five days. It means spending some time each day exposed to very bright light, at least ten times the intensity of domestic lighting. Ordinary light bulbs and fittings are not strong enough, and ordinary suntan lamps or boxes, which emit high levels of UV light, should not be used. Light treatment with the correct lights is perfectly safe. Enough UV is screened out, so there is no danger of eye problems or skin cancer. Theres an ever-growing range of light equipment available, including light boxes, visors and dawn simulators. The light boxes range in size from a small TV-sized tabletop box to a wall-mounted window-type fixture. They contain a number of bright light tubes covered by a screen. You sit about half a metre to a metre away from it, and can carry on with normal activities, such as reading, working, eating or even watching TV. A portable light visor fits on the head, shining light directly into the eyes and giving you complete freedom of movement. A dawn simulator is a bedside light, connected to an alarm clock, which mimics a sunrise and wakes the user gradually. You can use your lights at any time of day, except late evening. Morning light seems to work best for night owls and evening light for morning larks. Average use is one or two hours a day and the maximum about four hours. Some light boxes are much brighter and can cut treatment time down to half an hour. Use one daily in winter and during dull periods in the summer, beginning in the autumn, when the first symptoms appear. The benefits continue as long as its used every day. Once your routine is established, you can take occasional days off or go away for a long weekend, as long as you start again as soon as you return. Anyone whose SAD is already very severe by the time they start is unlikely to get much relief. Manufacturers advise trying again early in the following winter. Light boxes are not available on the NHS. Its best to try out light treatment before buying a fixture. Manufacturers and supplies may be able to offer you a free trial. (See Useful organisations, further down, for more information.) Occasionally, people report headaches, irritability or in very rare cases nausea, when using light treatment. Changing your position may help, but if problems persist, you must stop using light treatment. Anyone using light treatment, regularly, should tell their optician and have an annual eye check up. Anyone with existing eye problems should ask whether lights are safe. Talking treatments Talking treatments, such as counselling, psychotherapy or cognitive behaviour therapy, can be extremely useful in helping people to cope with symptoms. They also help to uncover other factors that may be contributing to your problem, and enable you to do something about them. Talking treatments are not always available on the NHS, although there may be a counselling service attached to your GP practice. Various organisations offer low-fee schemes. (See Useful organisations and Further reading, further down, for more information.) Antidepressants In severe cases of SAD, SSRI antidepressants, such as paroxetine (Seroxat), sertraline (Lustral) and fluoxetine (Prozac), which increase the activity of serotonin, have proved successful (see 'Low serotonin levels' under 'What causes SAD?' above). They can be combined with light treatment. Older antidepressants such as amitriptyline, imipramine and dothiepin are less commonly used nowadays and more problematic, because they increase symptoms like sleepiness. What else can I do to help myself? We know that being outdoors throughout the winter isnt a cure, because many farmers and outdoor workers have SAD. But, its still worth making the most of the available light. Go outdoors in natural daylight as much as possible, especially at midday and on bright days. Inside the home, choose pale colours that reflect light from outside. Sit near windows, when you can. Try to avoid putting yourself under stress. Pay attention to the messages that your mind and body are sending you that winter is a time to take it easier and go into hibernation. Even if you cant curl up in bed and sleep for six months, you can simplify your life in winter. Be ruthless about which tasks can be left until summer, especially major upheavals, such as changing jobs, moving home, extra housework and decorating or repairs. Plan ahead for the winter. Buy Christmas presents, stock up store cupboards and give parties in the summer, when you want to. You need to keep active during the winter, but with routine stress-free activities that dont require too much concentration or drain your energy. Theres plenty of evidence to show how good physical activity is for mental wellbeing, and for helping with problems such as depression. One research study showed that a daily one-hour walk, in the middle of the day, could be as helpful as light treatment for coping with the winter blues. A healthy diet is also important, and you should try to balance the SAD craving for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables. Some people find that taking extra vitamin B12 is helpful. Pamper yourself physically with a massage, or learn how relaxation exercises can help you unwind. Look into the benefits of complementary medicine as an option. St Johns wort is a popular herbal remedy available over the counter in the UK. There is some evidence that it is an effective treatment for mild to moderate depression. This would be appropriate for the winter blues, although not for severe SAD. Some people have reported positive benefits, but others have found it causes long-term, negative side effects, including over-sensitivity to light, which prevents them using light therapy. It is possible that it may react with antidepressants. The UK Government Committee on the Safety of Medicines warns people not to use St Johns wort when taking certain other prescription or non-prescription medicines, including oral contraceptives. (Contact NHS Direct, for more information.) There is only one permanent cure for SAD, and that is to live within 30 degrees of the equator. Failing that, think about taking a holiday in sunny places during the winter. Southern Spain and the Canary Islands would both be good options. Or go skiing and benefit from the extra brightnessof light reflected off the snow. One word of caution; some people with SAD have become much worse on returning to the UK gloom after very bright sunshine in places such as Africa. It seems that the contrast in light levels can do more harm than good sometimes, so consult your doctor or the SADAssociation if you have any doubts. Think about joining a support group, or setting one up locally. (Ask one of the organisations listed further down.) Sharing your experience with others who know what its like is very therapeutic. Knowing that you are not alone and that help is available can make SAD much more bearable. Get as much support as possible from your family and friends. Tell them about the condition, so they know what to expect and how to help. Find a supportive GP. How canfamilyand friends help? Its not always easy to live with someone who has SAD. Its like being with two different people, one who is lively, cheerful and energetic, during the summer, and the other who is sleepy, morose and irritable, during the winter. In summer, he or she can be hard to keep up with; in winter, you wont get much response from him or her. Try to accept that your friend or family member feels awful. They arent being lazy, or not making an effort. They sleep because they have to; they cant help it. Being hostile about it or teasing them is likely to make things worse. Having SAD is no joke; its been described as feeling half dead, half your life. Sometimes, it can drive people to suicide. Offer practical assistance, if you can. Its important to get treatment and other matters organised during the summer, because once winter comes, someone with SAD soon finds apathy taking hold. As soon as you notice signs of lethargy, encourage the person to start their treatment programme and to stick with it. If they are using light treatment, build it into daily life. If the person needs an hours light before going to work or school, make sure other chores or responsibilities dont interfere. Help them to pace themselves, and be sensitive about making too many demands on them (such as inviting a houseful of guests to stay). In the long run, its in nobodys interest if they become more stressed. It can be very upsetting when someone is constantly irritable and seems unwilling to give or accept love. Relationships can be strained to breaking point if one partner feels its all too one-sided. Hard though it might be to imagine or understand, being depressed can be emotionally paralyzing. Someone in the grip of it may be unable to feel happy, caring and loving in the usual way. Whatever it may seem, they are not deliberately rejecting you. They may be desperate for love and care, and yet not able to accept it, when its offered. Be patient, but insist they get treatment. You can then both look forward to better times. Further Information Mentality - A Department of Health commissioned web site, offering support, advice and information to people who are improve their own mental health.  HYPERLINK "http://www.mentality.org.uk/"www.mentality.org.uk Mental Health Foundation - An organization that undertakes research into mental health issues, a valuable source of information.  HYPERLINK "http://www.mentalhealth.org.uk/"www.mentalhealth.org.uk MIND - Offers support, advice and information to people who are experiencing mental health related problems and also supports their families.  HYPERLINK "http://www.mind.org.uk/"www.mind.org.uk Seasonal Affective Disorder Association - Offers support, advice and information to people who are experiencing seasonal affective disorder and their families and interested professionals.  HYPERLINK "http://www.sada.org.uk/"www.sada.org.uk *O  ]qr:!G!###'''(())`+t+u+55578899GHOO Pڹɨڹڹڹڹڹڹڹڹɚ#hh5CJOJQJ^JaJhdCJOJQJ^JaJ h_A h/CJOJQJ^JaJh_A 0JCJOJQJ^JaJ h_A hdCJOJQJ^JaJ$h_A hd0JCJOJQJ^JaJ#h_A h_A >*CJ4OJQJ^JaJ40*P 2_1j2 & Fgdgd_A $a$gd_A jS  ]r:!H!##b$>&''(())`+u+-N0222P455gd_A 567899k;=:@C#FGHUIJMO PPQtRiSjSgdgd_A  P PPPPPPPPPPPPfQgQQֿmImֿmGjhh>*B*CJKHOJQJU^JaJmH phsH 8hh>*B*CJKHOJQJ^JaJmH phsH Ajhh>*B*CJKHOJQJU^JaJmH phsH &hCJKHOJQJ^JaJmH sH ,hhCJKHOJQJ^JaJmH sH 2hh5CJKHOJQJ\^JaJmH sH h5CJOJQJ^JaJQQQQQQQ*B*CJKHOJQJU^JaJmH phsH ,hhCJKHOJQJ^JaJmH sH 2hh5CJKHOJQJ\^JaJmH sH 8hh>*B*CJKHOJQJ^JaJmH phsH Ajhh>*B*CJKHOJQJU^JaJmH phsH Gjhh>*B*CJKHOJQJU^JaJmH phsH VSWSXSgShSiSjSۺz h_A hCJOJQJ^JaJ#hh5CJOJQJ^JaJ8hh>*B*CJKHOJQJ^JaJmH phsH Ajhh>*B*CJKHOJQJU^JaJmH phsH Gjhh>*B*CJKHOJQJU^JaJmH phsH ,1h. A!"#$% DyK yK :http://www.mentality.org.uk/DyK yK @http://www.mentalhealth.org.uk/DyK yK 0http://www.mind.org.uk/DyK yK 0http://www.sada.org.uk/@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontRiR  Table Normal4 l4a (k(No Listb^@b d Normal (Web)ddd[$\$B*CJOJQJaJph*W@* dStrong5\.X@. dEmphasis6]jKd*P 2 _1j2  ]r:Hb> !!`#u#%N(2**P,--./011k35:8;#>?@UABEG HHItJiKlK00000000000000 0 0 0 0 0 0 0 0 0 0  0  0  0 0000000000000000000000000000000000000000000000000000P 2 _1j2  ]:Hb> !!`#%N(2**P,-./11k35:8;#>?@UABEtJlK@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0K00 @0 PQVSjS*/015jS+-.jS,HHHfIII">??GiKlKlK! p|bN^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH p         0-y -yeH'-ywUp5-yL"K-yr[-y3^-y7qP^-ysb-y Am-y-y{9qy-y/)y-y m-}-y_A d/@+jK@@UnknownGz Times New Roman5Symbol3& z Arial7&  Verdana?5 z Courier New;Wingdings"h f2& A )@&A )@&!r4DKDK 2QKX)?d2This booklet is for anyone who wants to know how seasonal changes in light levels affect behaviour or mood, and what can be done about it Lucy Gardner Lucy Gardner  Oh+'0,8P\hx    This booklet is for anyone who wants to know how seasonal changes in light levels affect behaviour or mood, and what can be done about itLucy GardnerNormalLucy Gardner4Microsoft Office Word@vA@vG@NmA )@՜.+,D՜.+,t hp  VHome&DK This booklet is for anyone who wants to know how seasonal changes in light levels affect behaviour or mood, and what can be done about it Title 8@ _PID_HLINKSA-% http://www.sada.org.uk/8 1http://www.mind.org.uk/81- http://www.mentalhealth.org.uk/8@ http://www.mentality.org.uk/8  !"#$%&'()*+,-./012456789:<=>?@ABCDEFGHIJKLMNPQRSTUVXYZ[\]^aRoot Entry FPcData 31Table;'WordDocument.dSummaryInformation(ODocumentSummaryInformation8WCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q