As I write this, I can feel it happening already. The evenings are drawing in, there's a chill in the air, and that peculiar autumn light has started to creep across the consulting-room window.
For many of my patients, this time of year brings a familiar sense of dread.
Not because of Christmas shopping or winter colds, but because they know what's coming: That heavy, oppressive blanket of low mood that descends with the darker months.
Seasonal Affective Disorder, or SAD, is far more common than most people realise. Depending on which research you read, somewhere between one in 15 and one in 30 people in the UK are affected each winter.
That's a staggering number when you think about it.
Most GPs rush their consultations because they do not have enough time. This is so sad.
I was taught that trust and understanding were a therapeutic element of the doctor-patient relationship. By chasing efficiency, we seem to have lost a vital benefit of seeing a doctor.
Yet despite its prevalence, I'm constantly surprised by how many people suffer in silence, assuming their winter blues are just something they have to endure.
Let me be clear: SAD is not simply feeling a bit fed up when it's cold and grey outside. It's a genuine form of depression with a seasonal pattern, and it can be utterly debilitating.
I've had patients describe it as feeling like they're wading through treacle from October through to March, struggling to get out of bed, losing interest in things they normally enjoy, and feeling an overwhelming urge to hibernate.
The symptoms mirror those of depression: persistent low mood, lethargy, difficulty concentrating, changes in appetite (often craving carbohydrates) and that awful feeling of hopelessness.
But what distinguishes SAD is its predictable pattern. It arrives like clockwork as the days shorten and lifts as spring approaches. Some patients tell me they can almost set their calendar by it.
The science behind SAD is fascinating. We know that reduced exposure to sunlight disrupts our body's internal clock and affects the production of serotonin, the neurotransmitter that regulates mood.
There's also evidence that the change in light levels affects melatonin production, which influences sleep patterns and mood. Essentially, our brains struggle to adjust to the dramatic reduction in natural light, and for some people, this manifests as depression.
But here's what concerns me most: Many people inadvertently make their SAD worse by the way in which they respond to it.
When you're feeling low and exhausted, it's entirely natural to want to cocoon yourself at home, cancel social plans, and comfort eat.
The problem is that these coping mechanisms, while understandable, create a vicious cycle that deepens the depression. I see this pattern repeatedly in my clinic.
Someone starts feeling low as autumn arrives. They begin declining invitations, reasoning that they're too tired or can't face going out in the dark and cold. They spend more time indoors, often in artificial light. They reach for sugary, starchy foods that provide a temporary lift but lead to energy crashes. They stop exercising because they lack motivation. Before long, they're trapped in a lifestyle that actually reinforces and worsens their symptoms.
We know that reduced exposure to sunlight disrupts our body's internal clock and affects the production of serotonin, writes Dr Max Pemberton
I WAS really interested by a study from the Institute of Psychiatry, Psychology and Neuroscience at King's College London, that found the number of Britons frightened of living near people with mental health problems has nearly doubled in ten years to one in seven. Why are we so wary when the risk of being killed by someone with mental illness is about the same as being killed by lightning? Far more are killed as a result of domestic violence. Yet we don't all get in a jitter when someone gets married.
The diet aspect is particularly important. When we're feeling low, we naturally crave carbohydrates and sugar because they give us a quick serotonin boost. But these foods cause blood sugar spikes and crashes that can actually worsen mood swings and fatigue.
I've had patients who have essentially been living on toast, pasta, and biscuits through winter, wondering why they feel terrible.
Similarly, social withdrawal is one of the worst things you can do for your mental health, and yet socialising is often the first casualty of SAD.
We're social creatures, and isolation feeds depression. I understand that leaving the house when it's dark and miserable feels like an enormous effort, but maintaining social connections is crucial for protecting your mental health.
So what can you do?
- First, get outside during daylight hours, even if it's overcast. Natural light, even on a grey day, is significantly brighter than indoor lighting and helps regulate your circadian rhythm. A lunchtime walk can make a real difference. Consider a light therapy box, which mimics natural sunlight. The evidence for these is actually quite robust, particularly if used first thing in the morning.
- Exercise is also vital - it boosts mood-enhancing endorphins and helps to regulate sleep.
- Be mindful of your diet. Focus on eating regular, balanced meals rather than quick carbohydrate fixes.
- Maintain your social connections, even when you don't feel like it. Often, you'll feel better once you're actually there.
And please, don't suffer in silence. If you recognise these patterns in yourself, speak to your GP.
SAD is a recognised medical condition, and there are effective treatments available, including talking therapies and, in some cases, antidepressants.
Winter doesn't have to be endured. With the right strategies and support, you can protect your mental health through the darker months. The key is recognising what's happening and taking action early before that low mood takes hold.
Your wellbeing is worth it.
Gwyneth was right to quit
Gwyneth Paltrow has a very prosaic reason for quitting smoking: her life insurance.
The actress, 53, said that when she was filling out insurance forms in 2018 she was warned that her policy would be nullified if she smoked a single cigarette. Until then, she only smoked one cigarette a week, but she quit that moment.
It got me thinking about health insurance in general. I've recently spent time in the US on a speaking tour and have been horrified by a health care system entirely reliant on insurance. I've heard of people being nearly bankrupted by an illness. Yet an interesting thing about this system is it forces people to be very mindful of lifestyle choices.
In the UK, there is no incentive to think about unhealthy options such as smoking. And we all pay for other people's choices. Shouldn't we consider it a collective moral duty to consider the pressure each of us is placing on the NHS?
Dr Max prescribes: Kiwi fruit
We all know we should consume more fibre. Western diets are consistently shown to be lacking, and doctors frequently recommend that patients 'eat more fibre'.
But it's all very well being told this; it's another thing knowing how to do it in practical terms.
A study from King's College London suggests eating several kiwi fruit a day provides all the fibre we need and is a much easier starting point than vague recommendations to increase our fibre intake.