When I moved to Georgia a few years ago I was looking forward to the sunny south and a break from shoveling all of the snow we would get in upstate NY. Although I did get a break from the snow, I quickly discovered that it gets much colder here than I thought!
With the colder seasons, many people tend to stay indoors, crave bigger meals, and gain a little weight as our exposure to sunlight decreases. Seasonal Affective Disorder, or SAD, is a type of recurrent major depressive disorder in which episodes of depression occur seasonally, most commonly in the late fall and winter. It is a more severe form of the “winter blues” that interferes with daily functioning.
To be diagnosed with SAD, an individual must meet criteria for major depression coinciding with specific seasons for at least two years. The individual must experience seasonal depressions much more frequently than any non-seasonal depressions.
Seasonal affective disorder is estimated to affect 10 million Americans. Another 10 percent to 20 percent may have mild SAD. SAD is four times more common in women than in men. The age of onset is estimated to be between the ages of 18 and 30.
Symptoms
- Feelings of hopelessness and sadness
- Thoughts of suicide
- Hypersomnia or a tendency to oversleep
- A change in appetite, especially a craving sweets/carbohydrates
- Weight gain
- A heavy feeling in the arms or legs
- A drop in energy level
- Decreased physical activity
- Fatigue
- Difficulty concentrating
- Irritability
- Hibernation/avoiding social situations
Causes
There are a few thoughts on the underlying etiology of SAD. One theory is that during the winter months we are exposed to less sunlight and our vitamin D levels decrease. Another thought is that with the shorter days and increase in darkness, our melatonin levels increase. Melatonin is a hormone produced by the pineal gland to regulate sleep and people tend to feel sleepier and more lethargic as levels increase.
Another thought is that people that suffer with SAD may have a higher level of SERT, a protein that lowers serotonin levels. Lower levels of serotonin and many drugs for depression target elevating serotonin levels.
Treatments
At CentreSpringMD, we consider all of the factors that contribute to a patient’s symptomatology.
Lifestyle intervention is one of the most important. Exercise, stress relief, proper sleep and a healthy diet are a few of the key factors.
Since SAD may be a reaction to a lack of sunlight, full spectrum light therapy using a light box for 20-60 minutes daily is a common recommendation.
In addition, vitamin D levels should be optimized. A more extensive lab evaluation to assess hormone balance and nutritional status may also be helpful.
One option for elevating serotonin and improving sleep is to use a supplement called 5HTP before bedtime. Typically, I will recommend 100 -200 mg before bed.
To improve melatonin levels and your circadian rhythm, establish a regular sleep cycle and go to bed and arise at the same time each day. Most people will require at least 7-9 hours of sleep. Avoid exposure to LED light, electronics, etc. at bedtime and consider black out shades for your bedroom.
Exercise and regular time outdoors has been associated with an improvement in depression. Get a friend and start walking regularly, take a hike in the mountains and enjoy the beauty of the outdoors and/or get onto your yoga mat in a class or at home. The hardest part of any new habit is starting. Set small goals that are easily achieved.
Consume a healthy, whole foods diet with plenty of healthy fats, clean protein sources and brightly colored fruits and vegetables. Avoid simple starches and sugars as well as over-indulging in alcohol.
Counseling, acupuncture, energy healing, meditation, regular exercise/yoga and vacationing to a warmer climate can all help improve symptoms of SAD.
One last thought…since it is the season of giving, consider helping others in need. Taking a “mini mental vacation” from your own life and looking for opportunities to help someone else in need has been shown to improve depression and your immune system. So, look for options to volunteer or help a friend or neighbor that could use some extra kindness this season. Living a heart-centered life from a place or authenticity can do wonders for your mood!
