• SAD sufferers Alice Ross, above, Stewart Bremner, below
STEWART BREMNER speaks for a lot of us when he describes his aversion to winter's gloom. When the days grow shorter everyone slows down, but for an estimated three million in Britain suffering from Seasonal Affective Disorder (SAD) – aka The Winter Blues – the season's more than gloomy, it's crippling.
Bremner, a freelance graphic designer, says: "There haven't been too many lost work days, but when it comes to my own work, as an artist, that's a different matter. That whole idea that artists can only create when they're in turmoil isn't true for anyone I know. I literally mirror the foliage: I shrivel up and shrink away during the winter, and when spring comes I wake up and feel like painting again.
"I have a history of depression, and I'd done a lot of work with counsellors to deal with it. But in winter, I was sleeping longer, comfort eating, and completely lacking in motivation. I'd become less outgoing. I wanted to stay in the house and hide.
"When last winter arrived, I could feel that the person I had worked so hard to become was crumbling. I was losing a grip. Because I was more tuned in to how I was reacting to situations, I could feel myself retreating. I decided, 'I'm not going to let this happen anymore.'"
Accessing the wealth of information online, Bremner, 37, educated himself about SAD's symptoms (see panel), and how to combat the condition. "I thought, 'What can I do to try and stop myself from slipping back into this horrible negative person in winter?'"
The answer was "Get a light box". Light boxes vary in size, but all operate along similar lines. Their bulbs are far stronger than an ordinary incandescent or fluorescent bulb, emitting upwards of 10,000 lux, a measure of the intensity of light. (The light outside on a bright summer's day is about 250,000 lux.) UV rays are filtered out, so light boxes do not promote cancer, unlike tanning beds, which are neither a safe nor effective substitute.
"Last winter I used my light box for about ten minutes in the morning, seven days a week," says Bremner, "starting around the middle of November, through late January. I also took St John's Wort. And, as a result, last winter I wasn't hiding, I was making the effort to get out and do things. In fact, last winter I was painting a lot, which was bucking the trend from the previous few years. I felt quite energised. It was partly to do with my life circumstances, but even so, in other years I don't think I would have behaved the same way."
It takes a few weeks for the light therapy to take effect, and Bremner worried that he'd wasted his money. "But I kept up with it and looking back, the winter wasn't as bad as previous ones. I'll try it again this year and see if it makes a difference. I'm pretty sure that it will. I feel a lot better. I'm not worried by winter this year. I feel armed and ready to take it on."
Dr Chris Thompson, chief medical officer at the Priory Group, says: "About 3 per cent of people have depression regularly in the winter months sufficient to cause them some degree of difficulty. Then there are a whole lot more who recognise that their behaviour changes. If you think about seasonality as a spectrum of severity, 10 per cent of the people at one end don't have any change with the seasons whatsoever. At the other end is this 3 per cent who have difficulty with it in that affects their everyday ability to function."
Research suggests that SAD is caused by change in light, which may be linked to the body's production of the hormone melatonin, which causes us to sleep and is thought to help regulate the body's wake/sleep cycle. It's produced in the pineal gland, located in the hypothalamus, inside the brain. The more light that shines on the pineal gland, the less melatonin it produces.
Levels of serotonin are lower in depressed people during winter months, as well, leading some researchers to hypothesise that this neurotransmitter doesn't work properly in people with SAD. Bright light helps increase the production of serotonin.
"A lot of research has been done and is ongoing, be we still don't really understand what SAD is, or why light treatment works," admits consultant psychiatrist Professor Anne Farmer, who runs the National Affective Disorders Unit at London's Maudsley Hospital. "It may be that lack of light causes a disruption in people's wake/sleep cycle, and this needs to be shifted back."
The most common age of onset is between 18 and 30, with most developing SAD before 21. It's more common among women. To be officially diagnosed, you must experience symptoms for three successive winters.
Scots don't suffer more than other northern nationalities, explains Thompson. "Whichever longitude you look at it, there's more SAD the further away you go from the equator. Twenty years ago we looked at Hampshire versus Inverness, and there were more instances of SAD in Inverness. In the US, they looked at comparisons between Florida and various degrees of latitude all the way up to Newfoundland and there's a very nice gradient of prevalence."
Light therapy on its own is effective in roughly 50 per cent of cases, says Thompson. "And the good thing about it is that it's non-invasive, so it's the first line treatment for SAD."
Gardener and television presenter Monty Don, who has spoken candidly about his bouts of depression, recently weighed in on the winter blues, saying: "I hate November and December… It's about the lack of light. It just feels that the year is turning grey and dying out." Like Bremner, he keeps a light box on his desk and leaves it on all winter long.
For some, though, light isn't enough. In those cases, says Thompson, SSRI anti-depressants are the drugs of choice. "I put people on medication during the winter months, and they come off it in the spring. If the symptoms are relatively mild there's no need to go to the doctor, you can just buy a light box off the shelf. But at the really severe end of the scale, people occasionally feel suicidal with SAD. You go to the doctor on the basis of how serious the depression is, rather than the fact that it's seasonal. I think a lot of doctors still don't quite get SAD, though."
That was the case for Alice Ross, now 37, who went to her GP when she was 15, complaining of extreme fatigue, thinking she had anaemia. Originally from London, the events and communications co-ordinator, who works in the charity sector, moved to Edinburgh eight years ago to attend university, where she studied linguistics.
"My family doctor wasn't very helpful. I'd gone because I had a real physical tiredness. I couldn't get out of bed and I felt exhausted all the time. I was able to go to school but I didn't have as much enthusiasm for it. I remember finding it much harder to apply myself."
Next she saw a homoeopath, who suggested SAD. She brought this idea to a different GP, who proved much more helpful. "She recommended taking St John's Wort and getting a light box. I don't think the St John's Wort helped much, and at the moment I can't take it because it interferes with contraception. But I didn't notice the difference as much as I did with the light box."
For Ross, one of the most dramatic effects of SAD is its impact on her relationships. "The physical tiredness means I don't want to do anything – no chores, no cooking or tidying up. And I'd been in denial. I'm quite an energetic person in the summer. It was quite difficult to admit to having SAD. I was resentful about it and found it hard to say that I've got this condition and I need to take things easy. I was being angry and horrible, and my partner said, 'It's really difficult to live with you in the winter.' That was probably the worst thing that's happened connected to having SAD. In a way, he can cope with me wanting to lie around, and not being great around the house. But being irritable and horrible all the time, that's way to much. It was partly to do with thinking, 'Why am I like this? Why can't I just get on with things?'
"I felt there was a perception that this is not a proper illness. There are people with cancer or HIV, so I felt like I was being dramatic saying, 'I don't like getting out of bed in the morning', because nobody likes doing that. I felt quite defensive about it, thinking maybe I should just tough it out. But it is noticeable. Everyone who's known me over a winter says they can see the difference."
She brought her light box to uni, and now keeps one on her desk at work. "I use it for two hours a day – I have it in my calendar to do every morning, from November until March. I find the beginning the hardest. It feels so long from November to December, and then I know I have to get through January and February, too."
Ross instinctively implemented many of the coping mechanisms recommended by the experts. She's careful about her diet, making sure to eat plenty of meat and pulses, and not to over-do the carbohydrates. Last winter she spent a week in Barcelona, soaking up the sun. "In spring time or on sunny days I think, 'It's not so bad!' I try to get out as much as I can at the weekends. I do find spring such a good time, so I guess it's an illness with an up side!"
Though she finds it harder to get to the gym in winter, Ross compensates by cycling to and from work. "I find that little bit of physical effort makes a big difference. Last winter I had an accident, and then the snow, and it kept me off my bike for about a month. I noticed I was much more lethargic.
Having people understand about SAD is good as well. It can be a vicious cycle – if I'm being nasty people don't want to be with me, and at the same time I'm avoiding social situations during the winter, though sometimes they can make you feel better. You just have to choose which things to go to, and spend time with people who will make you feel good. Otherwise, things that I could have handled in the spring or summer feel like too much effort or feel scary, because I lack the energy to face them.
"I have learned to accept my limitations in winter, and to not beat myself up about it or get angry about it."