Light and Darkness

Comment: Another wonderful article from Women to Women. It's well worth reading.

Seasonal affective disorder —
getting back to nature

by Marcelle Pick, OB/GYN NP

Here at my clinic in Northern New England, many of my patients tell me that as the days grow shorter and fall moves into winter, their lives begin to change. They might count the minutes until the winter solstice, or feel tired and want to sleep and eat more, or they might simply feel sad. We all notice a shift when the days get shorter — we spend more time inside, eat heartier foods, and slow down a little. In fact, many Eastern medical practices recognize that with the changing of the seasons, our bodies also change and have different needs than they do during warmer months. But modern society expects us to be upbeat and productive throughout the four seasons, and for women who suffer from seasonal affective disorder (SAD), this just isn’t possible.

Seasonal depression was written about as early as the 1840’s, but it was never studied seriously until the 1980’s. Today it is estimated that 10–20% of Americans suffer from SAD to some degree. And 70–80% of that group are women! It’s interesting that the most likely time for a woman to first notice symptoms of SAD is in her mid-20’s to mid-30s — about the same time many women begin to note other changes related to hormone imbalance, like PMS and perimenopausal symptoms.

But whether you are diagnosed with seasonal affective disorder or just feel out of sorts, the good news is that you don’t have to feel blue every time winter approaches. There are lots of ways to address the underlying causes of seasonal affective disorder — many of which require us to simply honor what Mother Nature intended. Let’s take a look at what SAD really signifies and how you can make this winter season naturally happier and healthier.

Sadness with a change of season

Seasonal affective disorder, widely referred to as SAD, is the technical name for the winter blues. It is a formally recognized depressive disorder linked to the amount of daylight we’re exposed to during the changing seasons. There are many symptoms associated with SAD and its subclinical forms — including carbohydrate cravings, a disinterest in social activities, sleepiness, irritability, weight gain and fatigue. Several of these are similar to symptoms of depression. But I’ve noticed that women with SAD tend to compartmentalize their lives, distinctly separating activities and even emotional states with the seasons.

It is this seasonal compartmentalization or cyclical view that separates a diagnosis of SAD from diagnosis of other depressive disorders. Symptoms of SAD generally show up as the days grow short in the fall and continue through the darkest months of winter. Then they begin to lift — either gradually or all at once — as daylight increases in spring and early summer, and may even be accompanied by a few days or weeks of intensified activity and exuberance.

For people prone to SAD in the northern hemisphere, November through February are the hardest months. The symptoms may come on slowly or appear all at once. They may be mild or severe, short-lived or prolonged. With such wide variation, SAD can be difficult to diagnose. Even if you do not experience full-blown SAD symptoms each year, you have probably experienced similar problems adjusting your sleep cycle when daylight savings reverts to standard time, or when you cross time zones and suffer jet lag.

If you’re wondering what causes SAD, there isn’t a clear-cut answer. As with many depressive disorders, there can be a genetic component or it can stem from a web of imbalances. But I can tell you that there is rarely just one thing that leads to seasonal affective disorder. There are usually many factors involved.

SAD and vitamin D

One of the first things I look at in my patients, especially when I suspect they have SAD, is their vitamin D levels. We do this through a simple lab test, and you can ask any healthcare provider to test you if you think you may fall short. Though it may be a surprise to you, more and more people are being found to have a vitamin D deficiency. And some of the symptoms associated with a lack of vitamin D — such as low energy and fatigue, depression and sleep irregularities — look much like those we see in seasonal affective disorder, leading me to believe this connection is stronger than we think.

Vitamin D3 (cholecalciferol) can be readily manufactured in our bodies when our skin is exposed to the ultraviolet rays of natural sunlight. It is then stored and converted in the liver and kidneys into the active form (calcitriol) when we need it. During the winter months, however, those of us who live at latitudes above 40º north or south don’t receive enough UVB radiation to make the conversion (for reference, Boston lies at 42º north). By exposing ourselves to the rays of the summer sun, our bodies are fully capable of stocking up enough D to last the winter. But the truth is, for whatever reason, many of us just don’t get adequate sun, and many of my patients’ vitamin D stores run surprisingly low, even in the summer months.

That nature designed us with such an elegant conversion mechanism for vitamin D may explain why foods that are naturally rich in it are scarce. Pink salmon, sardines and mackerel are good sources, as well as cod liver oil and eggs from vitamin D-fed hens. In the US, most of our milk is now fortified with D, but other dairy products such as cheese and yogurt may not be, so as always, read the labels carefully.

The best vitamin D is what you make yourself by exposing your skin to natural sunlight. But given the limitations of our lifestyle and dietary sources, replenishing your stores with a high-quality multivitamin with D can be helpful in minimizing symptoms of SAD. In fact, a recent study showed that subjects with SAD felt significantly better after vitamin D supplementation. (For more specifics, read our full article on preventing vitamin D deficiency.)

Sleep, light, and the changing seasons

Another element that can contribute to SAD is disruption in your natural circadian rhythm. This internal rhythm is dictated by a tiny nerve cluster in the brain (the suprachiasmatic nucleus) that runs our biological clock and is directly influenced by light. Because the winter months provide less light than the summer months, our sleep cycles can get disrupted. This can cause many women to feel more like crawling back to bed than rising and shining on winter mornings.

Melatonin, the hormone that makes us sleepy, is intimately related to light and darkness. When your brain notices that it’s getting dark, signals from the suprachiasmatic nucleus prompt the release of melatonin from your pineal gland. The level peaks during the darkest hours of the night. As light levels slowly increase with the approach of dawn, melatonin levels go down and your body prepares to awaken.

Studies have shown that patients with SAD tend to have what is called delayed dim-light melatonin onset (DLMO). This means that when the sun goes down or the lights are lowered, the brain is delayed in stimulating the release of melatonin. This pushes the sleep cycle back, which can leave these patients feeling more lethargic throughout the day.

Fortunately, some people can correct this shift by using morning light therapy during the darker months of the year. But simply screwing full-spectrum light bulbs into your lamps at home won’t do the trick. All light rays have both color and intensity. Regular full-spectrum bulbs are designed to ease eye strain by emitting all the colors of light, but they lack the necessary intensity to regulate your hormones. Illumination is sometimes measured in units of intensity called lux. Household light bulbs emit around 500 lux, while sunshine on a bright day emits around 100,000 lux. Studies have shown that light therapy can be effective at levels as low as 2000 lux, but you would need direct exposure to that light for a prolonged period of time — four hours. Modern light therapy boxes emit around 10,000 lux and require only about 30 minutes of exposure to be effective for most people suffering from SAD.

Along with color, intensity, and length of exposure, the timing of light therapy is also important. You can use a light box in the morning or evening to regulate your sleep rhythms, though many people experience insomnia with evening use. It may take some experimenting with time of day and duration of treatment before you achieve the best results. Regardless of timing, though, you should notice symptom improvement within a week of use (though some cases of SAD may take longer — and not all individuals will fully respond).

Hormones and SAD

Just as your sleep cycle is regulated by light and the hormone melatonin, your moods and whole health picture depend heavily on the delicate balance of your hormones. We know that no one hormone acts on its own. They all work synergistically, affecting everything from sleep to appetite, mood, growth, and sexual desire. Your body is a microcosm of the natural world, where all the elements interact to create a balanced ecosystem. In the case of SAD, the misstep may begin in the suprachiasmatic nucleus, with disruption of the pineal gland’s secretion of melatonin. From there, hormone secretion in the pituitary gland may in turn be impacted. And as the body’s “master gland,” the pituitary regulates hormones that control a host of bodily functions, including growth and reproduction. The pituitary also regulates the thyroid and adrenals, which are essential for healthy metabolism, steady weight, and stress management.

Light also affects serotonin, the neurotransmitter responsible for the production of melatonin. Serotonin levels fluctuate throughout the seasons, reaching their lowest point during December and January. When one hormone or neurotransmitter is out of balance, the whole system can get thrown off. Your body will do its best to compensate — at least to begin with. Low serotonin is frequently fingered as the primary culprit in depression, but in truth neurotransmitters like serotonin, dopamine and norepinephine are linked on many levels, so it is never just one thing. The easiest way for your body to address the imbalance is to send out signals to “get more now” in the form of intense carbohydrate cravings.

It’s true that foods high in carbohydrates fuel your brain to make and release serotonin. But problems arise when we take in excess simple carbs, such as white pasta, bread and sugar. Nearly everyone has experienced the erratic effects of a sugar buzz, where we feel better for an hour or two then crash when our serotonin levels drop back down. People whose days are gripped by this devastating cycle of ups and downs have afternoon grogginess and carb cravings, triggering a rush to the vending machines. It isn’t long before we start to see the inevitable weight gain, headaches, guilt, and depression with this pattern.

When you experience PMS or perimenopause symptoms, you have the added stress of normal hormonal fluctuations. Learning to deal with these fluctuations early on and getting your body back in balance can ultimately help you to coast through menopause with relative ease and avoid a host of hormone-related problems, including SAD.

Mother Nature doesn’t need a Palm Pilot

While we each follow our own natural rhythms and cycles, we do not live in isolation from one another. Ayurvedic medicine teaches us that humans are a microcosm of nature. Nature has its own rhythm, and try as we may to deny it, humans are part of that rhythm. Springtime is the beginning of all things new, when the whole world gears up for the most intense season — summer. Traditionally, summer was a time for growing, ripening, and toiling in the long hours of daylight to provide for a strong body capable of withstanding the harsh days to come. The shorter, crisper days of autumn are nature’s way of saying, “Finish up, thicken that blood, it’s almost over.” Winter, at last, is a time for rest, renewal and hibernation.

In our modern world, summer has become the lazy-hazy time of the year. It’s when we take our vacations, throw more parties, and slack off at work. The kids are out of school and stay up late, “vegging-out” in front of the TV and playing video games. Then when fall arrives, instead of slowing down like nature intended, we get all geared up again — it’s when we’re expected to be at our most productive because we just finished our resting season. Could this be why some of us feel so out-of-it when the winter months roll around?

To make matters worse, the deeper we move into fall and winter, the more pressure we place on ourselves to be active. The holiday season arrives with all its hustle and bustle, lengthening our to-do lists in an already-too-short day. Then once January hits, we’re supposed to get cracking on all those self-improvement resolutions. While the natural world around us lies deep in slumber, we’re rising at the crack of dawn to fit a workout at the gym into our day. No wonder our systems are out of whack. We take nature’s carefully drawn-out blueprint and flip it 180 degrees.

Unfortunately, unless you’re a rural farmer, already living in tune with nature’s schedule, you have to bear up under the demands that modern society places on us all. If you’re a parent or a working woman, you’re still going to have to get the kids ready for school in the fall, take vacations in the summer, show up at holiday parties, and complete those year-end reports. That said, the single most significant goal you can set is to get your body back in synch with nature as much as possible, which means putting it back in proper balance.

Keep the winter blues away — the Women to Women approach

When November arrives, you don’t have to dread the darker days and colder nights ahead. There are many things you can do to help your symptoms of SAD, or even resolve them for good. However, let me say very plainly that if you suffer from severe depression symptoms or if you’ve ever been diagnosed with a major depressive disorder, you should by all means work closely with your healthcare practitioner to formulate a strategy that works best for you. Prescription antidepressants are useful for some people, and we do not recommend simply abandoning them without the guidance of a trained professional.

On the other hand, there are many safe natural ways to relieve symptoms of seasonal sadness, irritability, carbohydrate cravings, and lethargy. Trying out one or two of these alternative treatments for SAD may be adequate. Or, you may need to follow each and every one to get lasting results. Yes, this approach requires more effort than popping a pill, but when used mindfully — with the care you certainly deserve — these methods will not harm you, and they may even be more affordable and effective.

If these lifestyle changes seem too overwhelming for you in your current state, just try them for two weeks. I tell my patients they can do anything for two weeks! You may be amazed to find how much better you can feel, inside and out.

• Get outside every day. This is one of the simplest ways to quickly ease the symptoms of seasonal depression. Spending as little as 15 minutes outside during the warmer months will expose your body to the sun’s healthful rays, helping you produce your own vitamin D and stave off seasonal depression. Try to connect more with nature, the ground beneath you and the sky above. At the very least, try to place your desk near a window so you are exposed to natural light.

• Supplement your diet with vitamin D. If you’re dealing with seasonal affective disorder and suspect your vitamin D levels are low, work with a healthcare provider to test your levels and get them back up to normal. Some people may need to take between 2000–6000 IU per day for several weeks to reach adequate levels and reverse symptoms of SAD. But before supplementing your diet with high levels of vitamin D, have your levels tested — vitamin D is fat-soluble and toxic at high doses, and your body doesn’t have a way to rid itself of D once it gets too much. So you can’t do this on your own. That said, people with vitamin D-dependent SAD can transform their lives by supplementing their diet with D, so this is well worth investigating.

• Consider neurotransmitters testing and support. If you have significant symptoms of SAD, you may want to consider the option of neurotransmitter testing and support. Any neurochemical imbalances identified in your profile can be addressed with targeted amino acid support and other natural supplemental formulas. In addition to relieving problems with mood and affect, this approach can greatly benefit all your body systems. For information on finding a provider near you, visit the NeuroScience website.

• Get some exercise. Daily exercise is vital to your overall well-being, especially if you are depressed. It’s a healthy way to increase your serotonin levels without digging into that gallon of Rocky Road in the freezer. The good news is, you can start small. Try short bursts of intense activity — walking up and down the stairs or skipping rope for 1–3 minutes (or until you’re tired out), four times a day, three times a week. These small steps can give you the motivation to keep going. You can walk, swim, dance, play tag with your kids — the key is to find something you enjoy and to keep doing it.

• Consider phototherapy. Light therapy has been shown to be very successful for many people suffering from symptoms of SAD. A recent study performed in Canada tested light therapy against the commonly prescribed fluoxetine (Prozac) for SAD patients. The study found that both treatments relieved symptoms equally well, but the light therapy worked much faster — showing positive results at less than one week! Phototherapy less likely to cause side effects such as agitation and sleep disturbance.

In fact, light therapy has no known side effects, other than the potential for overuse, which can result in headaches, jitters, insomnia, or unhealthy euphoria. Moreover, a light box has a one-time cost (around $200, though you can pay more for models with added features). When you compare that to the cost and multiple known side effects of prescribed antidepressants, it makes sense to use the natural alternative.

Another way to ease SAD symptoms with light is by using a dawn simulator. This is basically an alarm clock that emits light instead of sound to wake you gently and naturally. While you are still asleep, the simulator gradually brightens the light in your bedroom until you are ready to wake up. Depending on the model, you can program this process to take place in minutes or up to three hours, replicating a natural sunrise during the brighter months of the year.

• Keep a regular schedule. Since the goal is to establish an internal rhythm that’s in synch with nature’s own, it’s desirable for people with SAD to keep a regular waking and sleeping schedule. Research has shown that people who work extra shifts or split-shifts tend to have an imbalance in their melatonin cycles, especially if they work at night or have limited access to sunlight. Try to go to bed and rise around the same time every day, and be sure you are getting between seven and nine hours of sleep each night.

• Pay attention to the seasons, and eat accordingly. What and when we eat has such a profound effect on our physical and mental health. When we eat with the seasons, our energy levels better correspond to the time of year. In the spring and summer — nature’s active, expansive (yin) time — fresh greens, brightly colored berries, and water-laden fruits and vegetables are abundant. When you eat these foods, you feel light and full of energy. Grains ripen for harvest in the fall, nature’s time for contracting, prompting us to bake bread and prepare heavier (yang) meals. That extra bulk takes more energy to digest, so we may feel contented or drowsy after a meal. In winter, nature encourages us to eat starchy, stick-to-your-ribs foods that store well over time, like potatoes, winter squashes, and oatmeal. This is how our ancestors survived the harsh winters when food was hard to come by.

Today we can eat anything we want in any season. We are blessed with abundance and a transportation system that bring us kiwifruit in December, but the blessing is a mixed one. There’s a reason why mashed potatoes and stuffing are Thanksgiving dishes and watermelon is a Fourth of July treat. By consuming highly processed foods and out-of-season produce, we are confusing our bodies with mixed signals, throwing it out of balance and starving it of optimal nutrition. Stick to whole foods, minimally processed, with little or no artificial ingredients, and as locally grown as possible.

• Choose whole grains and complex carbohydrates. If you have SAD, your body will crave serotonin, and it’s so easy to reach for refined carbs and sugars that give you that good feeling. But those foods will only set you on a cycle of ups and downs with a negative effect on both your mood and your weight. Anything with white flour, white sugar, or processed chemical ingredients can set you up for cravings. So, put down the donuts and have a nice hot bowl of vegetable soup instead. And there are plenty of ways we can make our favorite comfort foods from healthy ingredients. If you don’t know where to start, our Personal Program includes delicious healthful recipes that will ease you off the overly processed carbs.

• Plan a vacation. Give yourself something to look forward to during those dark months. Book a weekend retreat at a yoga center or health spa, or head somewhere warm and sunny. You deserve it! If you plan a trip in November and another in February — even for a few days — it will not only improve your mental state, but your whole health picture will look brighter. And if you go somewhere sunny, sitting on the beach will help you refill those vitamin D stores.

• Take high-quality nutritional supplements. Treating the whole body means giving every system the highest possible level of support. Because the practices of our modern farming and food processing industries strip our food supply of its nutritional value, everyone can benefit from taking high-quality vitamin and mineral supplements. If you suffer from SAD, you may greatly benefit from adding extra vitamins, minerals, amino acids, and especially fatty acids like omega-3’s, to your diet. In fact, Harvard Medical School is producing some promising research on omega-3 fatty acids as an effective antidepressant. I provide my patients with high-quality nutritional supplements tailored to their individual needs. You can take advantage of these through Women to Women’s Personal Program.

The power of healing yourself

Now that you understand how many factors are involved in keeping your mind and body healthy, it’s not hard to see why conventional medicine has trouble solving several of the health problems we see today. Standard medical practice involves treating one symptom at a time, independent of the entire system. This usually involves a drug that introduces new man-made chemicals into your delicate system of natural chemicals. Unfortunately, that often throws off the balance in other places, resulting in new symptoms.

At Women to Women, we believe the answer to SAD and many other health-related issues lies in treating the whole body as a unit. We also recognize that each body has a unique set of rhythms and experiences. As health practitioners, we cannot simply apply a “one-size-fits-all” diagnosis and treatment protocol. SAD can have many roots at its core, and you have the power to find them. Listen to yourself — physically, mentally and emotionally — and find your own answers.