SAD? Coping with Seasonal Affective Disorder
By Karen Lee Richards* •
October 22, 2010
Do you find yourself feeling more moody and depressed during the winter months? If so, you're not alone. As winter approaches and the hours of daylight get shorter, there is a corresponding increase in the incidence of depression and moodiness.
Seasonal affective disorder (SAD), often called the “winter blues,” is a type of depression that recurs about the same time every year. It often begins in the fall, continues throughout the winter, and may even last into early spring.
SAD tends to occur more frequently in the northern latitudes where the hours of sunlight are shorter and the sun's rays are more indirect.(1) The incidence of full-blown SAD in the United States averages about 5% and ranges from 1.4% in Florida to 9.7% in New Hampshire.
It is thought that as many as 20% of people may experience some of the symptoms of SAD, although they don't meet the full diagnostic criteria.
Facts About Seasonal Affective Disorder
Symptoms: The symptoms of SAD include:
• Difficulty waking up in the morning
• Increased daytime sleepiness
• Lack of energy
• Decreased interest in work and other activities
• Carbohydrate cravings, leading to overeating and weight gain
• Difficulty concentrating
• Withdrawal from family, friends and social activity.
Diagnostic Criteria: The diagnostic criteria for seasonal affective disorder were established by the American Psychiatric Association.(2) All of the following criteria must be met for an official medical diagnosis of SAD:
• Regularly recurring depressive episodes in the fall and winter.
• At least two prior fall/winter depressive episodes that met the criteria for major depressive disorder.
• Remissions during the spring and summer months.
• Seasonal depressive episodes must outnumber non-seasonal ones.
Causes: The exact cause of SAD is unknown, but it is thought to be a biological process in which at least three factors may play a significant part:
• Circadian rhythm – The reduction in sunlight during fall and winter months throws your body's internal biological clock off and disrupts your circadian rhythm, which may lead to feelings of depression.
• Melatonin levels – The body's release of the natural hormone melatonin is affected by the light/dark cycle. The change of seasons can disrupt the balance of melatonin, which may result in more moodiness and depression.
• Serotonin levels – Reduced sunlight can cause a drop in serotonin, a brain chemical (neurotransmitter) that affects mood. People who suffer from depression are known to have low levels of serotonin. (Note: It is important to have a proper balance of both serotonin and norepinephrine. Check with your doctor before trying to increase just serotonin levels.)
Treatments: The first-line medical treatment for SAD is light therapy. Other treatments include supplements like melatonin and vitamin D, high-density ionized air administration, and in some cases, antidepressant medication. Although SAD is definitely a biological process, cognitive-behavioral therapy can also be helpful to identify and change negative thoughts and behaviors that may be making you feel worse.
Whether or not you have an official diagnosis of SAD, if you find yourself feeling depressed and moody as winter approaches, here are some tools that may help you overcome those winter blues.
Verilux® HappyLight® – Turns the Sun on Indoors
Since one of the probable causes of SAD is a disruption of the body's circadian rhythm clock due to less sunlight, it is usually treated with bright light in the morning. In fact, light therapy is the most effective treatment found for SAD to date.
The majority of SAD patients seem to benefit most by using light therapy early in the morning, thus resetting their internal clocks early. However, just as people are different, internal clocks are also different. Therefore, the best time for light therapy can vary greatly from one person to the next.
The Center for Environmental Therapeutics, a nonprofit professional organization, offers an on-line questionnaire that can help you calculate the best treatment time for your body's internal clock. Of course, you may need to make some adjustments based on how your body responds. You can access the questionnaire here [www.cet.org/eng/Tools_ENG.html#], then click on “Your circadian rhythm type (AutoMEQ)” and fill out the questionnaire.
An excellent light to use for light therapy is the HappyLight – a small, compact light source that you can set on your desk or tabletop. Like the sun, it provides full-spectrum light, meaning it covers all wavelengths that are useful for plant and animal life. Features of the HappyLight include:
• Up to 6,000 LUX of bright Natural Spectrum® light to lift spirits, sharpen concentration and improve energy levels.
• No-buzz operation with instant-on, flicker-free illumination.
• Brightness control that lets you choose your intensity.
Using the HappyLight is like turning on the sun, without the dangerous UV rays.
Properly Timed, Melatonin Helps Sync Body Rhythms
Melatonin is a natural hormone produced by the body that helps regulate other hormones and maintains the body's circadian rhythm. The pineal gland, located in the middle of the brain, responds to darkness by secreting melatonin, which re-sets the brain's central clock and helps re-set the sleep/wake cycle and other daily rhythms. When the amount of light and dark a person experiences changes, the amount of melatonin produced also changes, throwing the body's rhythms out of whack.
In 2006, researchers at Yale University School of Medicine hypothesized that in addition to light therapy, taking melatonin at the right time could reset circadian rhythms for SAD patients. The researchers tracked sleep, activity levels, melatonin rhythms and depression symptoms of 68 SAD patients who took either low doses of melatonin or a placebo in the morning or afternoon for a winter month when they were most symptomatic.
The scientists had determined from healthy subjects that a person's rhythms are synchronized when the interval between the time the pineal gland begins secreting melatonin and the middle of sleep is about 6 hours.
Seventy-one percent of the SAD patients had intervals shorter than 6 hours, indicating that their rhythms were delayed due to the later winter dawn.
Taking melatonin tablets in the afternoon lengthened their intervals, bringing their rhythms back toward normal. The closer their intervals approached the ideal 6 hours, the more their mood improved on depression rating scales, supporting the hypothesized link between out-of-sync rhythms and SAD.
Taking melatonin at the correct time of day - afternoon for patients with short intervals, and morning for the 29% of patients with long intervals - more than doubled their improvement in depression scores, compared to taking a placebo or the hormone at the incorrect time.(3)
High Doses of Vitamin D3 May Help Reduce SAD Symptoms
Vitamin D is actually not a vitamin at all, but a hormone that is produced by the body when the skin is exposed to sunlight. The two hormones, vitamin D and melatonin, actually have an inverse relationship to one another.
• Melatonin secretion is triggered by darkness.
• Sunlight shuts melatonin production off and triggers the release of vitamin D.
Scientists have shown that high doses of vitamin D3 during the fall and winter months when sunlight is at a premium can be very effective in reducing the symptoms of SAD.
In a 1998 study, Australian researchers gave 44 subjects 400 IU, 800 IU, or no vitamin D3 for 5 days during late winter in a random double-blind study. The results showed that vitamin D3 significantly enhanced positive affect and there was some evidence of a reduction in negative affect. The authors concluded, "...vitamin D3 deficiency provides a compelling and parsimonious explanation for seasonal variations in mood."(4)
The following year, researchers in Maryland compared high-dose vitamin D3 supplementation to light therapy. A prospective, randomized controlled trial was conducted in a group of 15 subjects with SAD. Eight subjects received 100,000 I.U. of vitamin D and 7 subjects received phototherapy. All of the subjects receiving the vitamin D3 improved in all outcome measures while the phototherapy group showed no significant change in depression scale measures.
Importantly, there was a significant association between the degree of improvement in measured vitamin D levels and the degree of symptom improvement.(5)
To learn about additional health benefits of vitamin D, read "D-ficient? Health Risks You Need to Know About."
5-HTP Supports Healthy Serotonin Levels
Because reduced sunlight can cause serotonin levels to drop, and low serotonin levels are related to depression, maintaining healthy serotonin levels may be an important factor in improving the symptoms of SAD.
The body synthesizes serotonin in a two-step process where L-tryptophan, a natural amino acid found in many dietary proteins, is converted to 5-HTP, which is then converted to serotonin. Supplementing 5-HTP helps to enhance the supply of serotonin, which in turn helps support healthy central nervous system functions such as sleep, appetite and mood patterns.
In a double-blind study, 50 patients were divided into two groups. The group that received 5-HTP (100mg a day) showed significant improvements, while the placebo group experienced virtually no improvement. The improvements were felt within a short time period, and increased further after 30 days of use.(6)
In a second study by the same group of researchers, patients who took 100mg of 5-HTP three times daily reported positive results after 30 days and throughout the length of the 90-day trial.
Significant Improvement Seen in Major Depression with SAM-e
Because 29% to 46% of patients with major depressive disorder have no response or only a partial response to pharmaceutical antidepressants, SAM-e has been studied extensively as a possible option for those with major depression. The results are three decades worth of impressive literature suggesting the mood supporting efficacy of SAM-e.(7)
• In an open trial, 20 outpatients with major depression were given SAM-e, beginning with 400 mg/day and gradually increasing to 1600 mg/day by day 12. Nine of the participants had a prior history of not responding to traditional antidepressant treatment. All 20 patients showed significant improvement with SAM-e, including 7 of the non-treatment-resistant and 2 of the treatment-resistant patients who experienced a full antidepressant response.(8)
• A double-blind randomized trial compared the efficacy of supplemental SAM-e with the antidepressant desipramine in 26 patients with major depression. At the end of four weeks, 62% of those given SAM-e had significant improvement compared to 50% of those taking desipramine.(9)
To learn more about the benefits of SAM-e, read “SAM-e: a Hard-Working Molecule that May Help Ease Pain & Brighten Mood.”
L-Theanine Calm-Plex Promotes Relaxation and Supports Mood
L-theanine, one of the main components of green tea, is best known for its relaxing effect. L-theanine readily crosses the blood-brain barrier of humans and exerts subtle changes in biochemistry.
• It directly stimulates production of alpha brain waves, which creates a deep state of relaxation while maintaining mental alertness.
• L-theanine also appears to play a role in the formation of gamma-aminobutyric acid (GABA) which acts as a powerful manager of neurotransmitters (like serotonin) and helps maintain relaxed levels of neuron activity.
Alpha wave generation in the brain is considered to be an index of relaxation. In one study, 50 females between 18 and 22 years old were divided into high and low general anxiety groups. Each group was given water, 50 mg L-theanine solution, or 200 mg L-theanine solution once a week for two months. Brain waves were measured for 60 minutes after each administration. Within 40 minutes, a significantly greater amount of alpha waves were generated on the brain surface of the L-theanine groups, signifying relaxation without causing drowsiness.(10)
L-Theanine Calm-Plex contains two additional mood enhancing ingredients – 5-HTP and GABA. These natural compounds work synergistically to help maintain balanced neurotransmitter levels in the brain. Together they support proper memory and nervous function, while promoting a strong sense of well being and relaxation.
Ultra EPA Fish Oil May Help Reduce Depression
The most common omega-3 polyunsaturated fatty acids in the brain are EPA (eicosapentaeoic acid) and DHA (docosahexaenoic acid). Two important functions of these omega-3 polyunsaturated fatty acids are:
• The regulation of cell membrane fluidity,
• And the transmission of dopamine and serotonin.
A 2009 review of scientific evidence found that an association between omega-3 polyunsaturated fatty acids and depression was repeatedly suggested in observational and experimental studies on populations affected by major depression, depressed mood or post-partum depression. The authors found that current evidence increasingly supports an inverse association between omega-3 polyunsaturated fatty acids and depression.(11)
In 2008, researchers conducted a study comparing the effects on depression of EPA and the widely prescribed antidepressant fluoxetine. Sixty outpatients with a diagnosis of major depressive disorder were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or a combination of the two. After eight weeks, EPA was slightly more effective in controlling depressive symptoms than fluoxetine, but the EPA/fluoxetine combo was significantly better than either by itself.
The response rates (a decrease in depression scores of 50% or more) were 50% in the fluoxetine group, 56% in the EPA group and 81% in the EPA/fluoxetine combination group.(12)
For those who are subject to seasonal blues, a number of natural defensive strategies are well worth investigating.
* Karen Lee Richards is Lead Expert specializing in Fibromyalgia and ME/CFS, for HealthCentral's ChronicPainConnection (www.chronicpainconnection.com). Karen is co-founder of the National Fibromyalgia Association (NFA) and was Executive Editor of Fibromyalgia AWARE magazine for four years.
1. Rosen LN, et al. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res. 1990 Feb;31(2):131-44.
2. Rosenthal, NE. Issues for DSM-V: Seasonal Affective Disorder and Seasonality. Am J Psychiatry 166:852-853, August 2009
3. Lewy AJ, et al. The circadian basis of winter depression. Proc Natl Acad Sci U S A. 2006 Apr 28.
4. Lansdowne, A., & Provost, S. 1998. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl.), 135 (4), 319–323.
5. Gloth FM 3rd. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging. 1999;3(1):5-7.
6. Caruso I, et al. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res. 1990 May-Jun;18(3):201-9.
7. Williams AL, et al. S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med. 2005 Jun;28(3):132-9.
8. Rosenbaum JF, et al. The antidepressant potential of oral S-adenosyl-l-methionine. Acta Psychiatr Scand. 1990 May;81(5):432-6.
9. Bell KM, et al. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-8.
10. Ito K, et al. Effects of L-theanine on the release of alpha brain waves in human volunteers. [Japanese] Nippon Nogeikagaku Kaishi 1998;72:153-7.
11. Liperoti R, et al. Omega-3 polyunsaturated fatty acids and depression: a review of the evidence. Curr Pharm Des. 2009;15(36):4165-72.
12. Jazayeri S, et al. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 2008 Mar;42(3):192-8.
Note: This information has not been evaluated by the FDA. It is general and is not meant to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.
ProHealth offers a wide range of nutritional supplements for optimal health.*
*These products are not intended to diagnose, treat, cure, or prevent any disease.
| (1 existing comment)
Norepinephrine and Serotonin Ratio
|Posted by: minuet48
Nov 19, 2010
Was this review helpful?
The role of Norepinephrine in relation to Serotonin was left out of this article. Norepinephrine is also a neurochemical hormone that mediates mood and it must exist in a certain ratio with Serotonin for normal affect. If the ratio between the two is skewed, or if the availability of both is diminished, depression results.
It is important not to give the impression that Serotonin is the only neurochemical hormone implicated in depression, because people suffering SAD or major depression will be left with the impression that if they increase their Serotonin levels, the will reduce their depression. In fact, if the balance between Norepinephrine and Serotonin is skewed so that there is too little Norepinephrine in relation to Serotonin, increasing Serotonin levels will make the depression worse.
The older tricyclic antidepressants tend to increase both Norepinephrine and Serotonin levels and relieve depression for most people. There are relatively recently developed antidepressants that more selectively increase Serotonin levels e. g. Paroxitine, Sertraline and Fluoxitine. They work best when the ratio between Norepinephrine and Serotonin is skewed in the direction of too little Serotonin in relation to Norepinephrine.
When this newer class of antidepressants were first being tried, one of them was prescribed for a suicidally depressed young man, and his depression became worse and he suicided. There was no way to tell if his depression resulted from too much Serotonin in relation to Norepinephrine.
It is unwise for you to publish any articles that tell people with SAD or any depressive disorder they should try to increase their Serotonin levels. Nor should you publish any article that discusses Serotonin as the only or the most important neurochemical hormone that mediates affect.
Shannon Martin, MA
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