Pauliann Long, LCSW-C




Feeling SAD This Season? About Seasonal Affective Disorder

Feeling SAD This Season?

Integrative therapies for seasonal affective disorder
Published on January 10, 2012 by Catherine Ulbricht, Pharm.D. in Natural Standard
 Seasonal Affective Disorder (SAD) should not be confused with mild winter blues. It can be as debilitating as other forms of depression.

Everyone feels blue from time to time, but if you notice that your symptoms are seasonal – and that they usually appear when the weather gets colder and the days get shorter – you may have a common condition known as seasonal affective disorder (SAD). According to the National Institute of Mental Health, these depressive disorders affect as many as 18.8 million Americans each year. Although it is also known as the “winter blues,” SAD can occur during any season. It tends to come around the same time each year, but does not usually last year round. If you have it, you may experience recurring, cyclic bouts of depression, an increased appetite, and a greater need for sleep.

What causes SAD?
Let’s face it – when the sun starts going down so early in the winter, before work is done – it’s tough to catch some rays. This is important because sunlight helps us balance a hormone called melatonin, which is produced by the pineal gland and regulates our sleep-wake cycle. When darkness falls, your body secretes melatonin, which makes you feel sleepy. Serotonin is another chemical in the brain that may play a role in SAD. Serotonin is associated with sleep, mood, movement, eating and nervousness, and may be reduced with decreased sunlight.
Risk factors for SAD include being female, being between the ages of 15 and 55, having a family history of the condition, living in a location far from the equator (which means less sunlight), or having a diagnosis or symptoms of depression or bipolar disorder.
What are some common signs and symptoms of SAD?
If you have SAD, you may experience feelings of hopelessness and sadness. Work, school, or even interacting with your friends and family might become more challenging, since the disorder can impact your ability to concentrate and make you lose interest in normal activities. You might also have a lot more trouble saying no to that tempting jelly doughnut, since SAD is linked to carbohydrate craving and weight gain.

What are the available treatment options?
The first-line treatment for SAD is light therapy, which exposes the patient to intense levels of fluorescent or incandescent light that mimics sunlight. Light boxes can be purchased over-the-counter without a doctor’s prescription, but it’s generally a good idea to talk to your healthcare practitioner before buying one. These tools can help regulate the sleep-wake cycle and reduce the secretion of melatonin. Alternatively, you can opt for a treatment called dawn simulation. Instead of sitting in front of a light box for 30 minutes, this strategy delivers a dim light automatically when you wake up via a tool that you can purchase and place beside your bed. The light gradually gets brighter to simulate a sunrise.
However, light therapy is not for everyone. If this is the case, there are certain lifestyle changes your doctor may advise you to make. This includes spending more time outside, braving cold weather, increasing exercise, and maintaining a healthy diet. Additionally, a number of prescription and non-prescription agents might help you fight your symptoms. Prescription drugs commonly prescribed for depressive disorders such as SAD are antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants.

5-hydroxytryptophan (5-HTP)
Supplemental use of 5-HTP may help balance levels of serotonin in the body, which can help you better control irritability, aggression, impatience, anxiety, and depression. Many studies suggest that 5-HTP may aid in the treatment of depression. However, it is not known whether 5-HTP is as effective as commonly prescribed antidepressant drugs, and studies specific to SAD are lacking. Caution is advised when taking 5-HTP supplements, as numerous adverse effects, including drug interactions, are possible. 5-HTP is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.

St. John’s Wort
St. John’s wort has been shown to be effective for depressive symptoms caused by low levels of neurotransmitters like serotonin and norepinephrine, which can sometimes occur in patients with depression. Studies have also found St. John’s wort to be effective in combination with light therapy.
It is important to note that St. John’s wort may interact with numerous medications, particularly SSRIs. Using these agents together may result in serotonin syndrome, a condition that involves blood pressure changes, agitation, delirium, rapid heartbeat, and confusion. This condition may also increase sensitivity to light.
Based on Natural Standard’s review of published studies, St. John’s wort has generally been well-tolerated at recommended doses for up to 1-3 months. The most common adverse effects include gastrointestinal upset, skin reactions, fatigue/sedation, restlessness or anxiety, sexual dysfunction (including impotence), dizziness, headache, and dry mouth. St. John’s wort should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Omega-3 fatty acids
Essential fatty acids (including omega-3 fatty acids) have many roles in the body, including proper nerve and brain function. Although there have been studies on the use of omega-3 fatty acids in depression, enough reliable evidence to form a clear conclusion is lacking. Some results suggest that SAD is less common in those who consume more omega-3 fatty acids, such as Icelandic people, who eat plenty of coldwater fish.
You should avoid omega-3 fatty acids if you are allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, or linolenic acid, or omega-3 fatty acid products that come from nuts. Also avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery.

Vitamin D
Low levels of vitamin D have been linked to depression. This nutrient helps regulate the activity of neurotransmitters like melatonin, serotonin, and dopamine. In fact, vitamin D was shown to be more effective than light therapy in the treatment of SAD. Taking 2000 IU of vitamin D each day may help rebalance your levels of these chemicals. However, you should avoid it if you are allergic or hypersensitive to vitamin D or to any of its components. Vitamin D is generally well-tolerated as long as you follow your doctor’s dosage recommendations. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.

If adding a little light to your life doesn’t curb your craving for jelly doughnuts, you may want to speak with your doctor about SAD, and how to handle it. Medications, dietary changes, and supplements can help you cope, and a medical professional can help you identify how to introduce these tweaks to your current lifestyle. 
If you do chose to take a natural product by mouth to help with SAD please be sure to check with your friendly neighborhood Pharmacist about potential interactions with other therapies you may be taking. Natural Standard also lists specific products that have been studied as not all brands are created equal. You want one that has been used in high quality clinical trials and tested for quality.

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