Seasonal affective disorder (SAD) is real

People are often familiar with the term seasonal affective disorder (SAD) or winter blues. This is a lowering of mood particularly during the winter months and is often described in places that are far from the equator and have long dark winters such as northern European countries. However, SAD is not confined to places with long winters as it also occurs in Australia and I see a reasonable amount of it in my practice in Melbourne.

Light and mood

Many people notice that light exposure can have an impact on their mood and that they feel that mood is not as good during periods when they do not get as much light exposure. Light is one of the key inputs in synchronising the circadian rhythm and people can also get into a similar situation with lowered mood when other inputs to the circadian rhythm are not regular. The other key inputs into the circadian rhythm are:

  1. Physical Activity
  2. Meals
  3. Noise and mental activation

Often once people develop difficulties with their mood they can withdraw from usual activities and also do not participate in their usual routine, so they’re not active, eating or stimulated at regular times. For many people this can actually exacerbate their mood problems as they are no longer getting the regular synchronising signals to their internal circadian rhythm provided by the above inputs.

What’s the relationship between light and mood?

The relationship between mood and light has been noted throughout history. Many historical writings describe melancholy, with trouble getting up in the morning, worse in winter. Recent over the last 20 years, have shown that light exposure has a significant effect on mood, via it’s effects on the circadian rhythm.

It also appears that in some types of depression, disturbance of circadian rhythm function is actually part of the biology. This can lead to symptoms such as sleeping longer and later in winter months, and shorter and earlier in summer with mood following a corresponding pattern. Whilst this has been described as SAD, in other forms of depression such as major depression or bipolar disorder, light and the circadian rhythm can have significant impacts.

A recent study looking at circadian rhythm management in people with depression showed improved rates of control of depression when people had specific circadian rhythm management compared to a usual treatment with antidepressants.

What should I do?

If you notice that mood is not as good in the winter months it is very important to try as best as possible to maintain a regular routine and ensure physical activity, particularly first thing in the morning. Light exposure first thing in the morning is also important. If it’s light when you get up, that can be out walking, no sunglasses or polarising lenses at this time, as this incorporates both light exposure and physical activity. Alternatively if it’s still dark at the time you get up, or you can’t face getting outside, light therapy can be used.

It’s also important to aim for regular meal times and a predictable schedule both around activity and sleep timing. This can be hard to do if you are feeling down so enlisting the help of other household members and friends can be an important way that they can assist you if you are having trouble with mood.

By no means does this approach replace the need for other treatments for depression including psychology-based strategies and when needed medications and support from mental health care professionals. However, adding circadian rhythm management to these existing treatments can improve outcomes and help you feel that you are functioning better.

Of course, if your mood symptoms are more difficult it is important to work with your health professional as managing your circadian rhythm is not adequate treatment alone for managing mood disorders but an important part of helping other treatments to be more effective.

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