Seasonal Affective Disorder (SAD)

By Dr Marysia Kratimenos

Seasonal affective disorder (SAD) was  first described in the 1980s, although many doctors and suffer­ers were  aware of the condition long before then. Indeed Hippocrates wrote in the  fifth century BC, “Such diseases that increase in the winter ought to  cease in the summer… The physician must treat disease with the  conviction that each of them is powerful in the body according to the  season which is most comfortable to it.”

In countries where the winter months are characterised by fewer  daylight hours, many people develop deep depression as a consequence of  the decreased light intensity. In Sweden, where there is six months of  total darkness in the more northerly parts of the country, the suicide  rate is the highest in the world.

Seasonal affective disorder is a form of depression that appears in  autumn and may continue until March or April. In the spring there is  often a mild state of euphoria, or hypomania. It is more common in  women, and typically begins between the ages of 18 and 30. Some studies  suggest it is very common, with one in 50 people having mood  distur­bances in the winter months.

The severity is variable. In mild forms of the condition, there may  just be a desire to “hibernate”, stay at home in the warm and avoid  socialising. In severe forms, there may be profound depres­sion, with  its concomitants. Sufferers may notice their sleep is disturbed, either  over-sleeping or finding sleep difficult. There is often lethargy and  fatigue, a lack of motivation and enthusiasm. Tasks seem onerous and  there is often a lack of concentration. Anxiety may follow, especially  associated with social events. Over-eating is common; the preferred  foods are usually carbohydrate-rich. A gain in weight is common and this  com­pounds the feelings of negativity and poor self-image. The libido  suffers, as does the immune system. There is a greater susceptibility to  viral and bac­terial infections. The depression may be so severe as to  precipitate suicidal feel­ings and deliberate self-harm may result. 

Causes 

There are several theories as to the cause of SAD, all of which  relate to the effect of light on the brain: lack of sunlight leads to a  higher level of a chemical, melatonin, which slows the body down.  Hibernating animals secrete high levels of melatonin in order to sleep  through the winter months. Another theory sug­gests the condition is  caused by a dis­turbance of the dopamine and serotonin levels in a  particular part of the brain, known as the hypothalamus. This area  controls mood and appetite – for life, for food and for sex. Some  researchers believe that sufferers of SAD have lower eye sensitivity to  light. All three theories may be true. The eye sensitivity to light will  affect the hormone levels, as the eye is essentially highly evolved  nervous tissue.

Although these theories may serve to explain the mechanisms at play,  there is still the unanswered question as to why some individuals are  more susceptible to depression than others. Since home­opathy looks at  the whole person, rather than a list of their symptoms, it is uniquely  placed to help with depressions of all types, including those that  exhibit periodicity. Such treatment must be undertaken by professional  homeopaths, with experience in the field of emotional health issues,  often in conjunction with other appropriate forms of treatment.

Like truth, depression is rarely pure and never simple. Many factors  are involved, both hereditary and environ­mental. Mental and emotional  problems are more common in certain families. Although twins may be  separated at birth and therefore brought up in different circumstances,  they are more likely to suffer from the same type of emotional health  problem, thus implying a hered­itary basis. A dysfunctional upbringing  further compounds the situation.

Depression does not just suddenly appear out of the blue, although it  may seem that way. People often describe it as descending like a dark  cloud over them. In reality depression has its roots in the past. It is a  reaction to unresolved emotional issues that are often partly, if not  totally, forgotten or buried by the sub-conscious mind. The events that  may cause depression in later life often occurred in childhood. In many  cases these issues have to be explored and the past truly laid to rest  before there is total healing. 

Poetry and myth 

In To Autumn  John Keats describes “seasons of mist and mellow  fruitful­ness”, but to many people the approach­ing winter is better  paralleled by his poem Ode on Melancholy. The opening verse depicts the  strong suicidal desire that many sufferers of the condition experience  and interestingly names many favourite homeopathic remedies for the  treatment of depression.

No, no, go not to Lethe, neither twist Wolf’s-bane (Aconite), tight-rooted, for its poisonous wine;                                  Nor suffer thy pale forehead to be kiss’d
By nightshade
(Belladonna), ruby grape of Proserpine …

The myth of Proserpine, or Persephone, is particularly  appropriate in the under­standing of seasonal affective disorder. In  Greek mythology, Persephone was the beautiful young daughter of Demeter,  the corn goddess and Zeus, the king of the gods. She was devoted to her  mother and spent her time tending to the gar­dens of Earth. Her beauty  and innocence enthralled the god of the underworld, Hades, and he  decided to make her his wife. He abducted her. Persephone was petrified  and stood rooted to the spot as the nymphs fled for safety. She dropped  her girdle as Hades swept her up in his chariot. Her mother, Demeter,  was beside herself with grief at the loss of her daughter. She scoured  the world look­ing for her, neglecting her duties. As a consequence the  crops withered. Deprived of her attention, the eternal summer ceased.  Leaves fell off the trees and coldness and darkness fell.

Eventually Demeter found the girdle and discovered Hades had abducted  her daughter. No one was allowed to pass into the underworld, so she  appealed to Zeus to intervene. Zeus took pity on the mother’s plight,  but he was also cautious of incurring the wrath of Hades. As Persephone  had eaten six pomegranate seeds of the twelve offered to her by Hades,  he decided that Persephone had to spend six months of the year with  Hades and could rejoin her mother for the other six. In celebration of  the reunion the earth blossomed and warm weather returned, only to fade  again when it was time for Persephone to return to Hades.

This charming explanation of the seasons has profound echoes with SAD  sufferers. To them winter is a living hell and they feel responsible  for their plight. Instead of being a season of celebration, of religious  festivities and the New Year, to them it is a time of reflection on  their misery. Existential fears surface as the body tries to adjust to  the harsh climate and memories of happier times haunt them. The sense of  isolation is com­pounded by the myth propagated by commercialism that  Christmas is the time for happy families. Actually Christ­mas is well  recognised as a major stress factor by psychologists.

Treatment

The use of light boxes, which recreate the summer light intensity,  is a well­recognised treatment and is highly effec­tive in mild cases.  It can cause problems though as the light is rather harsh and sore eyes  may result. It can also disturb sleep patterns further. Anti-depressants  are commonly prescribed, but these often cause side effects.

Counselling is recommended to ascertain the root causes of the  depres­sion and this is highly effective provid­ing the patient is  prepared to explore their psyche. It is painful and challeng­ing to  confront one’s past, to return to the underworld, yet this hero’s  journey is often the only way to find total free­dom from the mental  torture. It is imper­ative to find someone prepared to act as mentor or  guide to the labyrinths of one’s mind, someone that one can trust fully.  Often that person is oneself. I often recommend this path to patients  that are motivated to help themselves and pro­vide them with the  structure necessary to make this journey of transformation.

Despite the pervading quick fix cul­ture, it is imperative to  understand that true healing takes time and persistence. The use of  appropriate homeopathic remedies can bring about dramatic changes in  mood and behaviour and this is my favoured starting point in the  treatment of SAD. But I firmly believe that following a stabilisation in  the mood it is imperative to deal with any residual negative thought  processes. As the Dalai Lama so eloquently puts it, “an undisciplined  mind is like an ele­phant. If left to blunder out of control, it will  create havoc.” Negative thought processes must be countered effectively,  a process I liken to deadheading a plant. By regular removal of dead  blooms and judicious pruning a plant will display its full beauty and  potential, and so the human psyche. In his inspiring book The Art of  Happiness, the Dalai Lama states that “the very purpose of our lives is  to seek happiness” and clearly shows how this is attainable by training  the thought processes. The book is appro­priate for everyone, whatever  their reli­gious beliefs.

It is important to create a healthy environment at home to counter  depres­sion. Beauty lifts the spirits, as do wonderful scents.  Aromatherapy or even a simple pot pouri will gladden the soul. This is  not an invitation to a spending spree. Very simple and inexpensive  meas­ures can be employed. Flowering plants, like the Christmas cactus  will brighten a room. Hyacinths can be grown from bulbs and have a  sensual smell.

Good music will also feed the soul. Creative pursuits – any hobby  that fills one with enthusiasm and recaptures the zest for life – also  encourage healing. Consider an evening class – the company will combat  the sense of isolation. Go wild – sign up for the belly dancing class!  Laugh at yourself – think of all the happy hormones you’ll liberate.  Watch the film Patch Adams if you need sci­entific proof of the value of  laughter.

Being alone usually compounds depression but the company need not be  human. There are immense health bene­fits to having a pet. Who cannot  help laughing at the antics of a kitten with a ball of wool? If space is  limited, brightly coloured fish encourage a calm, healing environment,  as generations of dentists will attest to.

We are what we eat, as the television series of the same name so  clearly demonstrates. Carbohydrate rich and fatty foods lower the mood,  and lead to nutritional deficiencies of vitamins and trace elements,  which also impede the immune system. Healthy fresh food will have a  dramatic effect on one’s health, both physical and emotional.

SAD may feel like a life sentence, but there is an escape from Hades.  It requires action, imagination and determination. The rewards are more  precious than imaginable – a life of freedom and joy, a true awakening  from the sleep of the dead soul.

Dr Marysia Kratimenos MB BS FRCS(Ed)

Related