May 12, 2020

‘Let’s hide from the disease!’ urges my little one herding a group of favourite toys into a canvas tunnel. I wonder what he will remember of this coronavirus crisis as he knows something is going on as it is limited where we can go and who we can see and there will be...

HELLO DARKNESS – MY OLD STALKER I’ve got the phone in my hand to arrange a Drs appointment. It’s not an emergency, so I won’t see one for a couple of weeks. However, I feel so utterly despairingly depressed for no apparent reason I’m prepared to resort to anti depressants for the first time in years. I’ve kept a diary for a couple of years now and from my October to March mood and behavioural fluctuations a trend has emerged. Having read around and discussed this with others, I’m pretty sure that I’m suffering from Seasonal Adjustment Depression (SAD) and I’m not alone. The Royal College of Psychiatrists estimate that 3 in every 100 Britons and the SAD Association estimates that 7% of the population suffers badly from this winter bane. So how does this adversely affect quality of life? Generally for the SAD afflicted, busy daily routines that at lighter times of the year are breezed through with aplomb including negotiating crowds, shopping, sticking to a healthy diet, interpersonal relations, socialising and travel can at times be an ordeal. Similar to lack of sleep, these tasks seem much more effort in the cold and darkness. The NHS acknowledges this condition in the mental health spectrum aptly as ‘a loss of interest in ordinary things’ which may also adversely affect the effectiveness of the immune system. I can testify to this having been unlucky enough to get Flu for the first time in 12 years and since coming back to the miserable situation in Britain from sunny Australia, certain events have taken an exponential turn for the worst! I’ve managed to screw up a job interview which I should have sailed through, one of my ceilings and carpets is damaged by a leak. This compounds the fatigue, feeling utterly bereft and cheated every year of 4-5 months a year of optimism, energy, enthusiasm and general joie de vivre. So what causes this? SAD was first examined seriously in the 1980s, notably by Rosenthal and others. As with many barriers to mental wellbeing, there is increasing physiological scientific evidence to contradict the ‘snap out of it’ approach to lethargy, overeating and mood swings. In recent years, research by Lewy and others found that compromised light quality, intensity and deprivation was found to have a severe detrimental effect on the ideal workings of the human body clock or circadian rhythm in some people. This can cause an imbalance in the healthy production of the hormones melatonin governing sleep and wakefulness and serotonin affecting mood. In turn this affects the wellbeing of an individual’s metabolism and nervous system. The Royal College of Psychiatrists advises that light boxes as well as appropriate medication could work well in tandem with anti depressants in severe cases. They also recommend counselling, regular exercise and getting out of doors regularly. Light Boxes I’ve followed most of this advice in recent years including using gadgets. If you’ve also looked into this, you will be aware of the plethora of light boxes available on the internet. I’ve bought a light box, a small 15 X 10 cm contraption with wavy lights like a kitchen insectocutor. Working full time, I take the opportunity to use this on days off during the winter. I have it on for a while and it seems to lift my mood slightly used regularly over a few days although advice recommends using one in the morning to be more effective. Fresh Air Getting out in the fresh air and enjoying nature? At the weekend I’m in the habit of walking on a Sunday afternoon and of getting out to sporting events so I’m following the advice of getting daylight and associated nutrients into my body. However, faced with a blanket of grey sky and poor light, this often doesn’t work. I’ve entered and trained for half marathons in the first three months of the year, forcing me to exercise yet I limit my running in the dark because I don’t feel entirely safe. I’ve made myself go out and socialise although my SAD instinct is to cocoon myself away augmented by home comforts and warmth. By and large, I’m glad I made the effort and the time seems to go faster. Medication So what medicines are available to me if I go ahead with that hard won appointment with a GP? Firstly, most sources recommend starting a course of this type of medication in good time for the start of the autumn to obtain the maximum benefit. I’m a bit late for that so I could try it later this year. Secondly The British National Formulary along with NHS advice lists the SSRI group of anti depressants as suitable for this condition, their chief benefit being to improve the efficiency of the hormone serotonin mentioned earlier to improve mood. The cons as with most medicines are that you need to stick with them for weeks or even months to have a beneficial effect. Secondly, reading the small print the risk of side effects, you may endure dry mouth, gastrointestinal problems and palpitations. And you can’t just flush them down the toilet as similar side effects can manifest if you come off them abruptly. Counselling Talking it through is another remedy recommended, especially Cognitive Behavioural Therapy counselling (CBT). This type of therapy examines human behavioural stimuli and patterns leading to negative feelings ant outcomes, but has to be sustainable to be of real benefit to the client. Worth a try as long as one can remember to utilise the same thinking learned to combat negativity, although this does have its detractors. It is currently a growing branch of counselling in the treatment of SAD. Research by Dr Kelly Roan in 2009 believes CBT to be very effective, sometimes better than light therapy alone, although acknowledges that it is not for everyone. Winter Holiday Winter holiday? I’ve been fortunate to have three in my lifetime, one in Portugal some years ago, Australia in 2010 and Marrakech in 2013 once I’d battled and won the time off over Christmas and New Year. I can testify to the feeling younger, healthier, more optimistic and having my body clock stimulated in a more timely manner instead of being forced to get up in the dark. However, the exponential downer of coming back to the dark has been hard to cope with. In placing the handset back on the receiver, my own experience I would recommend incorporating a little of all these things into your life from October to March and enjoying the high points.

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