This month, our Sussex health consultant takes a look at Seasonal Affective Disorder (SAD). SAD affects millions of people every winter between September and April, especially from December to February. SAD is caused by a biochemical imbalance in the brain due to the shorter daylight hours and subsequent loss of sunlight during the winter months.
Symptoms:
- Sleep problems – oversleeping but not refreshed, cannot get out of bed, needing a nap in the afternoon
- Overeating – carbohydrate craving leading to weight gain
- Depression, despair, misery, guilt, anxiety – normal tasks become frustratingly difficult
- Family / social problems – avoiding company, irritability, loss of libido
- Lethargy – too tired to cope, everything an effort
- Physical symptoms – often joint pain or stomach problems, lowered resistance to infection
- Behavioural problems – especially in young people
The official figure states that around 2% of people in Northern Europe suffer with SAD. However, many more (at least 10%) suffer milder symptoms (officially known as “sub-syndromal SAD” or, more commonly, the “Winter Blues”). The further you live from the equator, the more likely you are to suffer from SAD, although the presence of snow makes it less likely.
Causes
SAD is more common in the northern latitudes, due to the lack of daylight hours during autumn and winter, so that includes us in Sussex. The lack of sunlight affects hormone levels, especially melatonin (the “sleep hormone”), which is naturally produced more during the hours of darkness and is always significantly higher in people with SAD.
Artificial fluorescent lighting exacerbates the symptoms of SAD. It lacks the full balanced spectrum of sunlight needed by the body and exposure is not only associated with depression, but also with chronic fatigue and a suppressed immune system.
Dietary modification
Increased consumption of vitamin C can help to counteract fatigue and listlessness during and immediately after a long winter. Citrus fruits, kiwi, broccoli and brussels sprouts are particularly good sources of vitamin C.
Caffeine is best avoided as it is a stimulant, the effects of which can last up to 20 hours, so even a cup of coffee in the morning can result in disturbed sleep. Black tea, cocoa, chocolate, energy drinks, and many over-the-counter pharmaceutical drugs also contain caffeine.
A carbohydrate snack before bed can significantly increase levels of serotonin, which is known to reduce anxiety and promote sleep.
Lifestyle modification
Bright light therapy is generally considered a first-line treatment option for SAD. Light therapy boxes (also known as phototherapy boxes), give off light that mimics natural sunlight. The light emits different wavelengths and is significantly brighter than that of a light bulb. Typical recommendation is to sit in front of the lightbox for 20 to 30 minutes a day (preferably within the first hour after waking up). This causes a chemical change in the brain that boosts mood and alleviates symptoms of SAD.
Dawn simulators can also help people with SAD. These devices are alarm clocks, but rather than waking you abruptly with noise or music, they produce light that gradually increases in intensity, just like the sun. The best models use full-spectrum light, which is closest to natural sunlight. Research shows that they are as effective as light therapy for people with mild SAD.
As with any form of depression, exercise can help alleviate SAD. Additionally, it will help to offset the weight gain that is common with SAD. Outdoor exercise is most helpful for relieving SAD symptoms.
A regular sleeping and eating routine combined with caffeine avoidance can reduce the insomnia associated with SAD. The use of behavioural therapy, relaxation tapes, and mindfulness can also help with symptoms.
A natural therapy for insomnia is to take a 15 – 20 minute hot Epsom-salts bath. One or two cups of Epsom salts (magnesium sulphate) in a hot bath act as a muscle relaxant. Even a simple hot bath will aid sleep, since melatonin production increases with rising body temperature, thereby inducing a state of sleepiness.
Nutritional supplement treatment options
Melatonin is a natural hormone that regulates the human biological clock. The body produces less melatonin with advancing age, which may be why elderly people often have difficulty sleeping and why melatonin supplements improve sleep in the elderly. (Melatonin is a prescription-only medication in the UK).
5-Hydroxytryptophan (5-HTP) has been used successfully for people with insomnia, as it converts to the chemical messenger, serotonin. (Serotonin is the “Happy Hormone” that stabilizes mood, feelings of well-being, and happiness; as well as helping to regulate appetite, digestion, sleep and memory). 5-HTP supplementation has been shown to particularly improve sleep patterns in those that wake repeatedly during the night. It can also help with the “binge-eating” and depressive tendencies that tend to accompany SAD.
Vitamin D influences the production of hormones that are important in the regulation of mood. Studies have shown that when people with SAD are prescribed vitamin D3 there is significant improvement in the level of depression. Most SAD sufferers have low vitamin D blood levels.
(High dose vitamin D treatment should always be supervised by a medical practitioner and monitored with blood tests)
GABA (Gamma Amino-Butyric Acid) is the main inhibitory and sedative chemical in the brain. It assists in inducing sleep, uplifting mood and reducing anxiety. Many B vitamins – B1, B2, B3, B5, B6 – as well as zinc are required in the production of GABA.
Taurine is an amino acid that supports neurotransmitter function, including melatonin and GABA. Low levels are associated with anxiety, hyperactivity and poor brain function.
Botanical treatment options
St. John’s wort, a herb well known for its antidepressant activity, has been found in a number of studies to reduce the symptoms of low mood and apathy associated with SAD.
There are several herbal remedies that have been used safely for centuries to help with insomnia. Probably the most common is Valerian root which helps to counteract difficulty in getting to sleep and increases deep sleep and dreaming. Additionally, Valerian does not cause a morning “hangover,” which is a common side effect of prescription drugs. Valerian root can be combined with other mildly sedating herbs e.g. Chamomile, Hops, Lemon Balm and Catnip.
Passion flower is popular for its ability to decrease anxiety and prolong sleep-time. Although it is a central nervous system depressant, it does not leave people feeling groggy.
Bacopa monneira – an Ayurvedic herb – is recognised as a brain enhancer and is traditionally used to reduce anxiety levels, mental fatigue and enhance memory span. Bacopa increases serotonin.
Article contributed by Dr Tracy S Gates, DO, DIBAK, L.C.P.H., Consultant, Pure Bio Ltd. Copyright © Pure Bio Ltd 2021. All rights reserved. Pure Bio Ltd are a leading UK supplier of the highest quality PURE nutritional supplements, based in Horsham, West Sussex. Visit www.purebio.co.uk for all your nutritional supplement needs
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