symptoms

- SLEEP PROBLEMS Usually desire to oversleep and difficulty staying awake but, in some cases, disturbed sleep and early morning wakening;

- LETHARGY Feeling of fatigue and inability to carry out normal routine Overeating: Craving for carbohydrates and sweet foods, usually resulting in weight gain;

- DEPRESSION Feelings of misery, guilt and loss of self-esteem, sometimes hopelessness and despair, sometimes apathy and loss of feelings;

- SOCIAL PROBLEMS Irritability and desire to avoid social contact;

- ANXIETY Tension and inability to tolerate stress;

- LOSS OF LIBIDO Decreased interest in sex and physical contact;

- MOOD CHANGES In some sufferers, extremes of mood and short periods of hypomania (overactivity) in spring and autumn;

- WEAKENED IMMUNE SYSTEM During the winter months, sufferers are more vulnerable to infections and other illnesses;

Symptoms disappear in spring Symproms vanish either suddenly with a short period (e.g., four weeks) of hypomania or hyperactivity, or gradually, depending on the intensity of sunlight in the spring and early summer.

In sub-syndromal SAD, symptoms such as tiredness, lethargy, sleep and eating problems occur, but depression and anxiety are absent or mild.

SAD may begin at any age but the main age of onset is between 18 and 30 years. It occurs throughout the northern and southern hemispheres but is extremely rare in those living within 30 degrees of the Equator, where daylight hours are long, constant and extremely bright.

light therapy + other therapies

Light therapy has been proved effective in up to 85 per cent of diagnosed cases - that is, exposure, for up to four hours per day (average 1-2 hours) to very bright light, at least ten times the intensity of ordinary domestic lighting.

Ordinary light bulbs and fittings are not strong enough. Average domestic or office lighting emits an intensity of 200-500 lux but the minimum dose, necessary to treat SAD is 2500 lux. The intensity of a bright summer day can be 100,000 lux!

Light treatment should be used daily during the winter months (and dull periods in summer), starting in early autumn when the first symptoms appear.

It consists of sitting two to three feet away from a specially designed light box, usually on a table, allowing the light to shine directly through the eyes. The user can carry out normal activity such as reading, working, eating and knitting while stationary in front of the box.

It is not necessary to stare at the light although it has been proved safe. Treatment is usually effective within three or four days and the effect continues provided it is used every day.

Tinted lenses, or any device that blocks the light to the retina of the eye, should not be worn. Some light boxes emit higher intensity of light, up to 10,000 lux, which can cut treatment time down to half an hour a day.

Light boxes have to be bought from specialist retailers; prices start at less than £100 [USD200].

The Seasonal Affective Disorder Association recommends trying before buying; several companies offer a home trial or hire scheme

Traditional antidepressant drugs such as tricyclics are NOT usually helpful for SAD as they exacerbate the sleepiness and lethargy that are symptoms of the illness.

Other psychotropic drugs e.g. lithium and benzodiazepines have NOT proved widely useful in the treatment of SAD.

Daily exposure to as much natural daylight as possible, especially at midday, should help.

Psychotherapy, counselling or any complementary therapy which helps the sufferer to relax, accept their problem and cope with its limitations are extremely useful.

Order the SADA Information Pack.

what your doctor can do

SAD is still not a widely recognised illness, but GPs can refer you to a an Affective Disorder Clinic - but there are only a handful of these. A clinic will also offer advice on how to manage the problem and where to buy or hire light boxes. UK Clinics are at:

- Royal Cornhill Hospital Aberdeen: 01224 663131;

- QE2 Hospital Welwyn Garden City: 01707 328111;

- Maudsley Hospital South London: 020 7703 6333;

- Menai Day Hospital Bangor: 01248 384384;

- St Mary's Hospital London: 020 7886 6666; and

- Kingsway Hospital Derby: 01332 362221.

* International sufferers may wish to contact these hospitals by telephone or email to discover local clinics.

self-help strategies

There are several effective ways to help yourself, but the most important is:

*GET SOME LIGHT THERAPY*

The next best thing to moving to the sun is to purchase a light box to use at home. In England, the Philips Bright Light Energy HF3305 is available from Boots - otherwise, access:

www.brightlight.philips.co.uk

Alternatively, contact the SAD Association for a list of suppliers.

The latest light boxes are compact, and so effective that just half an hour sitting in front of one each morning is enough to keep symptoms at bay. The "dawn simulator" alarm clocks are also good for those with milder symptoms.

boost your blood sugar levels

These play a large part in balancing mood and appetite, so it's important to keep them even.

To regulate blood sugar levels, eat protein and carbohydrates at each meal; and avoid or reduce your intake of sugar, refined foods (such as white flour), coffee, tea and alcohol.

go for counselling

This can help you deal with underlying depression or relationship problems.

Ask your GP to refer you to one and if in the UK, contact the British Association for Counselling on 01788 550899.

Otherwise, click here for information about therapy.

exercise

Getting outdoors for some exercise enables you to make the most of what daylight there is in winter.

Otherwise, click here for information about health and exercise.

go somewhere warm!

If at all possible, go somewhere warm - Spain, North Africa, Turkey, Greece, California, the Pacific - for some respite.

complementary therapies

Try homeopathic and herbal remedies.

Some people prefer these because of the possible side effects associated with conventional antidepressants.

In a recent trial, St John's Wort was shown to alleviate anxiety, improve libido and regulate sleep patterns equally in 133 people who took just the herb, as in 168 people who were having light therapy as well.

Try 900mcg a day from mid-autumn and take throughout the winter, but consult your doctor if you are taking other medication.

Reflexology, homeopathy and herbalism have all been very effective in treating depression.

To find a reflexologist in the UK, contact the British Reflexology Association; to find a homeopath, contact the Society of Homoeopaths; and to find a herbalist, contact the National Institute of Medical Herbalists.

* International sufferers may want to contact the above associations for information on local assistance.

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