ADHD and SAD. The case of the missing Serotonin.
Updated: Sep 22, 2022
Recently I asked my ADHD twitter folks if they have SAD, or seasonal affective disorder aka winter depression (in the northern hemisphere). Speaking to clients gave me a suspicion that SAD was common in the ADHD community. I get SAD, and this is the time of year that it hits, when the days get shorter and the weather gets worse making it harder to spend time outside.
The response to my twitter poll, while not scientific, was overwhelming. Around 70% of ADHDers report suffering from SAD: https://twitter.com/annagranta/status/1313099075286380545
That's a lot of people! So, what can we do to manage the effects of SAD?
Before I answer that, I'm going to go into some of the science behind ADHD and SAD to explore the link. If you just wanna skip to the practical solutions. Go ahead ;)
What is SAD?
SAD is thought to be caused by a lack of sunlight exposure which causes the hypothalamus to work poorly. This in turn causes:
More melatonin, causing sleepiness
Disrupted body clock, causing problems sleeping
Less serotonin, causing emotional instability and feelings of depression
How does that relate to ADHD?
ADHD brains have fewer receptors that collect serotonin. This means that when our brains are producing a normal amount of serotonin we experience a lack. In winter, when we have less serotonin to start with, it's a double whammy. No wonder many of us feel depressed.
Some ADHDers take melatonin supplements to help them sleep. If you are taking melatonin and feel you are becoming too sleepy during the winter, chat with your doctor/prescriber. They may suggest adjusting your dosage.
How can we get through it, and thrive?
Spend as much time as possible outside during the winter months. Invest in warm and weatherproof clothing and try to get outside when the sun is highest. A lunchtime walk can do wonders for milder cases.
Some people find a lightbox, which simulates sunlight helps. I like to have bright, sunlight-frequency bulbs in my living spaces.
Finally, if the above isn't helping then it's time to accept that your brain chemistry isn't working for you. Help is available and you should speak to your GP. SSRIs (selective serotonin reuptake inhibitors) are a type of medicine that helps your brain get the most benefit from each bit of serotonin. They can be prescribed for both SAD and ADHD. Tell your doctor that you believe you have both and they may be willing for you to try them.
A word of warning on CBT
Many neurodiverse folk report not getting on with CBT, but it is often prescribed for SAD. Ultimately this is between you and your doctor and I am not giving medical advice on what you should or shouldn't do. I want you to have the information to advocate for yourself and make a good plan with your doctor. Some people find that CBT, with its focus on questioning your thoughts, makes them feel that they are weak, lazy, etc for not overcoming their problems. You are not. SAD is real. ADHD is real. The combination of the two gives you challenging brain chemistry. This is not your fault. The quality of the therapist delivering any therapy has a big impact. If you feel any treatment is making you worse, get out of there, find a better therapist, or try a different treatment. You are not making this up. You deserve to feel better.
What else should I check?
Vitamin D deficiency can cause fatigue and depression and be confused for SAD. In the UK, we don't get enough vitamin D from sunlight between October and March. You may need a supplement.
Sometimes the lack of daylight can tip ADHDers into burnout. If you feel exhausted, frustrated, and desperate for a rest then know that you are not alone.
Learn to relax is a self paced course that will give you the skills you need to rest, relax, and renew your energy. Short videos are perfect for watching snuggled under a blanket.