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SAD (Seasonal Affective Disorder)

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Seasonal affective disorder (SAD) affects approximately half a million people each year. It is caused by a biochemical imbalance in the brain as a result of decreased hours of sunlight during the winter months. Some people are affected only mildly resulting in fatigue, lack of motivation and moodiness; but for others it is an incredibly debilitating condition causing severe depression, recurring infections, and chronic fatigue.

Causes of SAD
Doctors don’t know the causes of seasonal affective disorder, but heredity, age, and your body’s chemical makeup all seem to play a role. This is the genetic predisposition; however, there must also be an environmental trigger. The reduced availability of sunlight during winter months in what is implicated in triggering SAD

Reduced sunlight may disrupt circadian rhythms that regulate your body’s internal clock, which lets you know when it’s time to sleep and when it’s time to wake up. The disruption in circadian rhythm can cause mild to severe depression, fatigue and malaise. Melatonin, a sleep related hormone, has increased production during winter months. While its release is important during sleep, if melatonin is released during the day it can contribute to depression and fatigue.

The neurotransmitter serotonin (brain chemical) release is stimulated by sunlight. Low levels of serotonin are often found in people suffering from depression.

Signs and Symptoms
Seasonal affective disorder is a cyclic, seasonal condition, which means signs and symptoms are present only during a particular season and then go away. Most of the time, the signs and symptoms of SAD appear during the winter and recede during the spring and summer.
There are some exceptions to the rule, however. Some people have worsened signs and symptoms of depression in the spring. Other people— less than one in 10 — experience periods of mania or hypomania, a less intense form of mania, during the summer. This is sometimes referred to as reverse SAD. Characteristics of mania may include persistently elevated mood, increased social activity, hyperactivity, and unbridled enthusiasm out of proportion to the situation.

Typically, the symptoms of SAD are as follows:

1.  Sleep problems: Usually desire to oversleep and difficulty staying awake but, in some cases, disturbed sleep and early morning wakening.
2.  Lethargy: Feeling of fatigue and inability to carry out normal routine
3.  Overeating: Craving for carbohydrates and sweet foods, usually resulting in weight gain.
4.  Depression: Feelings of misery, guilt and loss of self-esteem, sometimes hopelessness and despair, sometimes apathy and loss of feelings
5.  Social problems: Irritability and desire to avoid social contact
6.  Anxiety: Tension and inability to tolerate stress
7.  Loss of libido: Decreased interest in sex and physical contact
8.  Mood changes: In some sufferers, extremes of mood and short periods of hypomania (overactivity) in spring and autumn.

1.  Establishing proper circadian rhythm: Regular sleep/wake patterns. Sleeping in complete darkness

2.  Stress reduction and management.  There is an intimate relationship between chronic stress and the onset of depression. Chronic stress stimulates chronic release of hormones (cortisol and epinephrine) that in turn affect the release of serotonin and other neurotransmitters important in maintaining a positive sense of well being.

3.  Eating a well balanced diet high in nutritional value, avoiding refined sugar, trans and saturated fat, and processed food. Plenty of green leafy vegetables will provide important vitamins and minerals necessary to support neurotransmitter production resulting in improved sense of wellbeing. Omega 3 fatty acids (DHA, EPA), are essential in preventing depression. Foods rich in omega 3s include fish (salmon, sardines, and mackerel), walnuts and flax seeds.

4.  Regular exercise releases endorphins which improve mood and establish a sense of wellbeing.

5.  Avoid depressants such as alcohol and drugs.

Although treatment can be very effective in reducing the symptoms of SAD, prevention is always the best defence.

1.  Light therapy has been shown to help SAD in up to 85% of people. Regular strength light bulbs are not sufficient to stimulate the pineal gland in the brain responsible for releasing the hormones deficient in SAD. Light intensity on a bright summer day reaches up to 100 000 lux while ordinary light bulbs have an intensity of only 200 – 500 lux. Light treatment at a minimum dose of 2500 lux daily starting in early autumn throughout the winter is very effective in treating SAD. The light must be allowed to shine directly through the eyes(rather than through a window or glasses) from a light box two to three feet away for a minimum of one hour (up to four hours) a day. Activities such as reading, working and eating while in front of the light box are encouraged. Effects can be noticed within two or three days.

2.  Serotonin inducers/enhancers (5 HTP, Griffonia, SSRIs): substances that promote serotonin production are often effective in increasing mood and combating depression. There are effective alternatives to anti depressants which block the clearance of serotonin from the nervous system but often have adverse side effects, such as dry mouth, weight gain, insomnia, migraines, and decreased libido. Supplementing with 5-HTP will directly increase the amount of circulating serotonin. Botanical medicines such as Griffonia will also enhance the production of serotonin without the adverse effects of anti depressants.

3.  Psychotherapy: identifying and addressing depression is often helpful in the restoration of balance. Counselling and psychotherapy can often help identify and give advice as to how to manage depression associated with SAD.

The information provided is courtesy of- The Seasonal Affective Disorder Association and The Mayo Clinic: SAD Seasonal Affective Disorder.

Have a great day,
The Vitality Clinic Team

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