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Seasonal Affective Disorder

Many of the women I see in the fall months tell me they dread the coming of winter. If they have been depressed in the past, their mood seems to plummet with the darkening days. If they ve had PMS symptoms, the irritability and cravings seem to be accentuated as the leaves start to fall and the nights get cooler. About 35 million Americans, 75-80% women and over 30, experience a form of depression that begins in early winter and lasts till spring. Loss of sunlight leads to chemical changes in the brain, specifically a reduction in serotonin and an increase in melatonin.

Typical symptoms of Seasonal Affective Disorder (SAD) include loss of energy, increased desire to sleep increased appetite, anxiety, difficulty concentrating, irritability, a desire to withdraw or isolate, and decreased sex drive. These symptoms differ from classic depression at the cellular level, and with their timing.

Norman Rosenthal, MD, Georgetown University professor of Psychiatry, in his book, Winter Blues, suggests several treatments that have proved beneficial to many of my patients:

Bright Light
Morning light therapy. In the spring and summer, 10,000 to 100,000 lux meet our retinas and boost serotonin in our brains. In the winter, especially above and below the 35th parallel, fewer than 5,000 lux hit our retinas. Light boxes and cool white fluorescent bulbs that emit 10,000 lux help simulate natural sunlight. If we sit one to three feet away from the source and allow it to shine on our faces for 30 minutes to two hours daily, it will help lighten SAD symptoms in 60% of those affected within four to five days. Light boxes can be purchased on- line or at medical supply stores, and full spectrum light bulbs are available at many hardware stores.

Melatonin
Melatonin often makes symptoms worse, since it is a source of the problem; it suppresses serotonin.

Tryptophan
Tryptophan is an amino acid found in turkey and milk. It can be taken as a supplement called 5-HTP before sleep and help deepen sleep as well as raise serotonin levels. A contaminated source of imported tryptophan in 1989 caused a temporary ban on its sale, but it can be found in most health food stores now. The appropriate dose is from 50 to 300mg. Tryptophan is an antioxidant and an immune system booster as well.

SSRIs
Many of these antidepressants help eradicate symptoms of SAD but need to be prescribed by your health care provider. Some of my patients start their antidepressant in the fall and wean off in spring.

B Vitamins
Most depressed individuals suffer from a B vitamin deficiency Vitamin B3 and 6 and inositol are necessary to convert tryptophan to serotonin. I suggest to my patients that they take 50 to 100mg of a B complex daily.

Vitamin D
Northern latitudes are deficient in sunlight necessary to make Vitamin D in our skin October to March. Even southern latitudes where sunscreen blocks sunlight, individuals are deficient in Vitamin D, which isn t a vitamin at all, but a hormone with receptors found not only in the skin but in the colon, bone breast, prostate, and myelin sheath of the nerves. Four hundred IUs of the vitamin has been the recommended daily allowance until recently. With current research finding most Americans deficient, 800 to 1200 IUs are being suggested, with serum levels being checked for deficiency. If levels of VitaminD3 are below 30, replacement at much higher levels is suggested until levels are normal. It s amazing how many symptoms are relieved with the establishment of normal levels of the vitamin. Vitamin D can be also found in fish oil and fatty fish. Most multiple vitamins contain 400IU, and many calcium tablets include Vitamin D as well.

Suggestions that I use in my practice to help women overcome the symptoms of SAD include:

• • Take a multiple vitamin with 400IU Vitamin D daily
• • Get as much natural sunlight as possible; go for a walk outside at lunch if possible
• • Stay physically active outdoors as much as possible
• • Avoid sugar and white flour, choose whole grains in small amounts
• • Eat a low fat diet, minimize red meat
• • Limit alcohol and caffeine, one daily, maximum, of each
• • Take vacation in a warm climate, even more important than summertime
• • Avoid melatonin October to March
• • Lighten up rooms with full spectrum bulbs, and open shades for sunlight
• • Take one to two grams of fish oil daily, eat fish twice weekly
• • Avoid isolating, plan activities ahead, staying connected with loved ones
• • Use ST. John s Wort, 5HTP, or an SSRI with monitoring

Much research is being done in this area, but until we have clearer information about why some of us are affected by decreased sunlight and others aren t, it s important to get the help we need by seeing our health care provider. Our magnificent Maine winters provide us with the opportunity to help ourselves become more aware of the light within us and those we love, when we take care of ourselves.

New England WomenCenter is a woman-centered health care practice founded in 1997. The Nurse Practitioners of New England WomenCenter provide gynecologic care for women of all ages with a caring, respectful approach.

 

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