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2 January 2019

“What is this thing called SAD?” Why we are still sceptical about the winter blues

Despite the science behind Seasonal Affective Disorder, winter can seem all too convenient an explanation. 

By Julia Rampen

It begins halfway through October. A sudden inner disintegration, like a sinkhole in the road. Then an emptiness, carefully fenced off with cups of tea and cinema trips. By November, you get up in the darkness, go home in the darkness. There are weeks without sun. You are on the verge of crumbling. In December, drunken crowds fill the streets, but you don’t know what they’re singing about. Being cheery is an act, a monologue you have to perform again and again to your co-workers at the Christmas party, your friends, your housemates. And it’s so dark. There is no road any more, just the sinkhole where the tarmac used to be.

What I’m describing might sound like a mild version of Seasonal Affective Disorder, or the aptly-named SAD. The NHS recognises it as a type of seasonal depression, and according to one YouGov poll, as much as a third of Brits display symptoms of it. Alternatively, it might just be a description of winter. A 2016 study published in the Clinical Psychological Science journal cast doubt over the connection between light deprivation and symptoms of depression. Responding in the Spectator, Julie Burchill wrote: “In my opinion, people who have SAD aren’t sick but rather simply sad that they’re not living some lotus-eating life in the sunshine, and don’t want to admit it as people might tell them to get over it.”

SAD was first described in medical terms by Norman E. Rosenthal, a South African doctor who had noticed his own seasonal change in mood after moving to the United States. “When the days became short and dark I personally experienced a draining away of energy,” he told a Wellcome Trust panel in 2013. His wife, meanwhile, was “bedridden”. In 1984, he and a group of researchers published a study describing 29 patients suffering from a depression that “seemed to respond to changes in climate and latitude”. The study also found that treating patients with bright artificial light had an antidepressant effect. By 1987, SAD had entered the Diagnostic and Statistical Manual of Mental Disorders, aka “the psychiatrist’s bible”.

In the following decades, SAD blazed into public consciousness. In some ways, it had always been there. “In the northern part of Sweden there’s a condition called lappsjuka, which means the sickness of the Lapps, which is essentially SAD,” Rosenthal told the Wellcome panel. “In the folk literature of Iceland they have a term called skamdegistunglindi, which means the depression of the short days. So it’s there in the cultural writings, if not in medical literature.” But now, theories for the causes emerged, many focusing on the idea that the body clock falls out of sync with the time of day in the depths of winter. In 2018 alone, there were publications tracking a group of patients over 20 years, monitoring seasonal levels of “the happy chemical”, serotonin, and the identification of a particular gene, all of which point towards a scientific basis for the winter blues.

Sales of SAD lamps – a form of light therapy – have ignited. “The first stirrings are in late August, ” Jonathan Cridland, the chief executive of Lumie, a light therapy supplier whose clients include the NHS, says about the sales patterns. “It still feels like summer but people are coming back from holiday, school is due to start and the days aren’t quite as long as they were.” Lumie’s sales surge over the Christmas period.

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But at a time of enlightenment about mental health, SAD has also attracted a level of scepticism. “What is this thing called SAD?” demanded a 2008 academic paper by three Norwegian researchers. “The scientific community in psychiatry in Tromsø was rather taken aback by the SAD concept, and the claim that prevalence increased with latitude of living,” the paper continued. The researchers reviewed data on self-reported depression for the northern Norwegian city, a higher latitude than any major US city, including Alaska’s Anchorage, and found no correlation between the symptoms and the amount of light.

The researchers also compared Norwegian and Russian communities on the same latitude, and found much higher rates of depression in the latter, poorer, population. A 2013 study by researchers at Oregon State University, meanwhile, did not dispute the existence of SAD, but suggested “what we often think of as the winter blues does not affect people nearly as much as we may think”.

SAD may be a modern-day example of a medical myth, suggests Steven LoBello, one of the authors named in the 2016 study, which analysed data from more than 34,000 US respondents and found no correlation between latitude and symptoms of depression. He tells me how, in 1793, the city of Philadelphia was gripped by a Yellow Fever epidemic. At first residents blamed it on the autumn, then on the putrid bale of rotting coffee sailors had dumped in the docks. The true cause, mosquitoes transmitting the disease, was not discovered until 1881. “It was a big, dramatic change in the environment that everyone could see and smell,” LoBello says, of the rotting coffee bale. As for the link between depression and light: “When the seasons change, I think a lot of things change.”

Take someone who loves to exercise outdoors. In the summer, they can play football in the park after work, and even squeeze in a run home before the sun sets. By December, the same park is muddy, the football team may have taken a winter break, and the running route feels too dangerous when unlit at night. It’s not hard to imagine that same person feeling frustrated, unfulfilled – and freezing.

Similarly, LoBello argues, it is hard to measure the impact of light therapy, which usually takes the form of sitting in front of a SAD lamp for 30 minutes to an hour a day, without controlling for a placebo effect. “There is more than one thing going on there,” he says. “A person is exposed to the light, but they are also slowing themselves down, they are quietening themselves. Maybe they are doing something enjoyable like reading.

“No one has said ‘yes, they are looking at the light, but they are also taking time for themselves.’”

While writing this article, I asked many friends and acquaintances whether SAD existed. Some felt the question was borderline offensive; others thought SAD sufferers should “harden up”. While everyone took depression seriously, there was a suspicion that real SAD patients were outnumbered by SAD pretenders, who saw an opportunity to medicalise their grumpiness, rather than take responsibility.

It is possible to detect some sexism in this enduring disbelief. Many studies find women are more likely to be affected – and we already know that when women report other issues, like pain, they are serially undertreated. “You’d expect that there are studies that won’t agree – that’s part of science,” Stephany Biello, professor of neuroscience and biopsychology at the University of Glasgow, tells me. “But the weight of the majority of evidence is that SAD is a real thing. It is a kind of depression and it is on a spectrum.”

Still, I do have some sympathy with the sceptics. I have felt some version of that sudden, inner disintegration every winter, at least since the age of 13, and perhaps even younger. I do not understand people who say the season “makes them feel cosy”. I have never got excited about a Pumpkin Spice Latte. If I won the lottery, I would immediately buy a winter home in Spain. I have, without any official medical diagnosis, occasionally speculated that I have SAD, and no one has challenged me.

But it is also true that I like being outdoors, and fingers that are not numb, and yet it took me 26 years to acquire sheepskin gloves and even longer to get winter running gear. I am a pessimist, even in the long, light days of summer, and as a journalist, I crave explanations. It is easier to blame winter. I have no doubt that sitting in front of a SAD lamp for 30 minutes a day would make me a better-balanced person, but that might also be down to the fact that my leisure time is one, long, endless to-do list that I have largely created for myself.

There are also, after all, beautiful things about winter. The sceptical researchers in Tromsø described a city in darkness for two months, but also a place where “there are fascinating changes from darkness to dim light”, and the Aurora fills the sky. The American winters that got Rosenthal so down took place on the same latitude as the Mediterranean – no doubt dark compared to South Africa, but with daylight hours Brits would envy.

Typical winter days in Scotland, where I return home at Christmas, are nasty, brutish and short. But one winter, 2010, it snowed and snowed. Life slowed down, because it had to. My mother towed her briefcase in a sledge to work. The mid-morning sunrises and tea-break sunsets crept like a blush over Edinburgh’s marble-white parks. It was a difficult winter for me, the winter I lost my grandfather and wrestled with a dissertation, but I still remember the hush of the snow.

Maybe, rather than trying to change people’s minds about SAD, we should change how we think about winter. Extend lunch breaks, so workers can see the sun. Cut relatives who disappear to Tunisia at Christmas a bit of slack. Spend more money on central heating. Celebrate all the festivals that fall in the darkest months of the year, as we should anyway in this diverse and dreich country. Get better street lights. Leave worrying about placebos to professional researchers, and just do what works.

One thing everyone involved in the SAD debate agrees on: we don’t have to resign ourselves to the winter blues. Steve Hayes founded Lumie, the light therapy shop, in 1991, after recognising the symptoms of SAD in himself. He wooed his girlfriend with gifts of SAD lamps. It worked – he married her, eventually sold the business, and they moved to the south of France. “It is bright sunshine streaming through the window right now,” he says to me over the phone on a grey London day in mid-December. “That’s a bit better than a SAD lamp.”

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