Recently, a 42-year-old patient approached Clinical Psychologist Seema Hingorrany complaining that she couldn’t eat, sleep or even get out of bed and was feeling lethargic and depressed.
Hingorrany diagnosed her with Seasonal Affective Disorder (SAD) and treated her with Cognitive Behaviour Therapy (CBT) where the patient is made to analyse and change their irrational beliefs. She also advised her to exercise, contact friends, and listen to upbeat songs to lift her spirits.
The city’s mental health professionals admit that such cases are not uncommon in Mumbai, especially during the monsoon. While typically in the West, SAD is prevalent in winter when exposure to the sun is restricted (also called Winter Blues), India has its share in the monsoon, mostly, and in winter as they play havoc with the mind.
SAD is a fairly recently described syndrome and was officially classified as a mood disorder in 1984, when doctors noticed that some of their patients had depressive symptoms that occurred with the onset of winter in Western Europe. The reduced exposure to sunlight threw the biological clock out of gear affecting hormones and a drop in Vitamin D and Serotonin levels (neurotransmitters which affect moods). Psychotherapist and Behaviour Skills Specialist H’vovi Bhagwagar describes SAD as a clinical depression triggered by gloomy weather: “Such people are pre-disposed to depression, so today, experts believe it is a “depressive disorder with a seasonal pattern” that seems to reduce once the season changes. People affected by SAD are cheerful and active predominantly through the year but start displaying signs of depression in winter (or in the monsoon in India).”
She adds that SAD is often mis-diagnosed as mood swings and is caused by a lack of light absorption. The hormone Melatonin, which is responsible for the sleep-wake cycle (circadian rhythms), shows disrupted levels in SAD sufferers, so their body cannot distinguish between day and night. “The body does not know when to wake up. Research also suggests that patients may have genetic and environmental predisposition to SAD,” explains Bhagwagar.
Hingorrany adds that a person who is sensitive by nature could be more prone to SAD. “During the monsoon, people have reduced levels of Vitamin D due to lesser exposure to sunshine. So, while bright sunlight may make a person feel energetic and cheerful, monsoon means the body clock changes and such people feel like sleeping a lot, feel withdrawn from everything, have frequent crying spells, insomnia, binging (as the body craves for more carbohydrates) or loss of appetite and low self-esteem. If it’s not treated, it could trigger suicidal tendencies,” she says.
Susan Walker, Clinical Psychologist and Psychotherapist, explains that someone affected by SAD may experience a constant feeling of being down in the dumps. “With SAD there is increased difficulty in beginning and completing tasks, a decline in concentration levels, thus an inability to settle into tasks, and sleeping problems. This may lead to difficulties at work, where people notice a lack of drive and at the home front, where tasks may be left incomplete and family relationships become strained. Libido may also be affected,” she explains.
Drive the blues away
Light therapy is one of the methods to treat this disorder. “Treatment in the West has been to prescribe Light Therapy where patients are required to sit in front of a special light for 30 minutes or more daily. Dawn stimulation alarm clocks, which simulate the gradual onset of light from the rising sun, have also been shown to be effective. Other treatments include low dose SRI antidepressants, and Cognitive Behaviour Therapy, which aids the patient in managing symptoms,” says Walker.
To treat mild SAD, Hingorrany advises better care of body and mind including a balanced diet (avoid fried foods; eat soups and salads and consume plenty of water). “Since it’s not easy to exercise outdoors during the monsoon, workout at home. To unwind, practice yoga or meditation with a friend. It’s about doing something that makes you happy be it shopping, a visit to the spa, listening to music, learning Salsa, painting or baking,” shares Hingorrany.
Bhagwagar suggests doing things without thinking too much: “Take a 20-minute walk even if you don’t feel motivated because motivation follows action. List out 25 happy activities and try doing at least one each day. Call / text at least two friends each day, don’t cut yourself off from the world.”
“Make sure that your head and a part of your body absorbs sunlight. Stay outdoors for least 20-30 minutes daily, regardless of whether there is sunshine or not, as light is always present. Combine this with a brisk walk,” stresses Walker. She continues, “beware of the trap of eating comfort foods, which lead to an increase in lethargy and if this continues, consult your psychologist for a proper diagnosis.”
Eventually, a positive outlook is important, shares Bhagwagar. “Apart from genes and environment, our thoughts cause us the most emotional suffering. Since we can’t change the genes / environment, working on negative thoughts makes us feel more in control. Be as ‘normal’ as you can. Gloomy weather is a trigger not the cause. Stick to a routine but make tasks simple,” she concludes.
Bring back the smiles
> Light therapy
> Eat a balanced diet
> High intake of fluids, especially water
> Engage in some kind of activity -- walk, run, meet people
> Call or text your friends to stay connected
> Get your dose of sunlight
> Positive thinking is the most important factor
How SAD affects our daily life
At the office
> Low efficiency
> Lack of concentration
> Bunking work
> Making mistakes
> Dozing off
Sex and relationships
> Low libido
> Partners become non-expressive
> Lack of interest in doing things together
> Withdrawal from daily life
> Ignoring calls
> Lack of empathy with other people