In New England as fall moves into winter and the daylight
hours shrink, many women say their lives begin to change abruptly. They feel extremely
tired, want to sleep and eat more, or feel sad all the time. Of course we all feel
a shift as the days shorten. We tend to spend more time inside, eat heartier foods,
and slow down a little. But when these changes interfere with your life, a lot more
could be going on.
Women are expected to be upbeat and productive throughout the four seasons, but
if you suffer from seasonal affective disorder (SAD), this just isn’t possible.
No wonder the more casual term for SAD is the “winter blues.” About 5% of the US
population experiences SAD symptoms for 40% of the year, but SAD affects women four
times more than men. The most likely time for women to first notice symptoms of
SAD is during their mid-20s-30s. This is about the same time as they begin to experience
changes related to hormone imbalance as PMS and perimenopausal symptoms.
Whether you are diagnosed with SAD or just feel out of sorts during the winter months,
you don’t have to feel gloomy every time the temperature begins to drop. Instead
you can attack the underlying causes of SAD in many ways — most of which honor your
biophysical needs during this time of year. Finding out what SAD really is all about
can help you have a happier, healthier winter naturally.
Sadness when the seasons change
Women with SAD have recurring symptoms of
major depression with a seasonal onset and subsequent remission as the days
start to lengthen again. These symptoms of depression include loss of interest,
insomnia, decreased energy,
anxiety, poor concentration, fatigue and excessive guilt.
Typically, SAD occurs in the fall and winter, and resolves during the spring and
summer. The underlying causes of SAD are not fully understood but are believed to
be linked to increased melatonin, circadian phase shifts, dysfunctional serotonin
synthesis, and/or genetics. We do know that, like other depressive disorders, it’s
rare to have just one event lead to SAD. Instead, there are usually many factors
SAD and Vitamin D
One thing to look at, especially if you suspect you have SAD, is your vitamin D
level. You can assess this through a simple blood test, either on your own or through
your healthcare practitioner. Many women have vitamin
D deficiency, especially if they live in the northern hemisphere. The symptoms
associated with low vitamin D — reduced energy, fatigue, depressed mood, and sleep
irregularities — look a lot like the symptoms of seasonal affective disorder, leading
us to believe this connection is stronger than we thought originally.
Vitamin D is readily manufactured in our bodies when skin is exposed to natural
sunlight (UVB radiation). During the winter months, those of us who live at latitudes
above 40 degrees north or south don’t receive enough light to make the appropriate
conversion to vitamin D. In theory, by exposing ourselves to the sun in summer months,
most of us should be capable of storing enough vitamin D to last the winter. However,
because modern day life keep us indoors longer and longer, this doesn’t occur in
Pink salmon, sardines and cod liver oil are good sources of vitamin D and in the
US, milk is fortified with Vitamin D. However, the amount of vitamin D we get in
food is not much compared to the amount we need for optimal wellness. A recent study
showed that symptoms of SAD were improved with vitamin D supplementation.
Sleep, light and the changing seasons
A disruption in your natural circadian rhythm can contribute to SAD. Your circadian
rhythm is a series of physical and mental behaviors that follows a 24-hour cycle.
This internal rhythm is dictated by a tiny nerve cluster in your brain called the
suprachiasmatic nucleus, or SCN. Under normal conditions, the SCN directs the release
of hormones through light exposure. The lack of light in the fall and winter months
upsets this essential process, leading to the dysfunctional release of certain hormones.
Melatonin is one of the key hormones involved in circadian rhythm and is responsible
for making us sleepy. As the sun goes down, the SCN prompts the pineal gland to
release melatonin. Levels peak during the darkest hours of night and decrease with
the returning light of dawn.
Early or prolonged release of melatonin can disrupt sleep cycles and cause you to
feel like crawling back into bed. You’ll generally stay tired throughout the day.
Current literature suggests that patients with SAD have circadian phase delay.
This means that when the sun goes down, the release of melatonin is delayed, which
pushes the sleep cycle back, leaving you lethargic throughout the day.
Fortunately, light therapy, primarily in the morning, is effective for treating
this circadian shift and subsequent symptoms of SAD. Just sitting under a reading
lamp won’t do the trick. Instead, you use specific light therapy boxes, or portable,
visible light sources found in most home-goods stores. They provide the appropriate
light intensity needed — about 10,000 lux. Use a light therapy box in the morning
for about 30 minutes (time may vary with specific brands). Most people should notice
improvement of symptoms within a week of use, though some cases of SAD may take
longer — and not all individuals will respond fully.
Serotonin, the “feel good” neurotransmitter plays a key role in the production of
melatonin as well. Serotonin levels fluctuate throughout the seasons, reaching the
lowest point during December and January. It is no wonder that we tend to approach
SAD treatment in a similar way to major depression.
Keep SAD and the winter blues away — the Women’s Health Network Approach
If you suffer from severe depression symptoms, or if you’ve been diagnosed with
a major depressive disorder, work closely with your healthcare practitioner to formulate
a strategy that works best for you.
Prescription antidepressants may be useful for some women. If you’re taking
medication now, don’t abandon it without professional guidance.
When November arrives, you don’t have to dread the darker days and colder nights
ahead. You can relieve your symptoms of SAD, or even resolve them for good.
There are many natural alternative treatments to try. You may need to adopt each
and every one to get lasting results. Yes, this approach requires more than popping
a pill, but when used carefully, these methods are safe, and may be more effective
and affordable than drugs. If these recommendations seem overwhelming, just try
them for two weeks. You can do anything for two weeks!
Natural relief options for SAD
- Get outside every day: Being outside for as little as 15 minutes
a day will expose your body to the sun’s healthful rays, help you produce your own
vitamin D and reconnect you with nature. If possible, move your desk or workspace
near a window with natural light.
- Get vitamin D testing and supplement with vitamin D: If you suspect
low vitamin D levels, work with your healthcare provider to have your blood levels
tested and supplement with vitamin
D as needed. Some women may need to take 2000-6000IU per day for several
weeks to reach adequate levels. Amounts higher than 2000IU daily should be ordered
by a health practitioner because vitamin D is toxic at very high levels. Find out
more about vitamin D testing.
- Enjoy some exercise: Daily exercise is vital to your overall wellbeing
if you are sad or depressed. It’s the healthiest way to increase your serotonin
levels and you can start small. Try short bursts of intense activity — walking up
and down the stairs or skipping rope for 1-3 minutes, four times a day, three times
per week. Work up to at least 30 minutes of activity a day, 5 days per week. You
can walk, swim, dance, play tag with your kids — the key is to find something you
- Consider phototherapy: Light therapy is an effective treatment
for SAD and has no known side effects when used as directed. A light box costs about
$100 so it makes sense to try this natural alternative. (Tanning beds are not equivalent
to light therapy and their use can actually be dangerous to your health.) Light
boxes can emit some UV radiation, so get one with a UV filter or diffusing screen
to protect your skin and eyes.
- Keep a regular schedule: The goal is to establish an internal rhythm
that’s in sync with nature. Research has shown that people who work long hours or
split shifts 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 get up at the
same time every day, and help yourself get at least 6-8 hours of sleep per night.
- Pay attention to what you eat: It’s important to avoid highly processed
foods as they can throw our bodies out of balance nutritionally. Stick to whole
foods, minimally processed, with little or no artificial ingredients. Often with
SAD, your body will crave foods that quickly raise serotonin levels, such as refined
carbohydrates and sugars. But these foods only set you on a cycle of ups and downs
with negative effects on your mood and weight. Stick to whole grains and complex
carbohydrates, and those cravings will go away.
- Take high-quality nutritional supplements: SAD affects the whole
body, which means you’ll need to support all of your body’s systems. Modern farming
and food processing strip food of its nutritional value, which is why everyone can
benefit from taking
high-quality vitamin and mineral supplements. Recent research suggests that
acids can play a key role in treating depression.
The power of healing yourself
At Women’s Health Network, we believe the solution to SAD symptoms lies in treating
the whole body as a single unit. Since each body has a unique set of rhythms and
experiences, a “one-size-fits-all” diagnosis and treatment protocol won’t apply.
SAD can have many root sources at its core, and when you listen to yourself physically,
mentally and emotionally, you will find your own true answers.
J Nutr Health Aging 1999;3(1):5
Am Fam Physician. 2012 Dec 1;86(11):1037-1041.
1 Suicide and Mental Health Association International. [No date of publication
listed.] SAD: Causes, symptoms, light therapy. URL: http://suicideandmentalhealthassociationinternational.org/SAD.html
2 Seasonal Affective Disorder Association. Seasonal affective disorder.
URL: http://sada.org.uk/ (accessed 01.15.2007).
3 Higdon, J. 03.03.2004. Linus Pauling Institute at Oregon State University
— Micronutrient Information Center: Vitamin D. URL: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/
4 Lansdowne, A. & Provost, S. 1998. Vitamin D3 enhances mood in healthy
subjects during winter. Psychopharmocology (Berl.), 135 (4), 319–323.
Gloth, F., et al. 1999. Vitamin D vs. broad-spectrum phototherapy in
the treatment of seasonal affective disorder. J. Nutr. Health Aging, 3
5 Arendt, J. 02.01.2006. Human pineal physiology and pathology. Endotext.org.
URL: http://www.endotext.org/neuroendo/neuroendo15/ch01s05.html (accessed 01.15.2007).
6 Lam, R., & Levitan, R. 2000. Pathophysiology of seasonal affective
disorder: A review. J. Psych. Neurosci.,25(5), 469-480.
7 Cleveland Clinic Foundation. Seasonal affective disorder and light
therapy. URL: http://www.clevelandclinic.org/health/health-
8 Lam & Levitan. 2000.
9 Lam, R., et al. 2006. The CAN–SAD Study: Randomized controlled
trial of the effectiveness of light therapy and fluoxetine in patients with winter
seasonal affective disorder. Am. J. Psychiatry, 163, 805–812.
Press Release: Light therapy and fluoxetine are equally effective for
winter depression. URL: http://www.psych.org/news_room/press_releases/
http://www.psych.org/news_room/press_releases/06-26LAMAJPrelease.pdf (accessed 01.15.2007).
10 Terman, M. 2006. Evidence-Based Mental Health. Review: Light
therapy is an effective treatment for seasonal affective disorder. URL: http://ebmh.bmjjournals.com/cgi/content/full/9/1/21
Golden, R., et al. 2005. The efficacy of light therapy in the treatment
of mood disorders: A review and meta-analysis of the evidence. Am. J. Psych., 162,
656–662. URL: http://ajp.psychiatryonline.org/cgi/content/abstract/162/4/656
Ivanhoe Broadcast News 01.15.2007. SAD? Help for the Winter Blues. URL: http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=15276
11 Carlezon, W., et al. 2005. Antidepressant-like effects of uridine
and omega-3 fatty acids are potentiated by combined treatment in rats. Biol. Psychiatry,
57 (4), 343–350.
Biological Psychology NewsLink. Links for keyword: Biological rhythms. URL: http://www.biopsychology.com/index.php?descType=always
adrenal symptoms today