Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Jan
03
2013

Thinking Of Health In The New Year

As we start a New Year it is a good time to reflect on our health, what makes us healthy, what keeps us healthy and what makes us age less quickly.
Here are a few thoughts, partially my own, partially influenced by the 20th Anti-aging conference in Las Vegas in December of 2012.

1. We know that cigarettes are no longer in, but in the casinos of Las Vegas and outside of restaurants a lot of people are still smoking! Here is a website that tells you why you should quit.  Cigarettes cause lung cancer, hardening of the arteries, strokes, and often reduce life expectancy by 10 to 15 years. So, if you are smoking do anything to quit this habit! Acupuncture helps, Nicorette assists you in overcoming the addiction part of smoking. Self hypnosis discs are also helpful.

2. Reduce toxins in your life: you may think that toxins consist of lead, mercury and other heavy metals and that only people in certain industries would be exposed to those. Not so. It is in the air we breathe. Your tooth fillings (silver amalgam fillings)may leech out mercury, old paints at home could still expose you to lead, as would fashion jewelry made in China. Various foods contain toxins in them in form of residues from herbicides and insecticides. How do we detoxify? Vitamin C is a good start. It can be taken as a daily vitamin supplement (see below). Detoxification can be done intravenously, if urine and blood tests show high levels of toxins. This is something an anti-aging doctor or a naturopathic doctor can help you with. Glutathione and vitamin C can be given intravenously for chelation treatment with the least side-effects. Here is a link that tells you more about chelation in general.

3. Cut out wheat and other genetically modified foods: What’s the thing about wheat? Read my blog about this.
All of the wheat we get today in bread, cereals, pasta, pizzas etc. has been genetically modified and has about 7 times the gliadin concentration that the original wheat species had before BASF did the chemical modification of  wheat in the 1960’s and 1970’s. Today practically all of the commercial wheat is this type.
As a result I have avoided wheat in my food intake since 2001. When you avoid wheat and sugar, which is another culprit (sugar is simply too strong for your body to handle and leads to hyperinsulinism and diabetes) you will likely loose whatever weight is too much for you without any effort.

Thinking Of Health In The New Year

Thinking Of Health In The New Year

4. Eat only organic food , if you can afford it. Or grow your own vegetables and lettuce in your vegetable garden, if you can. Because of what I said under point 2 above, I stay away from regular vegetables and lettuce that are sold in super markets as they contain residues of round-up (herbicides) and insecticides on them. Organic food nowadays is affordable as enough of us demand it. Even Wal-Mart has some organic foods! Keep an eye on your body weight and aim for a body mass index between 21.5 and 23.0. Several long-term studies have shown that the BMI is worth observing in order to reduce mortality.

The Singapore Chinese Health Study: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014000

The Buffalo Health Study:  http://aje.oxfordjournals.org/content/146/11/919.full.pdf+html

5. Exercise regularly 5 to 7 times per week. Perhaps one of the most important points is regular exercise. If you engage in ½ hour of vigorous exercise three times per week you will reduce your probability of coming down with a serious illness that could kill you by 15%. If you exercise 5 to 7 days per week for 30 minutes or more this percentage goes up to about 40%. If you exercise 60 minutes 6 to 7 times per week in a gym, you reduce mortality by about 50 to 60%. Here is an interesting graph that shows that older adults benefit more from exercise than younger adults do.

6. Have a yearly check-up including a check-up of your hormone status: As we age, our hormones reduce in a characteristic patterns with melatonin and growth hormone production going on a downhill slope after the age of 30, followed soon by DHEA and cortisol. Often by the time a woman reaches menopause at the age of 35 to 50, there is a lack of estrogens, progesterone, and often also of thyroid hormones. In a man this decline (andropause) may take longer until the age of 55 to 65 before he experiences a lack of energy, erectile dysfunction and muscle weakness from testosterone deficiency. Sex hormones are best measured in saliva samples, the remaining hormones in blood samples. Here is a website that describes the various hormones that often need replacement (note that I am not endorsing this center, just citing it as an example of what to look out for).

7. Replace hormones only with bioidentical hormones: When there is a hormone deficiency, a doctor would usually replace the deficiency with synthetic hormones from Big Pharma. This was good for the profits of the companies, but bad for people as the Women’s Health Initiative has shown.
As a result of this study (showing heart attacks, strokes, breast cancer) a lot of American women and women around the world were unjustly horrified of hormone replacement. However, many trials with bioidentical hormones around the world have proven that bioidentical hormone replacement with hormone creams from compounding pharmacies add years of life expectancy as these hormones restore all body functions back to normal. No breast cancer, no heart attacks and no strokes were noted on these natural hormones. The key is to replace with low doses and slowly under the supervision of a naturopathic physician or anti-aging physician.
Here is a site that explains bioidentical hormone replacement (note that I am not endorsing this center, just citing it as an example of what to look out for).

8. Have hobbies, cherish friendships. Social networking is good for your emotional health. It reduces stress, re-balances your hormones, reduces your risk of heart attacks and strokes.

9. Don‘t neglect your spirituality. Be part of a church community that builds you up, if you are religious. For those who no longer belong to a church group, meditate instead, use yoga, do self hypnosis or read an inspiring book. Music can energize you or contribute to relaxation.

10. Use vitamin and mineral supplements. There are a number of vitamins and minerals that have anti-oxidative effects. They help to detoxify your body and protect you from some of the environmental challenges. I have discussed them elsewhere in more detail under this link.

So, here they are, the 10 steps to a healthier 2013. Review what you are doing in your life . You may need to only modify the one or the other point. Otherwise, if you have identified several points you want to change, just start with the ones you feel can be achieved the easiest first and then gradually tackle the rest. You will be rewarded with more energy and you will probably find it difficult to hide your successes from your friends.

Last updated January 3, 2013