By: Lisa Murray-Doran N.D.
Mammals naturally want to hibernate in the winter, and many humans feel as if they would like to just curl up and sleep for the entire winter as well. Seasonal Affective Disorder (SAD) is an atypical form of depression related to changes in seasons. SAD is cyclic and seasonal with symptoms coming back year after year, tending to come and go at about the same time every year. The changes in mood are not necessarily related to obvious things that would make a certain season stressful (like regularly being unemployed during the winter). Signs and symptoms usually occur only in the darkest of winter months — when days are very short and nights are very long – however some people who suffer from SAD report that their symptoms can begin as early as mid September and last until March in Canada. Some researchers believe that a lack of sunlight disrupts the body's daily (circadian) rhythms, which regulate your internal clock.
Over 75% of sufferers are women & the Great Lakes region is one of the most affected areas in North America.
SAD is likely due to an imbalance of the two neurotransmitters – Serotonin & Melatonin. The production of these neurotransmitters is controlled by the pineal gland which is located at the centre of your brain and is sensitive to natural light.
Melatonin is produced in darkness; with high levels of this hormone you have symptoms of depression, fatigue, anxiety & require more sleep. The decreased hours of daylight allow for an increase in melatonin in winter.
Serotonin production is also lower in the winter, which is unfortunate as it accounts for calmness, feeling of well being & decreased stress and anxiety. One of the chief symptoms of SAD is a marked increase in appetite – especially a craving for carbohydrates, which often explains the resulting weight gain SAD sufferers remark on. As we increase the consumption of carbohydrates, our serotonin levels increase and so do positive feelings. So it is important to learn about other ways to assist in increasing our bodies serotonin levels.
SAD is characterized by the following symptoms:
· A change in sleeping patterns (don't feel refreshed after oversleeping, can't get out of bed, you need to take a nap during the day)
· Extreme fatigue
· increased appetite
· increased craving for carbohydrates (especially in evening)
· weight gain
· decreased concentration
· decreased libido
· withdrawal from family & friends
· feelings of depression, anxiety & irritability - you experience feelings of despair, guilt, anxiety and hopelessness
· Everyday chores become very hard
· Lack of feeling/emotion
· Joint pain
· Stomach problems
· Lowered resistance to infection
· Behavioural problems (usually in young people)
· P.M.S. that gets worse or only happens during the winter
· A decrease in productivity
· Feeling sad all the time
Traditional antidepressant drugs such as tricyclics are not usually helpful for SAD as they exacerbate the sleepiness and lethargy that are symptoms of the illness.
The non-sedative SSRI drugs such as sertraline (Lustral), paroxetine (Seroxat) and fluoxetine (Prozac) are effective in alleviating the depressive symptoms of SAD and combine well with light therapy.
Other psychotropic drugs e.g. lithium, benzodiazepines have not proved widely useful in the treatment of SAD.
Since lack of exposure to sunlight seems to be a key cause of Seasonal Affective Disorder, light therapy can make a big difference in your mood. This consists of exposure to intense light under specified conditions. Light therapy works by suppressing melatonin secretion in the early morning, which can negatively affect the biological clock or circaidian rhythm. Exposure to specific UV wavelengths (full spectrum) for a designated period of time (usually in the morning) relieves most or all symptoms in 80% of those affected.
Light therapy, especially dawn simulation in which full spectrum light is gradually increased in the morning, resets one ' s biological clock and keeps SAD in check. Between opaque blinds and a dawn simulator, you can decide to have dawn in your life every day at 6:30am - and your body gets used to that. This works well for those who have trouble adjusting to the time change in winter. You will feel happier, more interested in life and doing things."
Generally a combination of light boxes with full-spectrum lights at intensities up to 10,000 lux and a dawn simulator work best together for the prescribed phototherapy. Light boxes are a box containing a set of special fluorescent bulbs with a diffusing screen. The screen helps block harmful ultraviolet (UV) rays. Patients are asked to read or relax close to a light box for 30 minutes each morning.
In a 1998 conference on positive and negative effects of ultraviolet light, sponsored by the National Institutes of Health, Dr. Rosenthal, the Georgetown University researcher who was part of a group that first coined the term "SAD" in 1984 told researchers and government officials he had encouraged some patients to try tanning, and that indoor tanning seemed to improve their moods, raising speculation that a formal study on the effect of tanning on SAD should be conducted. Minimum use of a tanning bed could be employed by patients – 10-15 minutes once a week, during the darkest part of the year with the following cautions: the light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin. Exposure to UV light increases your risk of skin cancer, including melanoma, cataracts and premature aging.
Exercise increases the body' s production of endorphins - chemical substances that can relieve depression. In combination with light therapy and whole, live, fresh foods it is essential to get regular moderate outdoor exercise in the winter – morning & lunch time runs and walks are a great way to add to your light exposure (vit D)and to your fresh air! Winter sports are also wonderful things to investigate – skating, skiing, snowboarding (no, it’s never to late to learn), and snowshoeing all can boost the feeling of well-being and increase blood flow. As little as three hours per week of aerobic exercises can profoundly reduce the level of depression. Gentle exercise and relaxation techniques such as yoga, pilates, swimming and meditation or chi gung can all help to maintain harmony in body, mind and spirit. One of the most energizing exercises is yoga. Yoga exercises allow more oxygen to enter the system, relaxes the mind, stretches the muscles, and improves blood circulation. Exercise alleviates mental stress and increases blood flow to the brain.
The mainstay of a healthy lifestyle is of course our daily diet, and it is important to keep a special eye on what we eat/drink during the winter months. Whole, live, fresh foods is a general rule of thumb to remember. It's a good idea to try to eat organic, seasonally available foods as they are likely to be fresher, and they'll also be better for you and the environment as they won't have been treated with chemicals or flown half way around the world.
Eat plenty of fresh fruit and vegetables, good quality proteins (beans, nuts, seeds, chemical-free fish/animal products) and complex carbohydrates (whole grains). Try to avoid too many cold, chilled or mucus-forming foods such as dairy products in this season as they weaken the immune system. Instead have lots of homemade soups, stews, and casseroles and eat steamed rather than raw vegetables.
Also, drink plenty of fluids (6-8 large glasses of water a day), ideally at room temperature or above, to ensure adequate hydration and flush the body of infection which SAD sufferers are more prone to.
It's also important to keep your blood sugar stable. To maintain normal blood sugar, eat small but frequent meals every two to three hours. A small snack, such as fruit, is always a good choice. Healthy proteins and minimizing simple carbohydrates such as sugar are also key points in maintaining healthy blood sugar levels
Omega 3 Fatty Acids
Fish oils have been shown to be deficient in people who suffer from SAD. Omega-3 fatty acids are important for all around optimum brain function. Good sources of Omega 3 fatty acids (and vitamin D) include cod liver oil, salmon, mackerel, nuts and seeds. Cold water fish is also high in vitamin A and B, which are key nutrients. Salmon oil could be supplemented at 2000mg a day
Supplementing with vitamin D can help alleviate SAD, as well. Low blood levels of vitamin D correlate with a higher incidence of winter time depression. Patients with SAD and low blood levels of vitamin D who supplement with vitamin D have significant improvement in their symptoms of depression. The recommended RDA of Vitamin D, is 400 IU.
B vitamins are also effective in helping maintain adequate serotonin levels. The B-complex supplement should contain the essential B vitamins, which are thiamin, riboflavin, niacin, vitamin B6, vitamin B12 and pantothenic acid. B2 (riboflavin) is found in brewer's yeast, wheat, meat and dairy products. B6 is found in lean meat, fish, brewer's yeast, wheat germ, peas, soybeans, and cooked dried beans. If supplementing with a B complex take a B Stress 100mg complex.
Tryptophan, an amino acid, has been found to relieve depression because it is the precursor to Serotonin. Therefore increasing the available levels of Tryptophan may help to increase the levels of serotonin produced by the body. Tryptophan has been taken off the market in Ontario, however, Tryptophan occurs naturally in many foods. Eating these foods with a carbohydrate, such as potatoes, pasta or rice, can facilitate the brain's intake of tryptophan. Foods with natural sources of tryptophan include: fish, whole-grain cereals, vegetables, fruits, lean meats, and low-fat dairy products. Another form of Tryptophan, 5-HTP has proven safe and effective in many patients. Recommended dose is 50-100mg a day of 5-HTP.
Phosphatidylserine (PS) , a natural substance derived from the amino acid serine, affects neurotransmitter levels in the brain that affect mood. In a controlled trial, older women given 300 mg of PS had significantly less depression compared with placebo. 30 After forty-five days, the level of depression in the PS group was more than 60% lower than the level achieved with placebo.
Antioxidants such as vitamins A, C, E, selenium and zinc are ideal daily supplements (500 mg-1000mg in divided doses), and they can also be found naturally in many foods such as kiwi fruits, avocados, berries, nuts, and seeds. A high quality multivitamin is also a very good idea to begin.
Hypericum Perforatum (St. John’s Wort)
Depression is associated with low levels of serotonin, which is a neurotransmitter that establishes a sense of psychological well-being. St. John's wort, enhances levels of two neurotransmitters, serotonin and norepinephrine, thus countering depression. St. John's wort also increases melatonin levels, which helps seasonal affective disorder and related depression.
Melatonin triggers sleep and lowers body temperature. The result of the increase of melatonin caused by St. John's wort is that day/night and sleep/wake cycles are regulated. Research has shown that light therapy combined with a daily consumption of St. John's wort has a strong antidepressive effect. St. John's wort is also known to improve the ability to dream during sleep, which may be an important part of stress management.
Many studies confirm the effectiveness of St. John's wort. One study published in Germany found a 70% response rate among 97 patients who received 100-120 mg of St. John's wort extract. The researchers stated that, "Treatment resulted in an appreciable improvement in the symptoms of depression, and the 70% response rate corresponded to that of chemical antidepressants. The substances were extremely well tolerated, and no side effects were reported by any of the patients." (Fortschritte der Medizin, vol. 113, p. 408)
Clinical trials suggest that the best results are seen after 4 weeks. Those using prescribed antidepressant or antiepileptic medication should ideally seek the advice of a practitioner. In the German Commission E monograph, the amount St. John’s Wort taken is typically based on hypericin concentration in the extract, which should be approximately 1 mg per day. For example, an extract standardized to contain 0.2% hypericin would require a daily intake of 500 mg (usually given in two divided dosages). Many European studies use higher intakes of 900 mg daily and this has become the accepted daily dosage in modern herbal medicine. Recent research suggests, however, that hypericin is not the antidepressant compound in St. John ' s wort, and attention is starting to shift to the compound known as hyperforin. As an antidepressant, St. John ' s wort should be monitored for four to six weeks to check effectiveness. If possible, St. John ' s wort should be taken near mealtime. Caution anyone on any medication should consult their Doctor before taking this product.
Kava Kava (Piper methysticum)
Kava (Piper methysticum) is a natural remedy for depression. This plant has been used for years by South Pacific islanders - in Polynesia, we find that a drink made of the root has traditionally been used to lift the spirits. It is a calming plant that elicits a feeling of well-being and contentment. In one of several clinical studies, kava helped more than 50 people reduce both depression and high anxiety levels - a difference was noticed after only one week. And in a study conducted in Germany in which kava was given to women suffering from anxiety, depression and other symptoms associated with menopause, the symptoms were relieved, and the women reported an increased sense of well-being. According to German researchers who measured the brain waves of people subject to anxiety, kava has been as effective in treating some forms of anxiety as the powerful tranquilizers known as benzodiazepines. And unlike this drug and others used for similar purposes, kava does not dampen alertness or lead to addiction. In fact, it improves alertness, vigilance and memory. Kava is unfortunately no available currently in
Siberian ginseng (Eleuthrococcus)
Eleuthrococcus is what is called an “adaptogen” – meaning that it helps your body adapt to times of stress (such as a prolonged light imbalance. In a study conducted in 1982, nurses who switched from a day to a night shift were tested to see how efficient they were and how they reacted psychologically as they struggled to adjust to their new routine. Some of them were given ginseng to help them maintain emotional balance; another group was not given anything. Those who took ginseng felt less moody and were much more steady emotionally than those who did not take the herb.
Valerian and Hops
Valerian and hops are calming to the central nervous system. When volunteers took this combination, several measurements showed that they experienced less depression and anxiety. In fact, the herbs worked faster than if the subjects had been given prescription drugs – hops and Valerian worked in only two weeks, as opposed to the six weeks required for drugs. The herbs also caused far fewer side effects. You should know, though, that if you are used to strong prescription sedatives, herbs such as Valerian seem to have a harder time taking effect.
Lemon Balm or Mellisa officinalis works through its lovely essential oils through the oldest part of our brains – the limbic system to give us an over all feeling of health, happiness and wellbeing. Best used daily as leaves in a herbal tea combination, it can also be combined into a tincture with other herbs and used effectively that way.
Ideal homeopathic remedies include actea racemosa, Arsenicum, Coffea, Lycopodium, Nat. Mur, Nux Vomica, Pulsatilla, Aveena Sativa, Kali phos, Ignatia and Sepia. Constitutional Homeopathics should be prescribed for you by a Naturopathic Doctor or a Homeopath after an extensive case- taking. Homeopathics are effective, strong medicines.
Chinese medicine incorporates a holistic approach that can benefit those each pattern is unique, so we individualize treatment for SAD depending on what the patient's symptoms are Our goal is to restore the balance between the organs, balance the yin and yang and get the chi (or energy) flow going. Tai chi, Qi gong and yoga are all practices that restore the proper movement of chi. A Naturopathic Doctor or licensed acupuncturist with training and experience in Chinese herbs can also prescribe a combination of acupuncture and herbs to ease the symptoms of SAD and boost your mood.
Aromatherapy helps relieve depression by relaxing the body and reviving the nervous system. Some of the herbal oils that are good for depression are geranium, rose, jasmine, frankincense, sage, orange, palmarosa, neroli, yglang yglang and melissa; and citrus oils, such as bergamot, lime, grapefruit and mandarin. An aromatherapy blend can be made for you by an aromatherapist for use in your home – used in a diffuser morning and evening these oils can help greatly with depression. A caution to those using aromatherapy combined with homeopathy – the strong smells of the aromatherapy can antidote or counteract the effects of the homeopathic medicines you are taking.
Some patients may require counselling and or psychotherapy to explore some of their issues that may be brought up during a depressive episode. Speak to your Naturopathic doctor for a referral. Art therapy and other non-talking therapies such as body psychotherapy or craniosaccral therapy may also be indicated.
· Inspire yourself! Decorate in bright colors and surround yourself with attractive and interesting things such as pictures, quotes or mementos that can lift your mood.
· Dance in your kitchen! Another way of cheering up is to play some music. Music has long been used in the treatment of mood states, listen to what you enjoy and what makes you feel better. Better yet, if you play an instrument, get it out and regale yourself with some tuneful melodies. Just avoid playing songs in minor, weepy keys. Don't listen to depressing music when you are depressed.
· Stay out of department stores. Just as snapping at other people can have a boomerang effect on your depression, so can shopping binges. That is, while they can be loads of fun, they can come back to haunt you when the bills come in.
· Many depression triggers come from your own thinking. When you're criticized or something doesn't go the way you planned, the brain goes into overdrive with thoughts like, I'm the worst worker ever or I'm a terrible parent You convince yourself of your faults and fall right into depression. One way to get out of this negative-thinking rut is to ask yourself for proof. Stop and ask yourself to back up your own statements with evidence. Where does it say I'm a loser, a failure in life? If we dispute the ideas, then we see that they aren't true.
· Journal! Write down your negative thoughts. Then you can study your thinking patterns and work on challenging and changing them. A tecnique called Junk Journalling is often very effective during depression – write down everything you are thinking for 20 mins – use a timer with an alarm and stop when it goes off – your writing doesn’t have to have proper punctuation, neat handwriting or even be complete thoughts – just write what you are thinking. And when the timer goes off quit! When you are finished you can keep what you’ve written and re-read it – or you can throw it away – as junk – as an exercise to get at what feelings lie deeper. Writing a journal can also help you realize when bouts of the blues are coming. Sometimes, the low feelings creep up on you, but with a journal you can analyze what you're feeling and compare it to other times when you have felt low. Keeping a journal helps people put their feelings in black and white rather than allowing them to explain away their feelings and not pay any attention to them.
· Get busy. Do you have a hobby? Take up knitting or sewing or reading. Invite a friend out for tea, throw a dinner party, take pottery lessons. Be social and initiate social activities if possible. If you can keep yourself busy, it will help, because staying active can prevent you from dwelling on whatever is making you feel unhappy.
· Avoid television. It is easy to get sucked into watching 2-3 hours of television every night – in general the programming is bad, the amount of violence is unacceptable and most television shows take place in such unrealistic, artificial “perfect” environments that they make us feel inadequate. Research has shown that mood, immunity, and wellbeing are all increased when television is eliminated.
· Avoid drugs, alcohol, and caffeine. Drugs and alcohol can bring on depression or make it worse if it's already there, and if you use caffeine to climb back to a high after you have experienced the lows of drugs and alcohol, you're likely to mess up your health and sleep patterns. " You start to drink alcohol to get to sleep. Then you start to rely on caffeine to get you up. This can emphasize depressive symptoms, " . With those ups and downs, you'll probably feel more lethargic and potentially depressed and possibly anxious.
· Avoid making major decisions. You can't really trust your judgment when you're depressed,. Life decisions should be put off till you're feeling better, lest you make the wrong decisions, which, of course, can only drag you down further.
The treatment for SAD can be very effective, and under the guidance of a Naturopathic Doctor, very successful. It is always important to keep in mind that with the treatment of all mental/emotional disorders being under the care of a licensed professional is recommended rather than self diagnosis and prescriptions.