Dealing With Seasonal Affective Disorder

(Originally posted on bcotoronto.com on Nov 1st, 2012)

Seasonal Affective Disorder

Well, it’s November 1st and Halloween is over, the sun is rising late and setting early. There’s very little sunshine and when the sun is up, there are generally lots of clouds. So we can go days without seeing or feeling the sun. This is the season when we all feel a little slower and grumpier. We are thrown of our natural rhythms and start to hunker down for the winter.

This is the time of year for Seasonal Affective Disorder (SAD).

As animals, our bodies naturally slow down in the winter even if we do not hibernate. With the colder weather and less light we try to conserve energy because our bodies remember a time when these signals meant a scarcity of food. Modern conveniences have not bread this out of our systems. But it is important to differentiate between the natural decrease in energy and motivation during the colder months and the diagnosis of SAD, which describes a series of seasonally-based episodes of depression with multiple associated symptoms like sleep difficulties, apathy, and many others.

SAD can occur during spring and summer but is much more common during the autumn and winter months. It is also more common in regions that have less light during this time of year like Finland. This is why one of the more common theories is that it is associated with lower levels of light exposure.

This has lead to years of UV lamps being used as the primary therapy for SAD. When compared to antidepressants it shows earlier responses to treatment and less risk of side effects, but no significant difference between outcomes1. There are many difference types of light therapy ranging from Fluorescent light boxes to ambient bright light and even some new research looking into transcranial (across the brain) light through the ear canal, which seems to be a possibility2. Most sources in the literature and around the web say that 15-60 minutes a day of using a UV lamp is sufficient to treat SAD which is similar to the recommended time of uninterrupted sunlight for appropriate vitamin D production.

Vitamin D deficiency has been linked to depression in general (correlation, not causation yet) and supplementation has been used clinically to treat depression but very little research has been completed studying its efficiency. What little here is has been varied in quality and in their outcomes3,4. As far as I can find, only one study has explored vitamin D supplementation in SAD and they found no difference between the treatment and non-treatment groups5. Their study only looked at a population of women 70 years old and above, so it is not really applicable to the population at large.

So, with so much doubt about Vitamin D, why do I bring it up? Well, because Vitamin D deficiency is incredibly widespread around the globe. The general rule of thumb is that if you live in an area that does not enjoy a tropical climate then you are most likely Vitamin D deficient. So we should all by supplementing with D daily and eating foods high in this nutrient. But, back on topic, many physicians and patients claim to have success with Vitamin D supplementation as a treatment for SAD, so why not give it a try?

Other therapies for SAD include antidepressants, negative air ionizers, and supplementation with melatonin to try to aid in sleep and maintenance of circadian rhythms. Antidepressants have a similar success rate to light therapy and ionizers have slightly less. I was unable to find any solid evidence on the success of melatonin treatment though.

Acupuncture and chiropractic treatments have also been used with patients with SAD with mixed results. Naturopathy has also had mixed success with treating mood disorders of different kinds.

Seasonal Affective Disorder is still not a well understood condition yet and most treatments are still being adjusted to maximize their effectiveness. But this does not mean it hurts any less when it hits. So my recommendation is try different treatments and find something that works for you. Maybe it’s just getting to bed earlier during the cold months and maybe it’s a combination of light therapy and antidepressants. There are plenty of options out there, most people just don’t know where to look. I also suggest that everyone should take Vitamin D year round but we’ll talk about that more later.

I hope that this has given you are few more options to help you through these cold, dreary months and as always, thanks for reading.
Dr. Ben

Reference List
1. Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, and Tam EM. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. The American journal of psychiatry. 2006 May;163(5):805-12.
http://www.ncbi.nlm.nih.gov/pubmed/16648320

2. Timonen M, Nissilä J, Liettu A, Jokelainen J, Jurvelin H, Aunio A, Räsänen P, and Takala T. Can transcranial brain-targeted bright light treatment via ear canals be effective in relieving symptoms in seasonal affective disorder? A pilot study. Medical hypotheses. 2012 Apr;78(4):511-5.
http://www.ncbi.nlm.nih.gov/pubmed/22296809

3. Parker G and Brotchie H. ‘D’ for depression: any role for vitamin D? ‘Food for Thought’ II. Acta psychiatrica Scandinavica. 2011 Oct;124(4):243-9.
http://www.ncbi.nlm.nih.gov/pubmed/21480836

4. Howland RH. Vitamin D and depression. Journal of psychosocial nursing and mental health services. 2011 Feb;49(2):15-8.
http://www.ncbi.nlm.nih.gov/pubmed/21261225

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