For Robert*, no cloud has a silver lining. Once he detects an impending change in the weather, he knows the worst is yet to come. And when the first rain drops fall, the change in his character becomes inescapable.
“I become a repulsive person when I am suffering badly. I become moody, insecure, and defensive and I always feel as though someone is out to get me. If you are usually an active person, you cannot be yourself. It is like something is holding you back, turning you a completely different person.”
Robert is one of a small number of people in Malta who suffer from a chemical imbalance in the brain causing mood swings which only occur in particular seasons: mainly winter. Seasonal Affective Disorder, or SAD, is a form of depression, which has symptoms in common with major depression, but only occurs during particular seasons. It is one of the rarest forms of depression in Malta and not many people discuss it since we live in a reasonably sun-blessed country.
Robert explained the difficulty of coping with the disorder, which affects even the smallest everyday chore. He believes that many people also suffer from this disorder, but not to the same degree as others. He also says it is rare for people to actually come forward, say they have a problem and seek help.
Mr Henri Cassar, a chartered counselling psychologist, agrees. “Sometimes people attribute their anxieties and sadness to problems in their daily lives, although it is actually the changes in the weather alone which can cause a ‘good’ or ‘bad’ mood.”
It is has been difficult to quantify the number of SAD cases in Malta since no research has yet been carried out here. None of the psychologists or psychiatrists I spoke to had any real statistics to offer. However, out of five people within the psychologist profession, all had come across and treated at least one person suffering from SAD.
“A social scientist would need to do quantitative and qualitative research to see how common this situation is within the Maltese population. Until now, no social scientist has attempted to do this,” Cassar said.
Robert describes some of the symptoms experienced during his SAD periods: “I am hungry all the time and I have to eat every two hours. I can become very aggressive if I do not eat. There are certain side effects as a result of the pills and I believe all forms of medication need to be taken with food.
“SAD also heavily affects me sexually. I can turn from being a lion to a neutered uninterested pussycat. It reminds me of the movie American Pie and all the teenagers acting like idiots.”
Although medication is available to SAD sufferers, it is not enough to completely cure them of their symptoms. Therapy also helps along with medication and recent advances in forms of therapy have introduced Bright Light Therapy.
Dr Bernard Caruana, a senior clinical psychologist, explains: “In light therapy a person sits in front of what is called a ‘light therapy box’. The light box substitutes sun light because winter depression is affected by the lack of sunlight. The light therapy box can be purchased and the individual may make use of it in his or her own house or he or she may go for sessions to a clinic.”
Although sounding like a very effective way to cure symptoms of SAD, it remains purely therapy and is not a cure. For psychotherapist Dr Auriol Pullicino, it is best utilised in conjunction with medication and psychotherapy: “In psychotherapy, treatment may take longer, but the patient can learn how to cope with the symptoms. This is a more permanent method of treatment, since light therapy and some types of antidepressants work effectively but do not teach a patient the skills needed to cope with the condition. A combination of both usually works well.”
Pullicino has encountered about four cases over the past five years and she described what it was like to treat the worst, which was the classical case of SAD.
“Treatment was a combination of therapy and antidepressants prescribed by a psychiatrist. The patient was not in any danger of harming herself, but she was very withdrawn and uncommunicative. She was constantly tired and unable to carry out everyday chores.”
Well-known psychiatrist Dr Joe Cassar said the worst case of SAD he ever treated was a patient who needed hospitalisation because of the severity of his condition.
“He has now learnt to increase his medication accordingly in order to decrease the risk of SAD becoming so devastating, rendering him non-functional.”
All psychologists and psychiatrists seem to agree that if unrecognised and left untreated, symptoms could worsen until they become as severe to those of Major Depression. Suicidal behaviour, work-related problems, social problems and drug abuse may also materialise if the condition is not identified.
Robert has had a long history in dealing with this disorder. “I have been severely suffering from SAD for the past six years. I remember it was 11 September 2001, and I had started up a business and was heavily investing into it. It was not so noticeable before then, but I had not been in such a demanding position before. I spent about three years constantly taking medication, mainly antidepressants, to ease the symptoms.”
SAD is known to be a genetic disorder, but while there are many ways to avoid this form of depression, research has not to date provided definite methods of prevention. Moving to sunnier countries during winter is one option, although not always most financially or feasibly viable. Exercise and appropriate sleeping patterns can help in lessening the degree of the symptoms.
As long as treatment is always available and a few sunny days make their appearance during the winter, SAD sufferers will be able to look forward to summer and finally feel, as Robert puts it, “in heaven.”

*Real name withheld due to confidentiality agreement.

bcaruana@mediatoday.com.mt