Episode 47: Beat Those Winter Blues: How to Deal with Seasonal Affective Disorder (SAD)

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In today’s episode, Dr. Lisa and Dr. Toni are talking about how to be proactive to manage winter blues and seasonal affective disorder (SAD).

SAD occurs four times more often in women than in men, with the age of onset often happening sometime between 18 and 30 years of age. 

Where you live can make a big difference. You are most susceptible if you live farthest from the equator in northern latitudes. For example, in the United States, 1% of those who live in Florida and up to 9% of people who live in Alaska experience SAD. In Canada, 15% of the population experience winter blues and 2 to 6% experience SAD. 

Symptoms of winter blues and SAD center on sad mood and low energy. 

You might:

• feel sad, irritable, and may cry frequently
• feel tired and lethargic
• have difficulty concentrating
• sleep more than normal
• lack energy
• decrease your activity level
• withdraw from social situations
• crave carbohydrates and sugars
• tend to gain weight due to overeating

How you might experience symptoms of seasonal pattern disorders can vary in severity. You  may experience a milder form of SAD known as S-SAD or the winter blues. However, others can be severely incapacitated, unable to function and thoughts of suicide may be present.

SAD can be linked with other health issues like depression, other mood disorders, addiction and hypothyroidism.

Given that SAD is a disorder women often experience and one that is triggered by limited exposure to sunlight, nurses and other health professionals who do shift work may be at particular risk

How do you know if you have SAD or the winter blues?

Seasonal Pattern Assessment Questionnaire was developed by South African physician Norman Rosenthal and colleagues who researched circadian rhythms, melatonin and the impact of light. You can fill out the questionnaire and discuss it with your doctor.

Causes for SAD and the winter blues can include:

• Low levels of sunshine exposure and vitamin D
  • Vitamin D plays a role in your ability to produce serotonin
  • You could be low in vitamin D due to the following causes:
    • Staying inside
    • Using sunscreen on all exposed skin when outside
    • Darker skin
    • Obesity
    • Poor fat absorption
    • Digestive issues including gallbladder and gastric bypass surgery
    • Kidney problems
    • Aging
    • Medications like statins, steroids, thiazide diuretics
• Low serotonin
  • This neurotransmitter connected with mood balance can be lower if you have higher levels of SERT transport protein
  • SERT transport protein stays low in the summer, keeping your serotonin levels high
  • As sunlight decreases in the fall, your serotonin activity can also decrease
• High melatonin
  • This hormone is produced by the pineal gland in your brain and released in response to darkness to promote sleep
  • You may have higher melatonin levels with shorter and darker winter days, causing sleepiness and lethargy
• Circadian rhythm
  • Your body’s internal clock may be timed differently, making it more difficult to adjust to the seasonal changes, especially with daylight savings time changes
  • Your rhythm can be thrown off with less exposure to natural light during the day and high exposure to blue light and other light sources in the evening

What can you do if you have SAD or the winter blues?

Treatments can include:

• Light therapy
  • Sunlight – get outside for a minimum of 10 minutes daily, ideally first thing in the morning
  • Light boxes (also known as Bright Light Therapy or phototherapy) that have 10,000 lux of cool white fluorescent light can be used for 20-60 minutes in the morning while eating breakfast or working at a desk
• Counseling and mindfulness
  • In one study, six weeks of Cognitive Behavioral Therapy (CBT) provided in group format for 90-minute sessions twice weekly was as effective as 30 minutes of 10,000 lux of cool-white fluorescent light each morning for SAD
  • Yoga, meditation like Transcendental Meditation, walking, exercise 
• Nutrition
  • Limit your sugar and starch intake
  • Limit your caffeine intake, especially after noon if you are caffeine sensitive
  • Increase intake of whole unprocessed foods, vegetables and other complex carbohydrates, protein
• Vitamin D
  • Get your vitamin D levels tested and consider supplementation depending on your blood level
    • Deficiency: < 30 nmol/L
    • Inadequacy: 30-50 nmol/L
    • Sufficiency: 50 nmol/L 
    • Optimal: 75-125 nmol/L
    • Toxicity: 125 nmol/L and higher
• Supplementation
  • Anti-inflammatory herbs and nutrients like curcumin, omega 3 fish oil
  • Probiotics and other gut healing nutrients to support the gut-brain connection (see Episode 8)
  • Mood supportive herbs and nutrients like St. John’s Wort, SAMe, 5-HTP
• Social connections
  • Lower your stress hormones by connecting with supportive friends and family

Today’s Mama Must Have:

Dr. Lisa loves her new stand up desk at home that she has set up by a window to increase her sunlight exposure during the day.

Dr. Toni has supported her mental health by limiting her news intake (especially around US politics) to a trusted, balanced source. She relies on watching Rising with The Hill’s Krystal Ball and Saagar Enjeti for US election coverage.

Thank you for joining us today! 

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Stay safe and healthy everyone!