Seasonal Affective Disorder (SAD) - Do you have it? What can you do about it?

The days get shorter, you seek out your fuzzy pyjamas, and break out the winter coats. It sounds like a great prelude to a 'winter wonderland' but for some people (approximately 1-10% of the North American population) the darker winter months can spell emotional disaster. (Note: it is also possible to have Seasonal Affective Disorder during summer).

People who are affected by SAD experience a general drop in mood (depression), a tendency to want to sleep more, eat more and have low energy. (SAD during the summer can include periods of exacerbated anxiety).

The symptoms of SAD mimic those of depression.

There are a few treatments available including light therapy, medication (typical anti-depressants), and

cognitive-behavioural therapy.

Light therapy uses a lightbox or set of LED lights in a panel that emits far more lumens than normal room lighting (2,500-10,000 lux compared to 400-600 lumens). A bright, sunny day is around 5,000-7,000 lumens.
There is evidence to suggest that the alterations of melatonin* secretion affected by the changing photoperiod (the time and amount of light in a day) affects the seasonal mood cycles of SAD. Light therapy has a positive effect on SAD by altering the secretion of melatonin, modifying the circadian-rhythm as well as sleep patterns. The most effective time of day seems to be early morning just after awakening. But your individual "dosing" schedule may differ (in the evening, for example) depending on your body's reaction to the light therapy.

If medication is something that works for you, speak with your doctor. Ask whether herbal alternatives like St. John's Wort are suitable if you are interested in alternatives (be careful when selecting herbal remedies as the strength of each "batch" is variable - it really depends on the health and harvest of the plants). And if you are interested in typical pharmaceutical treatments for depression/anxiety, let you doctor know.

Additionally, there are many ways to integrate cognitive-behavioural therapy into your life, and speaking with your doctor to ask about local programs or therapists they can recommend is a good first step. Always make sure the person you are considering as your counselor/therapist is certified (either a psychologist, psychiatrist, certified counselor, etc.). Some of these are *not* covered by insurance, so make sure with your insurance company what kind of coverage you have.

And then get back to baking those Christmas cookies!


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Other topics you might be interested in: 

Vitamin D and Mental Health

Anxiety - What's it all about anyways?

Top 10 Depression Symptoms

The Nervous System


*Melatonin is a hormone in the brain that signals it’s time to sleep. Read more about sleep and anxiety here.

Top 10 Depression Symptoms - When To See Your Doctor

 Feeling down or out-of-sorts is common for many people and is usually a transient state. But, if these down-in-the-dumps feelings linger for a longer period of time, you may be dealing with depression.


Here are 10 common symptoms of depression (in no particular order):

1) You lose interest in your 'fun' activities: Your ability to enjoy once pleasurable pastimes and hobbies is diminished or non-existent. You may isolate yourself, ignore social invites and find your sex-drive is low.

2) You're sleeping more... or less: This is usually one of the first signs for many people. An inability to sleep, or falling asleep too late at night (if you're a shift-worker, this is a bit different). Also, waking very early, or having difficulty waking in the morning is common in many people suffering from depression. Total sleep time may be reduced or increased.

3) Difficulty concentrating on tasks: You are finding it hard to think straight, make decisions or remember. You may feel like you are in a "fog", or scatterbrained. You may be falling behind in school or having difficulties staying focused at work.

4) You are feeling hopeless and helpless: You feel as though things in your life are terrible and won't improve. You feel incapable of changing your situation and trapped.

5) Your body feels depressed: You're tired, slow, lethargic. You have no energy and even getting up to get a glass of water can feel like a marathon. Getting out of bed is very difficult, and you may not even make it that far.

6) Feelings of guilt and worthlessness: Self-loathing, harsh self-criticism and negative thought patterns regarding yourself. You pick on your "faults" and past mistakes, ruminating over them endlessly. This drives your feelings of guilt, shame and worthlessness.

7) Changes in your appetite or weight: You notice a significant (5% or more in a month) change in body weight - either gain or loss. You may feel hungrier than normal, or less than normal. You may notice you have specific food cravings (ie: fatty foods, salty foods, sugary foods, high-carbohydrate foods like pastas, etc.)


8) You are experiencing unusual/unexplained body pains/aches: You may be experiencing more headaches, back pain, muscle-aches or stomach-aches with no known cause.

9) You feel a deep need to "escape" your life: You abuse drugs or alcohol to numb your feelings or drown out your thoughts, you may gamble compulsively, or drive dangerously and recklessly or participate in dangerous or extreme sports. Also, if you find yourself spending many long hours in front of a computer screen browsing the internet or playing video games, you may also be exhibiting escapist behaviour.


10) You feel angry, on-edge or irritable: Every little thing is bothersome for you, you lose your temper at trivial issues, perhaps getting into fights with friends and/or family. Everyone and everything is getting on your nerves. You feel restless and agitated. Maybe you are beginning to exhibit signs of violence or feelings of violence.

If you are exhibiting any of these symptoms with no known other causes and have been feeling this way for most days of the past two weeks, see your doctor and discuss the possibility of depression. They may have you fill out a questionnaire to determine if you are depressed and if you are - how depressed. Treatment options are extensive and include: various types of therapy, medications*, natural herbs and remedies*, self-help programs and books, etc. Your doctor will point you in the right direction.

*Please speak with a pharmacist prior to using any medications or natural medicines as they may interact with other medicines or food you may be taking. Please read the bottle and pamphlet on any prescription or over-the-counter medication you take.

***** If you or a loved one are having thoughts of suicide or speaking about suicide call your local crisis-hotline numbers or the emergency department immediately.*****


Crisis number USA: http://www.suicidepreventionlifeline.org/  ( 1-800-273-TALK (8255))
Crisis numbers in Canada:  http://www.suicideprevention.ca/in-crisis-now/find-a-crisis-centre-now/
Crisis number Australia:  http://www.lifeline.org.au/



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Other topics you may be interested in:

The Nervous System 

13 Beliefs to Disbelieve 
  
The downward spiral: the fastest way down!
  
Staying motivated when discouraged

Sleep, Insomnia and Anxiety

Vitamin D and mental health: Clear away the clouds, make way for sunshine!

Vitamin D3; Cholecalciferol. No, we’re not back in high-school chemistry class struggling with compound names; we’re talking about “the sunshine vitamin” – vitamin D! We’ve all heard about “the sunshine vitamin” and how it helps maintain our bones and teeth, but did you know it also has functions related to maintaining mood and mental wellness?

Today I am going to discuss vitamin D and its relation to anxiety and depression.

Recent research into vitamins and their effects on the body have shown evidence for a relation between vitamin D and basic cognitive function, mood and general mental health and well-being, especially for depressive symptoms¹.

This has important implications for those suffering especially from Seasonal Affective Disorder (where mood drops during seasonal changes), depression and anxiety, as well as other mental illnesses. There are a few theories out there regarding SAD’s prevalence in higher latitude regions. One of which regards seasonal fluctuations in vitamin D levels as the sun’s intensity and prevalence drops during the darker winter months.

Dr. Serdar Durson, author of “Vitamin D for mental health and cognition”, mentions that vitamin D and its receptors have been found to be involved in the development and progression of mental illness. Vitamin D (whose active form is more like that of a steroid hormone²) activates neuron receptors in areas of the brain that are responsible for regulating behaviour.

Further research into the field of vitamin D and its role in mental health and illness reveals that it is an important element of maintaining mental wellness. Vitamin D and its role in bone formation and calcium regulation has long been known and studied well but its likely link to mental illness such as depression, schizophrenia, anxiety and even alzheimers is only just being discovered.

Low serum (blood component) levels of 25-hydroxyvitamin D (the inactive form of vitamin D) have been linked with various psychiatric disorders, including depression. In 1998 a pair of researchers⁴ supplemented 44 healthy people with either 400 or 800 IU of vitamin D daily for five days. They found that, when compared with a placebo group (receiving an inactive ‘dummy’ pill), the self-reported positive effect was elevated while the negative affect was reduced for either dose of vitamin D.

In a related study, vitamin D receptor knockout mice⁵ were found to exhibit increased anxiety behaviours. This isn’t to say that vitamin D necessarily has a mechanistic affect on mood or cognition as lower levels of vitamin D in the blood may just be an indicator of poor health – which then would lead to depressive symptoms on its own. There is also the potential that depression and its associated behavioural changes lead to lower levels of vitamin D as many depressed people tend to stay indoors, reducing outdoor activities

Given that there is some evidence for the affect of vitamin D on mental health and wellness, it could be a good idea to get some supplemental vitamin D, or even experiment with sunlamps and full spectrum lights. I find the idea of sunlamps appealing as the winter days grow shorter as it is easier to get some UV rays while the sun is less prevalent during the season.

I must caution, however, that if you decide to supplement with vitamin D pills that you first speak with your doctor and obtain clearance (as it could potentially interact with other medications or supplements you may be taking). Also, do not exceed the recommended daily intake of vitamin D unless otherwise advised by your doctor or medical counselor.

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^{1 -  Shipowick, CD; Moore, CB; Corbett, C; Bindler, R. 2009. Vitamin D and depressive symptoms in women during the winter: A pilot study. 22(3):221-225.}

^{2 – Norman, AW; Roth, J; Orci, L. 1982. The Vitamin D Endocrine System: Steroid Metabolism, Hormone Receptors, and Biological Response (Calcium Binding Proteins).  3(4): 331.}

^{3 -  Lee, DM et al. 2010. Lower vitamin D levels are associated with depression among community-dwelling European men. J Psychopharmacol. 0(0): 1-9.}

^{4 – Lansdowne AT and Provost SC (1998) Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl) 135: 319–323.}

^{5 - A strain of mice bred for experimental procedures whereby the receptors for vitamin D have been de-activated through genetic manipulation.}

Anxiety - What's It All About Anyways?

Many have felt the dark cloud of anxiety and depression in their lives. Usually they manifest during times of life change and stressful events. For anxiety, you may experience sweaty palms, a pounding heart, light-headed or feel even worse.  For depression you may feel low, down, heavy or just not-like-yourself. These are natural stress-reactions but if these symptoms of anxiety and depression seem overwhelming or are preventing you from doing what you’d like to be doing, or living your life the way you’d like to be living it, you might have an anxiety disorder or depression.

Today I am going to discuss anxiety. Depression and anxiety are often co-morbid disorders. This means that they usually present together, or as one after the other. I will explain in another article how depression is linked with anxiety, but for today, we will consider anxiety and panic attacks.

            Anxiety is a natural reaction of the body to perceived threats. Our minds and bodies are hardwired to understand the immediacy of escaping or fighting to protect ourselves... Unfortunately, in this day and age, we are no longer facing live-or-die type situations on a regular basis. Our hardwired anxiety machinery has nothing to fret about! So, we fret about traffic. We worry about money. We are scared of seemingly harmless things. This is because of our “fight-or-flight” system.

           

When a threat is perceived by a part of the brain known as the amygdala (the oldest portion of the brain) the sympathetic nervous system sparks into action, triggering cascades of hormones coursing throughout your brain and body. The adrenal glands (special glands atop the kidneys) release adrenaline. We’re all familiar with this hormone – the rush of excitement and fear when on a rollercoaster is due to adrenaline’s release into our bloodstream.

That same fear and buzz we get on the rollercoaster is what plagues most anxiety sufferers. Generally, it comes out of the blue. Suddenly the room begins to spin and you feel your heart pounding! Are you having a heart attack? Are you going crazy? No! this is an anxiety attack in the making!

Anyone who has ever experienced one of these will know that it’s a rough ride. You might even end up in emergency thinking you really are dying or going crazy! Don’t worry though no one has ever died from panic. It’s almost impossible.

            Now, after the panic attack is over, the frightening physical symptoms you’ve experienced will influence you to have thoughts about what just happened. These tend to be negative and future-based thoughts. You will definitely start thinking about how you’ll want to avoid another panic attack in the future! These thoughts can become more and more detailed and will ingrain themselves on your mind. You see, in the wild when we were foraging and fighting for our survival daily against large predators, we had to remember the situations in which we felt these fearful things – so that we could prevent it in the future to continue living.

            So our ancient little amygdala is only doing its job. Unfortunately for us, its software is a few thousand years outdated. 

            So we get ourselves worked up and negative thoughts begin to muddle and cloud our brains. This leads to us changing our behaviours in order to avoid these feelings and thoughts. However, this is not a practical solution for the long-term because it actually makes the anxiety worse! By trying to avoid the situations in which you’ve experienced anxiety you are feeding the anxiety. Your next panic attack may be worse, and will likely be in a place you’ve never experienced one – by the fact that you have been avoiding those previous places associated with panic.

The best way to deal with a panic attack is to: wait. That’s all. Breathe deeply through your nose and exhale through your mouth and wait. Panic attacks are short-lived – it’s the nature of the system. They may last up to thirty minutes but their intensity usually doesn’t exceed an hour or so. You may feel residually shaky for another few hours, but the brunt of the storm is usually over after 30 or so minutes.

Take a deep breath. Feel better?

Conquer on!