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Seasonal affective disorder (SAD) is a form of depression that follows the seasons. It typically occurs during the winter months and goes away during the spring and sum­mer, although a small number of people experience depression during the summer.

Approximately 4 percent of Canadians suffer from SAD. The exact cause is un­known. However, it may result from light deprivation that upsets the body’s internal clock, or from seasonal variations in serotonin (levels are lower in the winter and a deficiency of serotonin can cause depression) or melatonin (levels are higher during darker months, which causes sleepiness).

Fortunately, there are a number of lifestyle measures and supplements that can improve emotional well-being and reduce SAD symptoms.

SIGNS & SYMPTOMS

Cravings for carbohydrates (sweets and starchy foods)

Depression

Difficulty concentrating

Fatigue and increased sleep

Feelings of hopelessness and sadness

Increased appetite and weight gain

Irritability and anxiety

Loss of interest in sex

Social withdrawal

Thoughts of suicide

RISK FACTORS

• Family history

• Gender (women are at greater risk)

• Light deprivation (living in northern areas where there is less sunlight)

• Season: It most often occurs during December, January, and February

• Stress

DOCTOR’S ORDERS

Medical treatment of SAD involves light therapy and/or medication. Light therapy should be tried first, as it is highly effective—80 percent of people experience im­provement. A specially made light box providing full-spectrum light is used for 30-60 minutes. Benefits may be noticed in as little as a few days to a week. Light therapy should be used daily during the fall and winter until symptoms subside and enough daylight is available.

If light therapy doesn’t help, doctors may recommend medication. The selective serotonin reuptake inhibitors (SSRIs) drugs raise serotonin levels and help alleviate symptoms. However, they cause numerous side effects and drug interactions. Ex­amples include Paxil, Prozac, Zoloft, and Effexor.

Dietary Recommendations

Foods to include:

•  Vegetables, fruits, whole grains, nuts, and seeds provide vitamins, minerals, and essential fatty acids, which may be depleted in those with depression.

•  Turkey, chicken, tuna, salmon, legumes, nuts, and seeds contain the amino acid trypto-phan, which elevates serotonin production.

•   Fish is also a good source of essential fatty acids.

•   Eat small, frequent meals to maintain energy levels and mood.

Foods to avoid:

•   Sugar and refined carbohydrates may temporarily elevate your mood, but the effect is short term and these foods cause blood sugar imbalances, mood swings, and irritability.

•  Caffeine is a stimulant that offers a temporary rush of energy followed by fatigue and ir­ritability, plus it depletes nutrients from your body. Have no more than one cup per day.

•   Processed and fast foods often contain chemicals and preservatives that may upset brain chemistry.

•  Alcohol is a depressant and should be minimized or avoided completely.

Lifestyle Suggestions

•   Regular exercise; engage in fall/winter activities outside to maximize available sunshine. With proper winter clothing, walking, skating, and skiing can be a great way to get exercise and sunshine, plus exercise is a natural mood elevator, improves sleep, and helps combat stress.

•   Increase the amount of light in your environment—sit near a window, open blinds, and trim any trees that block your exposure to the sun.

•  Try light therapy. Specially made light boxes or light visors are available that provide broad-spectrum light. These are used for 30 minutes to several hours each day. Benefits may be noticed in as little as a few days. However, it may take a week or longer to get the full effect. Light therapy should be used regularly during the fall and winter until symp­toms subside and enough daylight is available.

•  Acupuncture has been found to be beneficial for depression. It may work by stimulating the production of neurotransmitters.

•   Massage and reflexology relieve stress and tension, and promote relaxation.

Top Recommended Supplements

5-Hydroxytryptophan (5-HTP): A substance used by the body to create serotonin. Research shows benefits for depression. It may cause nausea, which can be minimized by taking an enteric-coated product. Dosage: 100-200 mg three times daily.

Fish oils: Rich in omega-3 fatty acids, which are essential for the nervous system and neurotransmitter function. Levels may be depleted in those with depression. Studies show benefits for depression, especially for those not getting an adequate response to antidepres-sant drugs. Dosage: 3-9 g daily.

S-adenosylmethionine (SAMe): Supports the production of neurotransmitters (serotonin, dopamine, and norepinephrine); is shown to be beneficial for depression. SAMe is well toler­ated, has benefits for joint and liver health, and a quick onset of action (two weeks). Dosage: 400-1,600 mg daily on an empty stomach; start with a low dose and gradually increase if needed.

AVOID EXCESS SEROTONIN

Be cautious about combining products that elevate serotonin, such as SSRI or MAO-I drugs, St. John’s wort, SAMe, and 5-HTP, together. This should be done only under the supervision of a health care professional, as excess serotonin can cause serotonin syn­drome. Symptoms include confusion, anxiety, racing heart, nausea, and muscle spasms.

Complementary Supplements

B-Complex: B-vitamins (such as B12 and folic acid) may be deficient with SAD. Folic acid works with SAMe to boost neurotransmitter levels. Several studies have found benefits. Dos­age: Take 400-1,000 meg of folic acid along with 50-100 mg of other B-vitamins daily to support brain function.

Vitamin D: Vitamin D is produced by the body in response to sun exposure and levels may be depleted in those with SAD. Preliminary studies have found benefits with supplements. Dosage: 400-800 IU daily.

Note: St. John’s wort is helpful for mild to moderate depression. However, it should not be used with light therapy for SAD due to the risk of light sensitivity, skin rash, and eye damage.

FINAL THOUGHTS

To improve mood and reduce the symptoms of SAD, consider the following:

1. Minimize sugar, refined/processed foods, caffeine, and alcohol.

2. Eat more tryptophan-containing foods.

3. Exercise regularly to reduce stress and improve mood and sleep.

4. Maximize your exposure to natural light and try light therapy.

5. Supplements of SAMe or 5-HTP, fish oils, B-vitamins, and vitamin D can reduce symptoms and improve mood.