Treating Seasonal Affective Disorder

It’s the SAD time of year, Seasonal Affective Disorder

Seasonal Affective Disorder, or SAD, or the Winter Blues, is officially recognised by Doctors and Psychiatrists as a medical condition that is thought to affect 2 million people in the UK and Ireland and over 12 Million people across Northern Europe.

If you have had episodes of depression that clearly have an onset in autumn or winter followed by remission of symptoms in the spring or summer, you may have SAD. Young people (in their early twenties) are more likely to be affected and as with depression, SAD affects twice as many women as men

 Why do we suffer in Ireland?

Historically 75% of the population worked outdoors, now less than 10% of us work in natural light. Whilst this is fine in summer months with long daylight hours, in the winter months we tend to go to work in the dark and go home in the dark and so we get very little natural daylight. The advent of electric light has allowed us to abandon natures natural cues, work longer hours, work shiftwork and allow our personal activities and social gatherings to extend well into the night. In Ireland we are more susceptible to SAD as we are situated in the higher latitudes of the northern hemisphere. A combination of a change in seasonal light, our hectic lifestyles and the periods of darker days and poorer weather, can result in dramatic effects on our circadian rhythms; our natural body clock. As a direct consequence of these environmental and lifestyle factors more people than ever before are suffering from Seasonal Affective Disorder.

Understanding Circadian Rhythms

 The body uses natural light to regulate;

  • Mood
  • Sleep
  • Energy levels
  • Appetite
  • Digestion

 

How lack of daylight can cause circadian rhythm imbalance and therefore SAD

Neurochemicals such as melatonin and seratonin are known to be involved in the regulation of our mood and functioning. The production of these chemicals is directly affected by daylight and they inturn influence our circadian rhythms.

Melatonin is a hormone that our brains produce during the hours of darkness. It is involved with regulation of sleep, body temperature and release of hormones. As with any hormone, the amount produced is important and people with SAD may respond to a decrease in light by secreting more melatonin than people without SAD. This disrupts our internal body clock leading to depressive symptoms.

A chemical called serotonin also has a role in mood, appetite and sleep. It's thought that people with SAD may have abnormally low levels of chemicals such as serotonin in winter.

 

Symptoms of SAD

·      Depressed mood

·      Irritability

·      Hopelessness

·      Anxiety

·      Loss of energy

·      Oversleeping (feeling like you want to hibernate)

·      Loss of interest in activities you normally enjoy

·      Appetite changes, especially a craving for foods high in carbohydrates such as pastas, rice, bread and cereal

·      Weight gain

·      Difficulty concentrating and processing information

·      Loss of libido

Diagnosis of SAD

It is important to visit a medical herbalist or your GP if you are experiencing any number of the above symptoms. Other underlying causes may first need to be ruled out before a diagnosis of SAD is arrived at.

Treatment of SAD

Always seek a professional diagnosis first.

Self-help

There are a number of steps you can take that may help reduce the effects of SAD. Wherever possible, you should:

·      Find time each day to get outside

·      Sit near windows when you are inside

·      Take regular, moderate exercise or physical activity

·      Eat a well-balanced diet

·      Decorate your home in light colours

·      Leave any major projects until summer and plan ahead for winter

·      Learn to reduce and manage stress

             

Tell your family and friends about the condition and its effects so that they are able to help and support you. You may find it helpful to join a support group (see list below). Knowing that you are not alone and that help is available can be a great comfort.

 

Light therapy (also called phototherapy)

Some people find light therapy, exposure to bright artificial, full spectrum ight, improves symptoms of SAD. The idea is that providing bright light may stimulate a change in the levels of chemicals and hormones which affect your circadian rhythms . Bright light can be delivered using a specially made lightbox. The light is similar to natural daylight, although it will not emit harmful UV rays. You should never use tanning lights or beds for light therapy. The light given out by these is high in UV rays and can harm your skin and eyes.

The type of light used, distance from the light, and amount of time, are very specific. The light should be of adequate intensity, 10,000 lux (lux is a measurement of light intensity). At 10,000 lux, the amount of time required in front of the light is 30 minutes.

You need to have your eyes open, so that the light can reach the retina in the back of your eye. You do not have to look directly at the light. You can read, knit, etc. The light purchased should have information on exactly how to use the light effectively. The distance you sit from the light will range from about 12-18 inches.

You may notice an improvement in symptoms within three to five days but it may take a week or more to see any effects.

Many SAD sufferers find it useful to use a ‘Dawn Simulator’ in conjunction with their lightbox. This is a timed bedside light that mimics the sunrise and will help to wake you gradually.

SAD Light Therapy products are entirely safe to use for for the majority of people and if you are generally healthy you should have no problem using one. However, consult your doctor/medical practitioner before you start using a lightbox:

  • If you have an eye problem or if you are particularly sensitive to light.
  • If you are (or have been) taking antidepressants or medication against epilepsy.
  • If you suffer from Bipolar disorder.

 

Consult your practitioner for guidance in choosing the correct lightbox for you. The cost may be covered if you are a medical card holder or may be covered by your private health insurance policy. Lightboxes can be purchased without a prescription.

 

 

 

 

 

 

 

 

Herbal Medicine

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St. John’s wort (Hypericum perforatum)

 

                                                                                                                 

St. John’s wort is a wonderful healing herb with many actions but these days it is most commonly known for it’s role in the treatment of depression and seasonal affective disorder (SAD).

 

What the scientific research says

 The Cochrane Collaboration reviewed 29 studies in 5489 patients with depression that compared treatment with St. John’s wort for 4 to 12 weeks with placebo treatment or standard antidepressants. Overall, the St.John’s wort proved superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants.

 

Patients suffering from depressive symptoms who wish to use St. John’s wort should consult a medical herbalist or G.P. The herb is only available on prescription from a fully qualified medical herbalist or doctor. St. John’s wort can interact with other prescription drugs and therefore should never be taken without the appropriate consultation and prescription.

 

 In addition herbs that will help you adapt to stress, restore balance to the  adrenal hormones (adrenaline, cortisol) and protect the immune system will all help the body to adapt and deal with the symptoms of SAD.

 

Peace of Ease Tea

Cat mint

Chamomile

Oat straw

Rose petals

Lemon Balm

 

Take an equal pinch of one or more of these dried herbs (1-2 tsp in total) and add a cup of hot water, cover and leave to infuse for 3-4 minutes. Strain and pour into a favourite cup to savour the delicate flavour. Hold the tea as you drink to inhale the fragrant steam which will contain some of the herbs relaxing volatile oils. Sweeten with honey if you wish. If you are feeling hot headed and need calming, drink the tea as a refreshing cooling iced tea. Sip hot tea if you need warming and your spirits lifted.

 

A strong infusion of this tea can also be added to a bath for a relaxing soak. Just make a large pot, strain and pop it in the bath water!

 

 

Oats (Avena sativa)

Oat sraw will help relieve the exhaustion experienced by ongoing stress, anxiety and sleep disturbance. It will help to nourish and build you up.  Take as a tea or tincture.

 

Chamomile (Matricaria recutita)

Chamomile is a mild nervous sedative and it’s calming effect on the digestion can help those who get a ‘funny nervous tummy’ when stressed. It will help to relax and reduce feelings of anxiety and help in the wind down process at nighttime. Take as a tea or tincture. Use 2-3 drops of essential oil in the bath or in an oil burner to disperse to the room.

 

 

Lemon balm (Melissa officinalis)

Lemon balm is another herb that is useful for a nervous stomach. This herb will help sleep disturbed by anxiety dreams or nightmares. It lifts the spirits and good to have when you are feeling cold and miserable or when in need of  a little clarity and uplifting while working, combine it with some peppermint tea.

 

 

Cat mint / Cat nip (Nepita cataria)

A wonderful herb to gently relieve nervous tension. I find this herb to be nice and cooling if you feel hot tempered when stressed. Drink as a tea.

 

 

Rose (Rosa damascena)

Rose is gently sedative and has an uplifting light fragrance. This is a herb traditionally used in states of anxiety and depression related to grief.

  

Caution: Please note that the advice given in these notes is not intended to be a replacement for professional medical advice and treatment. Always visit a fully qualified medical herbalist or G.P. for diagnosis. If you are pregnant, have an existing condition or are currently taking medication consult a medical herbalist to see which herbs are appropriate for you to take.

 

Handy Tips!

 

  • If buying essential oils, make certain that they are labelled with the correct latin name of the medicinal plant.
  • Use infusions of dried or fresh herbs rather than oils for those with sensitive skins.
  • Order seeds or plants on line or your local garden centre will be pleased to help you.
  • Never add more than a total of 10 drops of essential oil to your bath and it is essential to agitate the surface of the water well before you enter the bath to disperse the oil as undiluted aromatic oils can burn tender and delicate areas.

 

 Vitamin D Supplementation

Much of the recent research on Vitamin D has highlighted the fact that a deficiency may be a possible cause of SAD or at least deficiency produces similar symptoms, leading most practitioners to believe that normal neurotransmitter function depends in part on adequate vitamin D synthesis.

Vitamin D levels are inversely related to those of melatonin, another mood-regulating hormone. Melatonin helps modulate your circadian rhythms, with darkness triggering melatonin secretion by the pineal gland within your brain, bringing you down gently at night for sleep. Insomnia, mood swings and food cravings are influenced by melatonin. Sunlight shuts melatonin production off, while triggering release of vitamin D — that’s why it’s recommend to get outdoors as a remedy for jet lag.

Most of us can sense the positive influence of sunlight in our own lives by the immediate lift we get from taking a walk outdoors on a beautiful sunny day. Now there may be many factors at work that brighten our mood in such cases, but sun exposure is almost certainly a critical piece. Soaking in the warmth of the sun is one of the most relaxing activities we share with all living creatures — just watch a cat dozing in a beam of sunlight!

 

 Other current research being done on Vitamin D is showing that a deficiency in this vitamin may also play a role in 17 varieties of cancer (including breast, colon and prostrate cancer) heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects and periodontal disease

 

 

How Do You Know If You're Deficient in Vitamin D?

 

Your vitamin D levels can be measured with a blood test. The 25-OH Vitamin D3 can be measured.

 

How Do You Get Vitamin D? Can You Get It From Food?

Few foods contain Vitamin D. You will note on your milk carton that it is fortified with vitamin D but this is very little and certainly not anywhere near enough to restore levels.

Fish and egg yolks are the only foods that have Vitamin D in any significant quantity.

There really isn't a good alternative to producing Vitamin D yourself. So, if you don't make enough on your own then you may need to take it as a supplement (400-800 IU daily).

 

 

Background Info on Vitamin D

- Vitamin D is known as the Sunshine vitamin. With the aid of sunlight, vitamin D is made from cholestrol in the skin, liver and kidneys.

- Vitamin D is actually a hormone not a vitamin. The body must manufacture it.

- As we age, the ability of the body to produce Vitamin D decreases.

- One reason for there being such high numbers of people being Vitamin D deficient is that we're encouraged to stay out of the sun and we're using more and more sunblocks whenever we're outside. Sunblock and avoiding too much exposure to the sun is a good thing to prevent skin cancer but it is having an effect on your Vitamin D levels.

- If you are on a low fat or a low cholestrol diet, you will have decreased production of Vitamin D.

- Other reasons why you may have a decreased level of vitamin D are if you have a liver or kidney disorder or if you're using medication that decreases cholesterol production or inhibits its absorption from the intestines into the body.

- "Stress contributes to decreased Vitamin D production. The stress hormone cortisol is made from cholesterol. Therefore, a body experiencing any type of stress will, preferentially, use cholesterol to manufacture cortisol, depleting the amount left to make sufficient amounts of Vitamin D." - Diana Schwarzbein

 

 

As for SAD, it may turn out to be a major cause. It also seems to play a role in a number of SAD symptoms like feeling tired, depression, not sleeping properly, and not thinking clearly. Even if taking Vitamin D could aid in addressing these symptoms it would make SAD far more manageable. So, I think it's definitely worth considering.

 

Vitamin D has co-factors that the body needs in order to utilise vitamin D properly. They are:

      magnesium

      zinc

      vitamin K2

      boron

      a tiny amount of vitamin A

       

Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why.

 

Useful Resources

Aware Helpline: 1890 303 302 (aware.ie)

Samaritans Helpline: 1850 60 90 90 (Samaritans.org)

ReachOut (reachout.com)

Lean on Me (leanonme.net)

Mental Health Ireland (mentalhealthireland.ie)

SpunOut (spunout.ie)

Shine (shineonline.ie)

GROW (grow.ie)

Suicide Prevention (suicideprevention.ie)

Suicide or Survive (suicideorsurvive.ie) 

Caution! Always consult your prescribing practitioner if you have any existing medical condition or are currently taking any medication before supplementing with Vitamin D.

 

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