Depression & Seasonal Affective Disorder
Feeling SAD? Seasonal Affective Disorder (SAD) is commonly referred to as the winter blues, but clinically defined as winter depression for at least two years with remissions in between. February is when I see many patients that suffer from SAD who typically feel depressed, lethargic, and irritable. Sometimes SAD sufferers can also experience difficulty concentrating and difficulty waking in the morning; sleeping more, and craving carbohydrates.
This is a common condition largely affecting people between the ages of 20-50. SAD impacts women more than men and those of us living further north. Family history also plays a role. There are many causes, but an obvious one to this mood disorder, is the lack of exposure to full-spectrum natural light.
On the bright side (literally), there is an effective, drug-free approach to treating SAD.
Researchers from the University of British Columbia showed that light therapy is more effective than fluoxetine (Prozac) on patients with significant depression. Although SAD is seasonal, this study still applies. Researchers gathered one hundred and twenty two patients who were randomly assigned to four groups:
Group one: received the bright light therapy
Group two: received a placebo light that did not emit full spectrum lighting
Group three: received a combination of medication, Fluoxetine (20mg per day)
Group four: received a placebo device and placebo pill
Light Therapy consisted of 30 minutes a day of exposure to the full-spectrum light device, plus a fluorescent light box upon waking. After eight weeks of treatment, the light therapy group had prominent mood improvements over all other groups. Remarkably, 43.8 percent of the patients in the light therapy group went into remission, versus only 19.4 percent in those receiving fluoxetine.
If you suffer with SAD, and would like to improve your mood and sense of well-being, you could benefit from light therapy. The recommended daily dose of light is 10,000 lux for 30 minutes per day in the morning.
For other drug-free recommendations for Seasonal Affective Disorder (SAD), consider seeing a Naturopathic Doctor and consider some of the following therapeutic options:
Vitamin D3 is critical for hormone and thyroid health, brain function and neurotransmitter uptake. I always recommend, in line with many other health experts, that patients take 2000 IU daily during summer months, and increase to 4000 or 5000 IU during winter months. If you have any concerns on Vitamin D levels, or have been taking levels higher than this, blood testing is recommended.
Omega-3 Fatty Acids in the form of fish oil (there are plant-based options too!) play an important role in cellular brain health. There is encouraging data about their use in depressive disorders. For example, researchers have found that SAD is very rare among Icelandic peoples, who eat a lot of omega-3 fatty acids in fresh cold-water fish. When fish consumption goes down, the incidence of SAD begins to climb. Omega-3 fatty acids play a role in the synthesis of serotonin, by lowering inflammatory cytokines that can deplete Serotonin levels – our “Happy Hormone,” so-to speak.
Melatonin can benefit some individuals, although the studies are mixed. For those who respond well to therapy, 2-3 mg at bedtime helps to reset the circadian rhythm.
St. John’s Wort extract is shown to be very effective in reducing depression scores in patients with SAD and can be used to enhance the effects of the bright light therapy instead of standard antidepressant drugs. Typical dosage is 900 to 1,800 mg daily. Caution must be taken, if you are on any prescription medication, including birth control pills - do not take St. John's Wort without approval from your naturopathic or medical doctor.
Cott J, Hibbeln JR. Lack of seasonal mood change in Icelanders. Am J Psychiatry. 2001 Feb;158(2):328.
Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. “The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.” Am J Psychiatry 2005 Apr;162(4):656-62.
Lam RW, Levitt AJ, Levitan RD, et al. Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2015 Nov 18:1-9.
Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, Tam EM. “The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry 2006 May;163(5):805-12.
Magnusson A, Axelsson J, et al. Lack of seasonal mood change in the Icelandic population: Results of a cross-sectional study. Am J Psychiatry. 2000 Feb;157(2):234–8.
McGrath-Hanna NK, Greene DM, et al. Diet and mental health in the Arctic: Is diet an important risk factor for mental health in circumpolar peoples?—a review. Int J Circumpolar Health. 2003 Sep;62(3):228–41. Review.