S.A.D.

by Arko Datto

I do not want to go out during winter. I slow down. I do not get much done during the day. I have very low motivation. My bed turns into my most important space in the room. In summer I can not stay there long as soon as the sun comes up…the world keeps turning but I am just waiting for spring to arrive…

-Wiebke Bickhardt.

Dark days of the North

Winter depression was first described by the 6th century Goth scholar Jordanes in his magnum opus Getica: Origin and Deeds of the Goths, wherein he described the common slump in the mood of the inhabitants of Scandza during the dark days of winter.

Also known as Seasonal Affective Disorder (SAD), this is a mood disorder in which people who otherwise have normal mental health during most of the year experience depressive symptoms in winter or summer. Since I arrived in Denmark almost a year back, I have been hearing about winter depression and have realized that a lot of people, across the greater spectrum of age and gender, suffer from it in varying degrees.

The last winter in Denmark was especially long and when the month of April came, I realized I could not take it anymore. I refused to get out of bed unless absolutely necessary and shunned human contact whenever possible. I realized after talking to a few people that I was exhibiting symptoms of SAD to an appreciable degree.

The description of SAD as a syndrome and the systematic development of light therapy to treat it occurred only as recently as the 1980s, when the National Institute of Mental Health (NIMH) started focussing on it in the United States, under the guidance of Norman E. Rosenthal. Although his pioneering work was initially greeted with skepticism, his book Winter Blues has since become standard introduction to the subject.

A medical study

To some degree, a lot of people are affected by the cyclical changes in seasons. For some, it is but a minor inconvenience, that can be adjusted with their daily routines. For others, it poses enough of a threat to become a major disorder.

People affected by SAD come from all walks of life, regardless of gender, race or ethnicity. However, Norman E. Rosenthal mentions in his book, that the disorder is about four times more common among women than men. Also, he mentions that people in the age bracket of 20 to 40 are among the most susceptible, although children and the elderly are affected by it as well.

SAD is often thought of as a mild condition and not a major depression. However, a study conducted in Scandinavia showed that people with SAD showed more symptoms of depression than those with non-seasonal depression who had been recently hospitalized following a suicide attempt.

A lot of research on SAD in Scandinavia started after Joseph Wechsberg wrote an article in The New Yorker called ‘Morketiden’ which means ‘murky times’. It describes the psychological effects of dark wintry nights on the people of Tromso, which lies 215 miles north of the Arctic Circle. He reports people feeling tired, having difficulty getting up in the mornings and going about their daily lives, disturbed sleep and low energy levels.

Even though people suffering from SAD have widely different experiences, they roughly have some manifestations of the core symptoms, which include reduced energy, increased eating and carbohydrate cravings, disturbed sleep, lowered sex drive, difficulties with concentration and processing information, mood problems.

A Finnish Academic Report published in the Scandinavian Journal of Work, Environment and Health confirmed previous reports on women having more seasonal changes in mood and behaviour than men while also stating that working evenings and nights is associated with extensive seasonal changes among men in particular. As Christoffer Holmsteen, one of the participants in this project says, “My SAD was provoked by working too many hours at night, not seeing the sunlight for days in a row, over periods that lasted too long. It did not help that back then I had recently returned to my native country after almost a decade in New York City, where winters are comparatively sunnier.”

The DSM-IV-TR criteria of the American Psychiatric Association states the following in the Diagnostic and Statistical Manual of Mental Disorders :

-There has been a regular temporal relationship between the onset of major depressive episodes and a particular time of the year.

-In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationship , and no nonseasonal major depressive episodes have occurred during the same period.

-Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year.

-There is no obvious effect of seasonal related psychosocial stressors.

How it feels

SAD symptoms often involve daily physical activities. Sadness and gloom that one is wont to normally associate with depression are normally not the most prominent part of the general picture. Most of those suffering from SAD have problems with their energy levels.

As Lilli Breininger, one of those who participated in the project says, “When it gets dark early and the days get shorter, there is less light and it gravely influences my mood. I don’t want to go out of my house anymore and I feel unmotivated to do anything. It is also very hard for me to get up in the morning, sometimes I stay in bed and turn around many times.’’

There is a marked increase in carbohydrate consumption for people with SAD. Eating carbohydrates seems to give them more energy. Lani Holmberg, recounts that her chocolate intake goes through the roof during the winter months. In a study carried out by NIMH, high carbohydrate meals given to SAD and non-seasonal people showed that the SAD group felt more energetic while the non-seasonal group ended up being more fatigued. The medical reasoning for this might perhaps lie in brain serotonin transmission deficiency. It could also be a response to over-secretion of insulin in SAD patients, which lowers blood sugar levels, resulting in a craving for sweets and starches. People tend to gain weight, often times dramatically. As Lani continues, “part of that numbing is definitely emotional and mindless eating…resulting in weight gain during the colder months. I punish myself for it a little, but I know that it drops off again in spring time pretty naturally.’’

Many individuals have also reported a decrease in sexual drive and the need to curl up in bed and be left alone. Thomas Ryan says of his relationships, “my winter depression has a pretty curious aspect. It seems that I seek out a girlfriend in this state of melancholia, or put another way, it seems that my relationships have all begun during the height of winter, probably because that makes it easier to cope with it. All but one of these relationships have also ended in the height of my state of melancholia. The conclusion to be drawn must be that they just get enough of my I-don’t-really-want-to attitude.” For others, cognitive problems present a major hurdle, with seemingly trivial day-to-day tasks often becoming difficult to accomplish. Logical tasks are difficult to work with, presenting a major hurdle for professionals and executives.

Mood fluctuations are common, with the emotional aspects of depression being painful experiences to have. For Lilli, “Sometimes even when I am already awake, I stay in bed and just stare at the room for some time. Everything just seems senseless. My mood is generally more sentimental and melancholic in winter, sometimes I get very sad, I feel weak and I cry.”

The connection between light and mood is a very strong one. In search of light, people seek out brightly lit supermarkets or photocopying rooms. People with SAD instinctively choose to travel during the winter months, vacationing in southern climes. As Tejs Møller puts it, “Some years back when I was living steadily in Denmark, the winters would be endlessly long and almost unbearable. So I stopped living here. At least during the winter. For many winters I have been leaving Denmark to get new energy. It can be south to sun and heat, or north to snow and mountains.”

SAD in different countries Population surveys have shown that people living farther from the Equator are more likely to develop SAD. Although there is a predictably high proportion of SAD sufferers in Scandinavia and Scotland, some presence of SAD has been documented in Australia, China and Japan. Inhabitants of Iceland and Canadians of Icelandic descent show a surprisingly low frequency of SAD, which could be due to some amount of genetic protection.

According to the SAD Association in the UK, half a million people experience some form of winter depression whereas in Sweden, doctors estimate that around 2 million people, more than 20% of the population suffer from winter depression. The percentage is roughly the same in Finland and Denmark.

Summer SAD

Although the most common form of seasonal depression occurs in winter, there are also those that suffer from summer SAD, people who regularly become depressed each summer but feel better when fall arrives. People with summer depression attribute their symptoms to heat or intense light, while those with winter depression often times attribute it to the lack of light. As Trine Cederlöf, one of the participants in the project says, “In summer, when there is natural light from 4 am to 10 pm, I never feel properly relaxed. One thing is the light disturbing my sleep; it makes me a light sleeper and I don’t get the deep sleep I need. It often wakes me up at dawn as well, which would be worse if I wasn’t a morning person.” For Trine, the light also “activates my guilt of not being outside and ‘doing stuff ’.”

Treatments

Although there is little one can do about the seasons themselves, there are ways to help cope with the effects of SAD. Along with the initial description of SAD in 1984 came the development of light therapy. There has also been the development of anti-depressant medications, psychotherapy and meditation.

As Tejs says, “you spend 4 months every year out of roughly 80 years that you might live. That means 27 years of your life. You had better find a way to live those years in the healthiest way possible, even if that requires medical attention.”

Light-boxes, with light of the intensity ranging from 2,500 to 10,000 lux have been found to be very therapeutic. An average room is illuminated to a level of 300 to 500 lux. More recently, higher levels of light intensity have been in use since they allow for shorter daily treatments and are more effective.

Melatonin secretion begins during the evening and continues into the night, stopping with the onset of morning. For a lot of the affected, with the prevalence of darkness in winter, the body gets confused and ends up over-producing melatonin which makes the individual tired and sleepy. For Thomas Steen, light therapy in the morning right after getting up helps to tell his body that it is time to be awake, cutting off the melatonin production. Even using a little therapy in the afternoon helps in adjusting his circadian rhythms to the lack of sunlight.

For some time, the Kolding School of Design has been working on developing a course on teaching light design in collaboration with the the Danish Lighting Centre and the Aarhus School of Architecture. Sabine Knudsen, among many others, chose to work with light therapy as part of her project, the overarching reason being that upto 15% of the Danish population experience winter depression to varying degrees while an additional 25% experience milder symptoms of winter blues.

Some find it easier to travel to places which do not lack in light. Winter vacations are an ideal solution to winter depression. A two week or more gap in the middle of winter will go a long way in alleviating seasonal blues. Christoffer echoes Tejs, “Danish winters push me to head for the Equator.”

A research paper on light treatment against SAD has found that outdoor walks have a therapeutic effect comparable to that of light therapy. For Lilli, “even though it is grey or rainy outside I try to take a walk regularly, it helps me to feel better. I feel more warm and fresh. Doing Acro-Yoga, acrobatics and Thai-Massage also helps me feel better and it makes my circulation better and my body feel warm in winter. Changing eating patterns also helps me – drinking hot water with ginger and cardamom, eating more soups and warm dishes instead of cold bread or salad and far more chocolate for sure! That’s like warming up from the inside.” Lani agrees, “I’ve also been sun-baking in my room to try and get some Vitamin D and have also been going regularly to the sauna. “

For a number of women, having children have helped. For Nicole Jensen, “my six year old son is my sun in these months, well, always, but especially in those months. He brings warmth and laughter to sadness and darkness.” Pauline Drasbæk continues, “after having a child I no longer have time to have winter depression. My daily life has been far more compressed. I do not have time to just be or be bored. I no longer have the same focus on myself and my own mind fluctuations. My son is the centre of my life now.”

Norman Rosenthal states in his book that more than fifty percent of patients with SAD have not been treated for it, even though they have suffered through an average of thirteen winter depressions. Light treatment effectively paved a way for the likes of Christoffer and Thomas to get out of it. Sometimes taking SAD seriously entails making significant decisions to ease life in winter. The famous Danish writer Ib Michael chooses to spend the entire winter season in his exile in south-east Asia, as a direct result of his SAD.

Different people have different approaches to help cope with seasonal depression. Recognizing the difficulties associated with this, acceptance of the situation and dealing with it in a manner befitting the concerned individual will go a long way in turning a dreaded time into one of joy.

When it gets dark early and the days get shorter, there is less light and it gravely influences my mood. I don’t want to go out of my house anymore and I feel unmotivated to do anything. It is also very hard for me to get up in the morning, sometimes I stay in bed and turn around many times. Sometimes even when I am already awake, I stay in bed and just stare at the room for some time. Everything just seems senseless. My mood is generally more sentimental and melancholic in winter, sometimes I get very sad, I feel weak and I cry.

- Lilli Breininger.

For around eight years now, I have been troubled by SAD. It was provoked by working too many hours at night, not seeing the sunlight for days in a row, over periods that lasted too long. It did not help that I retuned to Denmark after close to a decade in New York City, where winters are much sunnier. It is not so much the cold, rather the lack of sun on cloudy and rainy days that is the problem. A freezing day with snow on the ground and the sun shining bright from the blue sky makes me a happy man. However, Danish winters push me to head for the Equator. When I have not been able to do just that, artificial sunlight lamps have helped me a great deal.

- Christoffer Holmsteen.

I miss the Sun, light and warmth. Depression plays a big role during these winter months. When I have to get up, go about doing my daily activities, somebody inside me asks ‘Why bother?’

- Peter Allan Bekke.

My winter depression comes creeping in during December, paradoxically around my birthday, when the darkness and cold quietly but surely becomes a fact of life.

The first ‘symptom’ is a general sense of not being bothered to do anything. Like everything else, it is two-sided; I would really like to go out and have fun, but I know that even if I had the energy to do so I wouldn’t really have fun. So I stay in bed, in front of the TV or just sit and wallow.

The second ‘symptom’ is something that I have all year round, however it increases in strength when the sun decides it doesn’t want to show up anymore; a general discontent with my life. In Summer and Spring I can tell myself that in spite of the things that I’m not that happy with concerning the past and the future, I’m pretty happy and my life is pretty damn good. But in the black season, I use large amounts of time thinking about what could have been, how I wish I was and how I wish people saw me; best described by melancholia.

The third ‘symptom’ is actually a somewhat positive symptom, I dream of getting the hell out of here, somewhere warm where I can reinvent myself, be happy all the time. It is though depressing to know that it is not going to happen, not right now anyway.

My winter depression has a pretty curious aspect. It seems that I seek out a girlfriend in this state of melancholia, or put another way, it seems that my relationships have all begun during the height of winter, probably because it makes it easier to cope with it. All but one of these relationships have also ended in the height of my state of melancholia. The conclusion to be drawn must be that they just get enough of my I-don’t-really-want-to attitude.

- Thomas Ryan.

I no longer have winter depression. One time I tried to always go to travel during winter. I missed the light and warmth tremendously. I felt tired and felt that the days were relentless. I was sad and discouraged in my activities. Last winter I was home when I got a child in early November. After having a child I no longer have time to have winter depression. My daily life has been far more compressed. Currently I am on maternity leave with my son while we wait for daycare while I’m taking courses at my school in the evening. I do not have time to just be or be bored. I have no longer the same focus on myself and my own mind fluctuations. My son is the centre of my life now. He beams like a little sun in my life. As of now, he has just learned to run. Maybe my winter depression is still inside me somewhere…

- Pauline Drasbæek.

In summer, when there is natural light from 4 am to 10 pm, I never feel properly relaxed. The light disturbs my sleep: it makes me a light sleeper and I don’t get the deep sleep I need. It often wakes me up at dawn as well, which would be worse if I wasn’t a morning person. If I don’t fall back asleep, I get up, put on a snug sweater and make a cup of tea. I don’t really do anything. I try to relax and pay my cats some attention. If the sun doesn’t wake me up, it wakes up the cats and then they wake me up - same result.

The light also activates my guilt of not being outside and ‘doing stuff ’. This is all year round, not just summer. Even in the winter, if there’s a sunny clear sky and I don’t have time or feel like engaging in an outdoor activity, I feel guilty for not being outside.

When others are depressed by the darkness of winter, I feel calm and relaxed: like I have all the time in the world and no rush.

- Trine Johanne Cederlöf.

As the winter is closing in, the days are getting shorter, day light is shrinking, so does my world... I wake up early in the morning and it is pitch black, after a days worth of studying it is again dark outside, even though it is only 4 pm. The weather makes it seem unbearable to even get up, out of the warm bed. The cold, rain and wind keep me inside my apartment. I have to force myself to leave the house! Often, knowing that I have class isn’t even reason enough. My six year old son is my sun in these months, well, always, but especially in those months. He brings warmth and laughter to sadness and darkness.

One of the big issues while suffering from depression is staying at home and having no contact to the world outside, nor people in general. It can get very lonely. This is where my cats come in. They give life to my apartment, they need attention and love and caring, which gives me a reason to get out of bed every day, even when it gets real bad. They sleep in my bed with me, on top of my blanket by my feet and I am greeted by them in the morning, when I wake up.

- Nicole Ligaard Jensen.

Little tasks that were manageable before seem like big mountains and it seems easier to just give up. I have kids now, and they read and mimic their surroundings. Winter Depression is not something I want to pass on to them. I promise not to be depressed during winter!

- Sara Lynge Bjarnholt Olsen.

My winter depressions started when I was 17. At first, I did not know what it was, but as the years passed by, I became nervous when November approached. In my late 20s, I found out that there was something called winter depression, and that there was nothing you could do about it. From here on, it became a hobby for me to find out which things could dampen my condition. Today I am 40 and use light therapy for at least half an hour every day. I also take vitamin D during winter and the seasonal depression is almost gone. But I still have a lack of energy and less self-esteem between December and April.

- Thomas Steen.

I’m affected a lot by the changing seasons. My mood depended eighty percent on the weather. Some years back when I was living steadily in Denmark, the winters would be endlessly long and almost unbearable. For many winters I have been leaving Denmark to get new energy. It can be south to sun and heat or north to snow and mountains. Anywhere but here. I know quite a few people that are mainly waiting for the winter to be over. Say it’s four month long, that’s one third of the year. If they’ll live to be 80 years old it means that they have more than 25 years of their lives that they want to pass as fast as possible. I choose to leave!

- Tejs Møller.

I tend to shrink away from social events and prefer quiet nights at home by myself where I can cook, watch something or use the internet. In fact I would say my internet use gets a little out of control during winter. In the last few weeks I have noticed a near obsessive checking of news feeds and emails even during the night if I wake up. It seems somehow linked to the mood I was describing before, it’s almost a mindless scrolling of the news-feeds to pass time. Numbing in a way. But perhaps also a way to connect with people without going out.

Part of that numbing is definitely emotional and mindless eating, resulting in weight gain during the colder months. I punish myself for it a little, but I know that it drops off again in spring time pretty naturally.

In recent years I have been able to see the patterns of winter blahs and am a little more able to counteract them rather than wallow in them. Exercise is quite important for me and I think the bike riding here helps a lot. The last couple of weeks I’ve made sure I’ve gone on two big walks when the sun is out. I’ve also been sun-baking in my room to try and get some Vitamin D. I also regularly go to the sauna. I tend to drink less coffee during winter because I know I’m more prone to anxiety and have trouble sleeping: caffeine doesn’t help.

- Lani Holmberg.