{"id":6192,"date":"2013-12-16T07:59:26","date_gmt":"2013-12-16T13:59:26","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=5953"},"modified":"2021-09-12T22:23:40","modified_gmt":"2021-09-13T03:23:40","slug":"its-that-sad-time-again","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2013\/12\/16\/its-that-sad-time-again","title":{"rendered":"It\u2019s That SAD Time Again"},"content":{"rendered":"\n

Right now, mid-December, if you happen to be sitting in a room with five of your friends, the odds are strong that one of you has seasonal affective disorder, or SAD<\/a>. If you\u2019re the one, you\u2019re probably in your 20s or early 30s (the vulnerable years for SAD, though you can have it at any age), you know something\u2019s wrong, and you know you\u2019ve been dreading winter more with each passing year. Then again, you may never have connected your symptoms with either winter or the increased number of dark hours it brings.<\/p>\n\n\n\n

If you have SAD, it\u2019s a safe bet you\u2019re a woman, like a majority of SAD sufferers. You may have heard of something called the winter blues, but you\u2019re thinking, \u201cThis is more than the blues. I feel really awful!\u201d If you tried discussing your symptoms with your doctor, know this: surveys of physicians show a remarkable lack of awareness about SAD. Your doctor may have recommended an antidepressant, but, fearing side effects, you never filled the prescription.<\/p>\n\n\n\n

The three most common symptoms of SAD are depression, anxiety, and panic attacks.  If you\u2019ve suffered with these during the bright sunny days of summer and are already on medication, you probably discovered that by mid-December everything\u2019s getting worse and you may wonder if you need your dose increased.<\/p>\n\n\n\n

Other symptoms of SAD include:
\u2022 An overall lack of energy even for everyday tasks.<\/strong> \u201cDo I have chronic fatigue syndrome?\u201d \u201cAll I want to do after work is go to bed.\u201d
\u2022 A weakened immune system.<\/strong> \u201cI get one cold after another.\u201d \u201cCuts take forever to heal.\u201d \u201cMy candida is back!\u201d
\u2022 Irritability.<\/strong> \u201cI want to bite the head off my boyfriend and I think, \u2018This isn\u2019t me!  THIS ISN\u2019T ME!\u2019\u201d
\u2022 Lack of concentration.<\/strong> \u201cI just stare at the TV.\u201d \u201cI can\u2019t read a book anymore.\u201d \u201cI\u2019m missing appointments and deadlines.\u201d
\u2022 Overeating, carb cravings, and weight gain.<\/strong> \u201cDo you know what it\u2019s like to gain a pound a week?!\u201d
\u2022 Alcohol and other drug use\/abuse.<\/strong> \u201cI know I\u2019m drinking too much when I get home from work.\u201d
\u2022 Feelings of guilt and worry.<\/strong> \u201cSomething\u2019s wrong. I\u2019m thinking about my health too much.\u201d \u201cI\u2019m really worried about my life.\u201d
\u2022 Sleep problems.<\/strong> \u201cI haven\u2019t felt refreshed in the morning in weeks.\u201d
\u2022 Reduced sex drive.<\/strong> \u201cThere\u2019s nothing. I feel nothing.\u201d<\/p>\n\n\n\n

If you have SAD, it\u2019s possible you\u2019ve had a history of depression or anxiety, or that one of these runs in your family. People with SAD often endure symptoms for two or three years before being diagnosed and learning about treatment.<\/p>\n\n\n\n

According to the Cleveland<\/a> <\/a>Clinic<\/a>, approximately 500,000 people in the US have SAD, and at least 10 to 20% of the US population suffer from the disorder to a greater or lesser degree. SAD can begin at any age but commonly starts around age 21, peaking throughout your 20s. At that point it seems to relent\u2026or people who have it simply learn coping skills. Because SAD is one of several low-serotonin disorders, there\u2019s a second peak during pre-menopause and the menopause years. This occurs because serotonin levels are closely linked to estrogen levels, and as estrogen heads south during menopause so does a woman\u2019s stress-buffering serotonin.<\/p>\n\n\n\n

Here\u2019s what\u2019s happening in SAD<\/strong><\/h3>\n\n\n\n

As light enters your eyes, falling on your retina, your serotonin rises. The SSRI antidepressants (like Prozac) raise serotonin as well, so sunshine is indeed a lot like Prozac. Conversely, the darkness of short, overcast winter days reduces serotonin production–Prozac in reverse, so to speak\u2014rendering you susceptible to SAD.<\/p>\n\n\n\n

But there\u2019s more. The same light that boosts serotonin also stimulates the hypothalamus, deep in your brain, which controls sleep, appetite, sex drive, temperature, mood, and physical activity. This occurs because your hypothalamus rules the pituitary, the master gland controlling your adrenal glands, thyroid, and ovaries.<\/p>\n\n\n\n

In winter, with insufficient light, the functions of these three glands slow down. This is extremely useful if you happen to be a hibernating bear, however, if you’re a twenty-something woman, you may require quite a bit of light for your body to function normally. Without it, you’ll be in the group developing SAD symptoms<\/p>\n\n\n\n

And even more! Enter the pineal gland. Research has also found that people with SAD, compared to people who don\u2019t have the condition, produce higher levels of the sleep-inducing hormone melatonin in winter. The pineal, a tiny gland about the size of a grain of rice nestled deep in your brain, produces melatonin in response to being in the dark. When your melatonin levels rise, you feel sleepy.<\/p>\n\n\n\n

As an aside, synthetic melatonin is readily available over-the-counter as a sleep aid, working dramatically well for some people who probably have sluggish pineal glands, but doing absolutely nothing for others. No one is really sure why this occurs. Interestingly, some people sleep really deeply when they wear a sleep mask, likely an effect of the total darkness enhancing their melatonin production.<\/p>\n\n\n\n

When you\u2019re exposed to light, as you are in the morning, melatonin levels fall and you wake up. Light also raises serotonin, and likely it\u2019s the combination of rising serotonin and falling melatonin that causes many people to feel better during the summer months and worse in winter. These physiologic responses to light are also behind the usefulness of full-spectrum light boxes as the best known treatment for SAD.<\/p>\n\n\n\n

Many people with SAD find they have specific triggers. Because serotonin is your stress buffer, any form of stress capable of overwhelming your buffering system can trigger SAD symptoms. These stressors include the usual culprits like traumatic life events (a relationship break-up, a job loss) and physical illness.<\/p>\n\n\n\n

Another such stressor is disruption of your body clock. If you have difficulty setting your body\u2019s circadian rhythm to daylight hours you can fall victim to SAD. An example: someone with a circadian rhythm disorder keeps going to bed later and later, and sleeping later as well. The college student who stays up until 3 am and can\u2019t make any class before noon sets the stage for this disorder. Then, when school is over, she can\u2019t get back on a normal schedule. Mixing up day and night is quite stressful on her body and she\u2019ll be a good candidate for SAD as she sleeps through the few daylight hours that are left in wintertime.<\/p>\n\n\n\n

SAD is a perfect storm of neurotransmitter and hormone hell.<\/strong><\/h3>\n\n\n\n

\u2022 First, you\u2019re a woman whose genetics render you a low-serotonin person with a compromised stress-buffering system.
\u2022 Second, your already low serotonin drops further in the dim light of winter.
\u2022 Third, your pineal gland, sensing darkness, pumps out more melatonin, making your main form of speech a yawn.
\u2022 Fourth, receiving little bright light to stimulate it, your sluggish hypothalamus slows your pituitary, adrenal, thyroid, and ovarian hormone function.
\u2022 And finally, stress from just about anything, including the stress of wondering what\u2019s happening to your mind and body, throws you over the proverbial edge.<\/p>\n\n\n\n

All these physiologic changes would be just fine if you could, like a bear, go into hibernation. But you can\u2019t. You\u2019ve got to be in the office on Monday. (By the way, if you happened to awaken our hibernating bear prematurely, he\u2019d likely have each and every symptom of SAD, including anger management issues.)<\/p>\n\n\n\n

Treatment<\/strong><\/h3>\n\n\n\n

The very best treatment for SAD is light therapy from a full-spectrum lightbox or spending the winter in the Florida Keys or locations farther south. That\u2019s because light raises serotonin, reduces melatonin, and jump-starts your hypothalamic-pituitary-adrenal+thyroid+ovary axis.<\/p>\n\n\n\n

Light therapy is effective for 85% of people with SAD and works best if you expose yourself for about two hours, ideally in the morning or early afternoon. Using a lightbox in the evening will lower your melatonin so much that you might find yourself unable to sleep. Along with the lightbox, I also suggest sleeping with a sleep mask to further increase nighttime melatonin levels and force your brain into a healthy circadian rhythm.<\/p>\n\n\n\n

But light therapy isn\u2019t the only treatment for SAD. To deal with stress triggers, you might benefit from talk therapy such as counseling, psychotherapy, or cognitive behavior therapy (CBT). Here\u2019s a further to-do list for the many (many!) of you with SAD:
\u2022 Get outside every day<\/strong>, even when it\u2019s cold. If the sun is shining, stay out longer. When you\u2019re outside, avoid sunglasses for at least 30 minutes.
\u2022 Move your work area near a window.<\/strong>
\u2022 Keep curtains and window blinds open throughout the day<\/strong> to let light in.
\u2022 Walk briskly every day and do other types of exercise, such as lifting weights, several times a week.<\/strong> Do as much of your routine as possible outside or near a window.
\u2022 Avoid going from one indoor space to another without getting a little sunlight.<\/strong> Going from house to car to mall to home or from home to subway to office to subway and back home has you living like a mole. At each transfer point, stay outside for awhile in the light. Better yet, walk part of the distance.
\u2022 Carbohydrates will raise your serotonin, but don\u2019t capitulate to the Ho-Hos.<\/strong> Have plenty of fresh fruit and veggies throughout your day and also some good whole grains–half a cup of oatmeal in the morning, half a cup of kidney bean salad at lunch, and half a cup of brown rice with dinner.
\u2022 Replace home light bulbs<\/strong> with full-spectrum bulbs, available in any hardware store
\u2022 Low levels of vitamin D are linked to all sorts of health problems,<\/strong> including susceptibility to flu, so take at least 2,000 IU of vitamin D daily. Levels of vitamin D<\/a> plummet in wintertime because of reduced sunlight in contact with your skin.
\u2022 If you feel yourself slipping into mild depression or increased anxiety,<\/strong> consider St. John\u2019s wort<\/a>, 450 mg twice daily. It will raise your serotonin virtually without side effects. Don\u2019t try it if you\u2019re taking an antidepressant, though. Too much serotonin could result.
\u2022 If SAD is a regular event in your life, rent or purchase a full spectrum light box<\/a>. <\/strong>Contact the WholeHealth Chicago Apothecary for details on rental or purchase.
\u2022 Budget a winter vacation if possible.<\/strong> Even ski resorts are sunnier than Chicago.<\/p>\n\n\n\n

If you feel truly overwhelmed by SAD, don\u2019t reflexively refuse a prescription antidepressant like Lexapro or Celexa. These can raise your serotonin quite quickly and, if you know you do best in summertime, can be discontinued (with your physician\u2019s supervision) when clocks are set to Daylight Savings Time.<\/p>\n\n\n\n

We have many patients in our practice who know their bodies so well they simply send me an email to renew their antidepressants with a line like \u201cHey, it\u2019s September. I feel my SAD coming on. Would you mind calling CVS for a refill?\u201d<\/p>\n\n\n\n

Be well,
David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Right now, mid-December, if you happen to be sitting in a room with five of your friends, the odds are strong that one of you has seasonal affective disorder, or SAD. If you\u2019re the one, you\u2019re probably in your 20s or early 30s (the vulnerable years for SAD, though you can have it at any age), you know […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,50,256,3,43,70],"tags":[1585,1586,38,1587,194,243],"class_list":["post-6192","post","type-post","status-publish","format-standard","hentry","category-blog","category-healthy-lifestyle","category-i","category-knowledge-base","category-nutrition-nutritional-supplements-vitamins-herbal-remedies","category-s","tag-lack-of-energy","tag-light-therapy","tag-sad","tag-sleepiness","tag-st-johns-wort","tag-vitamin-d"],"yoast_head":"\r\nIt\u2019s That SAD Time Again<\/title>\r\n<meta name=\"description\" content=\"If you have SAD, it\u2019s possible you\u2019ve had a history of depression or anxiety, or that one\u00a0of these runs in your family.\" 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