Ask The Doctor: Seasional Affective Disorder

I can barely get out of bed on winter mornings. What’s wrong with me?
By James S. Gordon, MD

It sounds like you have seasonal affective disorder (appropriately abbreviatedas “SAD”). The diagnosis requires that symptoms, which may include feelings of depression, hopelessness, loss of energy, anxiety, sleeplessness, difficulty concentrating, and carbohydrate cravings, be present for two winters. These begin as the days grow shorter in late fall or early winter and lift with the longer, more light-filled days of spring and summer.

Why only in winter? Longer hours of darkness can disrupt your circadian rhythms (your body clock) and cause the body to produce too much melatonin (the hormone that increases with darkness and during sleep), making it harder to get out of bed in the morning. Deficiencies in serotonin (a neurotransmitter often diminished in other kinds of depression) may also accompany longer hours of darkness. Thankfully, researchers have discovered effective, natural therapies that directly address the lack of light and its consequences that precipitate SAD.

The best-researched therapy is the “light box”—a source of full-spectrum light like the sun. The standard dose is 10,000 lux of light for 30 minutes daily (from late fall to early spring). Simply sit in front of—but don’t look at—the box. In clinical trials, the light box has proven more effective than antidepressant drugs for SAD and has no negative side effects. Check out Apollo Health, The SunBox Company, or Full Spectrum Solutions for reliable light boxes.

Taking the sunshine vitamin, aka vitamin D, may work for you. During winter, our levels of D, produced by sunlight acting on the skin, decrease significantly. In some people, this deficiency may produce SAD symptoms. Taking 2,000 to 3,000 IU of D daily for three to six months may make a significant difference in your mood. Get your D levels checked with a blood test before you begin (to see if they are indeed low), and make sure you take D3, ergocalciferol—the active, nontoxic form.

For the most effective and enduring results year-round, lay off or cut down on sugar and meat, and add plenty of whole foods and fiber to your diet. Eat whole grains, fruit, nuts, and omega-3–rich fish (sardines are particularly good for depression), and include fresh, organic fruits and veggies with every meal. I also recommend a high-dose multivitamin and mineral supplement that includes the B vitamins. The Bs, which may be low in people who suffer from depression, help protect against stress. Include at least 800 mcg of folic acid and 200 mcg each of selenium and chromium, which may also be depleted in people with depression. Add to this regimen 1,000 mg two times a day of vitamin C and 3,000 mg per day of omega-3 fish oil, divided in two doses.

A meditation practice is essential for lowering stress and improving mood. I recommend concentrative meditation (focusing on a sound, word, or image), mindfulness meditation, or active meditation like t’ai chi. Writing your feelings down in a journal or drawing them on paper can also relieve stress.

Exercise is one of the single best treatments for SAD. Just about all forms of depression come with physical and emotional inertia and low levels of neurotransmitters like serotonin—all of which improve with exercise. One study showed exercise to be more effective at relieving depression than a serotonin-boosting antidepressant. The one side effect? You’ll feel better!

Many studies have focused on jogging, but most any form of movement can help. A number of my patients boost their energy by dancing to music in the morning. Yoga also has mood-enhancing benefits. Begin gradually with 10 minutes of walking or dancing a day (and build up to 30 minutes or so every day), or join a beginner’s yoga class a couple of times a week. Adopt this approach, and this winter (and all the ones hereafter) should be far brighter and far happier. n

James S. Gordon, MD, the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression, is the founder and director of The Center for Mind-Body Medicine in Washington, DC