In the first 2 parts of this series I began a brief exploration of Seasonal Affective Disorder (SAD) a condition affecting around 2% of the U.K. population, with women more likely to suffer than men, and with a typical age of onset between 18 and 30.  SAD is directly related to the amount of sunshine available, but the likelihood of experiencing SAD does increase where a close family member suffers.  We looked also at “sub-syndromal SAD”, affecting a larger, 10% of the U.K. population, and itself producing symptoms ranging from problems with sleeping and eating, and tiredness and lethargy, but no actual depression.  At the other end of the spectrum, full-blown SAD is a major disabling illness, preventing a person suffering from it from functioning normally, without medical and/or psychological treatment. 

There is also a rare, reverse form of SAD, known as summer SAD, where symptoms occur each summer and remit in winter.

 We went on to look at probable causes of the condition, where SAD is believed to be caused by biochemical change - a move away from what is “normal” for us - in a part of the brain called the hypothalamus, due it is believed to the shortening of daylight hours and the lack of sunlight in winter.  The hypothalamus gland is designed to regulate and achieve balance in our system, taking inputs from other organs and systems, and then making changes to regulate operation. It is known there is a strong link between this gland and the retina, and this may be why the reduction of light entering the body through the eyes is thought to impact the ability of the hypothalamus to achieve balance, or homeostasis.

 In this final article I want to look at some of the treatments available to SAD sufferers.  The most important thing with SAD, as with any other illness, is to recognize and accept that you may be a sufferer – there is no way forward until you have done this.  Your G.P. is a good person to start with in terms of analyzing symptoms and moving to a diagnosis. In this way to you can rule out other forms of psychological illness dictating a different treatment response.

Treatment falls into 3 categories.  Psychotherapy and counselling can help come to terms with the illness and manage out some of the impacts of resultant behaviour on your life and those around you.  Families are also impacted by the symptoms of SAD, where many aspects of the sufferer’s personality alter significantly during the winter months.

A second form of treatment is medication.  Anti-depressant drugs, which often have sleepiness and lethargy as side-effects, are not particularly useful, exacerbating facets of the illness itself.  However SSRI drugs (like Prozac and Seroxat) work in a different way and are often effective in alleviating the depressive symptoms of SAD. Some sufferers find the use of “herbal” treatments like St John’s Wort very effective. 

By far the most effective treatment however is light therapy, in many surveys alleviating symptoms for more than 80% of participants. This is delivered by exposure, for one to four hours each day, to very bright light, having at least ten times the intensity of the lighting found in most homes and offices. The time period is determined by individual symptoms and the intensity of the light source used. Daily treatment begins with the first onset of symptoms, and consists of sitting in front of a specially designed light box, available from specialist retailers at a cost of around £100. This treatment often produces very rapid alleviation of symptoms, with relief continuing with daily use throughout the affected months.

As always, it is advisable to talk to your G.P. before beginning any treatment.  Combination of light therapy and medication appears to be O.K. in many cases, while for some the light therapy itself can produce headaches, irritability, fatigue and problem sleeping.  Similarly research suggests that the combination of light therapy and St John’s Wort has adverse reactions for some people. We are all individuals who change over time, and what works for one may not for another. Know yourself and be aware and monitor your feelings, and the sensations and reactions in your body, and review these with your G.P as you move forward.

There are things you can do to help yourself. These include: making your home and workplace the brightest environments you can, and sitting near windows; getting outside each day for some form of exercise (walk, run or cycle) especially around midday, and when it is sunny; plus all the other essentials for psychological well-being, like drinking lots of water, a balanced diet, avoiding excess alcohol, taking exercise, getting enough sleep and having some fun!

That's all I have space for. Thanks for reading and I hope these articles have been both interesting and useful. My thanks to those who have taken the time to write and share their experiences of SAD.