Seasonal Affective Disorder (SAD Syndrome)

DESCRIPTION

A seasonal disruption of mood that typically occurs during the winter months, SAD symptoms usually begin in September when days begin to shorten and last until March when the days begin to lengthen again. Individuals with SAD feel depressed, slow down, overeat, and crave carbohydrates in the winter. In the summer, these same individuals feel elated, active and energetic. Both adults and children can be affected. In individuals intolerant to heat, SAD symptoms may occur in summer.

FREQUENT SIGNS AND SYMPTOMS

The following can be experienced at the start of winter:

• Depression
• Tiredness
• Sluggishness
• Increased appetite (especially for carbohydrates)
• Weight gain
• Irritability
• Increased need for sleep
• Feeling less cheerful
• Socializing less
• Difficulty in coping with life as a result of these changes.

CAUSES

• Lessened exposure to full-spectrum natural light:
• The shortening of daylight hours in winter causes a shift in normal circadian rhythms; specifically, it leads to increased production of melatonin by the pineal gland and increased secretion of cortisol by the adrenal glands.
• Since the body uses serotonin, a mood-elevating neurotransmitter, to produce melatonin, an increase in melatonin production could lead to a decrease in serotonin, reducing to below adequate levels in sensitive individuals.
• This shift from normal circadian rhythms, particularly when combined with an elevation in levels of the stress hormone, cortisol, may produce symptoms associated with SAD.
• The critical factor appears to be the amount of light coming in through the eyes. Light receptor cells in the retina transmit information to a cluster of cells in the hypothalamus – the control center of the brain that regulates mood, appetite and menstrual cycles. In winter, when people are light deprived, the hypothalamus does not regulate and balance mood as smoothly as during the light-rich summer months.

RISK INCREASES WITH

• Geographical location: in northern latitudes, daylight hours are significantly shortened in winter, and
  the geographic distribution of SAD parallels this lack of sun..
• Other depressive illness

PREVENTIVE MEASURES

• Keep drapes and blinds open in the home.
• Sit near windows and gaze outside frequently.
• Turn on bright lights on cloudy days; even though artificial light is not full-spectrum light, it can help.
• Get outside as much as possible, especially in the early morning light. Try to spend 1 hour in the sun each day:
• Winter sunlight is far less intense than summer sunlight; however, it is still best to avoid exposure between 10AM and 2PM when the sun’s rays are strongest, and to use proper sunscreen protection, especially if at risk for skin cancer.
• Exercise regularly – a minimum of 30 min, at least three times a week:
• Regular exercise increases beta-endorphin levels and has been shown in more than 100 clinical studies to
  improve self-esteem, lower levels of cortisol and perceived stress, and relieve depression as effectively as antidepressant drugs and psychotherapy.
• The best exercises are strength training (weight lifting) and/or aerobic activities such as walking briskly, jogging, bicycling, cross-country skiing, swimming, aerobic dance, and racquet sports.
• Try to take a vacation to a sunny place in the winter months.
• Avoid alcohol consumption: alcohol, a brain depressant, increases adrenal hormone output, interferes with many brain cell processes, disrupts normal sleep cycles, and leads to hypoglycemia.
• Limit caffeine intake: caffeine, particularly when combined with refined sugar, has been correlated with depression in numerous studies, which show that people prone to depression tend to be highly sensitive to
  adverse effects from caffeine.
• Stop smoking:
• Nicotine stimulates secretion of the stress hormone, cortisol, which lowers both the amount of serotonin
  produced and its uptake by brain receptors.
• The process of detoxifying cigarette smoke dramatically lowers vitamin C levels in the brain, which can
  result in depression.

Expected outcomes

Significant improvement should be seen within 1 week.

  
TREATMENT

Nutritional supplements

• Melatonin: night-time supplementation may prevent conversion of serotonin to melatonin, thus helping to restore higher serotonin levels and improving mood.
• 5-Hydroxytryptophan (5-HTP): the immediate precursor to serotonin, 5-HTP has been found in numerous double-blind studies to raise serotonin levels as effectively as the antidepressant drugs Prozac, paroxetine and sertraline, at significantly less cost and with much fewer and milder side effects:
• To facilitate uptake into the brain, take 5-HTP with a carbohydrate snack such as a wholegrain cracker, apple or banana.
• Vitamin B6: ensures the timely conversion of 5-HTP into serotonin.

Botanical medicines

• Hypericum perforatum (St John’s wort): in numerous double-blind placebo-controlled studies, extracts of St John’s wort standardized for hypericin content have been found to produce improvements in psychological symptoms comparable to antidepressant drugs, with a significant advantage in terms of lack of side effects (the major side effect is mild stomach irritation in some patients), excellent patient tolerance, and much lower cost:
• In SAD patients, St John’s wort extract is more effective when used together with light therapy.

Drug–herb interaction cautions

• Hypericum perforatum (St John’s wort):
• Plus monoamine oxidase inhibitors (MAO inhibitors): possible additive effects of St John’s wort with these drugs, so physician monitoring is advised.
• Plus selective serotonin reuptake inhibitors (SSRIs): possible additive effects of St John’s wort with these
  drugs, so physician monitoring is advised. When replacement of an SSRI is desirable, either of two physician-supervised approaches may be used: (1) a trial for several weeks combining a reduced dose of St John’s wort or the SSRI prior to withdrawal of the pharmaceutical medication, or (2) a 3-week wash-out period for the SSRI before switching to St John’s wort.

Physical medicine

• Phototherapy (light therapy): controlled exposure to bright light has been shown to help restore proper
  circadian rhythm.
• Specially designed light boxes equipped with a set of full-spectrum fluorescent tubes, a metal reflector, and a protective plastic screen are designed to emit light that closely resembles full-spectrum sunlight, while downplaying the more harmful UV and blue rays.
• A typical light box provides 10,000 lux of bright indoor lighting (one-third the intensity of sunshine).
• Patients should position themselves 3 feet away from the light box from 5AM to 8AM and again from 5.30PM to 8.30PM. Activities can be undertaken while glancing at the light at least once per minute.
• Some patients find that 30 min of exposure in the morning is all that is needed to improve mood and reduce SAD symptoms, while other individuals require longer exposure – from 2 to the full 6 hours.
• Should the above protocol be too difficult to work into a lifestyle, replacing standard light bulbs with full-spectrum bulbs may help.

ICIM Medics Approach

If you feel that this article relates to you and you suspect that you are suffering from SAD syndrome, then please make an appointment to see one of our Natural Medical Practitioners.

If appropriate saliva testing can be conducted to measure melatonin, cortisol and dhea hormone levels. The results from the assessment can be used by one of our Natural Medical Practitioners who will help you with your individualised treatment plan. This may include dietary, nutritional and/or botanical advice.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  Both appointments can be arranged for you.

Tags: SAD, SAD Syndrome, Seasonal Affective Disorder