S.A.D. is an appropriate acronym for Seasonal Affective Disorder. It is a recurrent mood disorder that can take the form of depression in all ages. But the interesting thing is it is limited to the months where sun and light is all but non-existent.  Symptoms of S.A.D. include a depressed mood which is typically worse in the evening, usually with certain characteristic features, namely incessant sleeping, extreme lack of energy, depression, and increased appetite, often with carbohydrate craving and weight gain.
Other than the direct tie-in to the sun connection, the cause of seasonal affective disorder is not fully understood. One important factor to consider is where you live in the world. Latitude is one of the most predictive factors as those who live at high or low points on the earth’s hemispheres are far more predisposed to S.A.D (as well as vitamin D deficiency) due to less overall sun (and therefore light) exposure. In cases of S.A.D, there is also a family history of mood disorder, usually depression, in about 50% of people.  The condition is twice as popular in women as it is in men, the average age of onset is 23 years old, and stress seems to precipitate acute episodes of S.A.D. The condition regularly recurs during fall and winter nearly and spontaneously remits during spring and summer. One very common oversight is that thyroid dysfunction (hypothyroidism) may be an underlying condition. (Ask your doctor to run the necessary blood work to rule this out).
Ensure you speak to your family doctor if you have these symptoms:

• Depressed mood: feelings of hopelessness predominate. The future looks black, and life may not seem worth living. Normal activities and interests hold little pleasure. Sometimes depression is worse in the evenings (the reverse of classic depression). Depression is usually mild to moderate, but can be severe with risk of suicide.
• Irritability and anxiety: these are common, and may cause interpersonal and work difficulties
• Fatigue and lethargy: increased somnolence during the day and increased sleep duration at night
• Decreased libido
• Increased appetite: carbohydrate craving and, very often, substantial weight gain

But here is the good news. People with SAD respond very well to light therapy (phototherapy) and vitamin D supplementation as well as other forms of natural medicine.

LIGHT THERAPY

70% of patients with mild-to-moderate symptoms respond to light therapy from a light box at 2500 lux 2h/day or 10,000 lux one hour/day, within 1-2 weeks where about 50% achieve complete remission. “Lux” is a unit of illuminance or luminous emittance from a light source. The latest research suggests that were wavelength might matter (the more blue the light, the better) the intensity of the light exposure is more important than the spectrum or wavelength.  So, avoid getting lured in to buying one of the very expensive units which profess having a “special” wavelength that “mimics the sun”. Also, consider a dawn simulator to help wake you up in the morning and get that immediate exposure to light so as to shut down brain melatonin production and fire up serotonin production – which is all regulated by light!

VITAMIN D

It used to be suggested that 400iu vitamin D was enough in order to maintain good bones. That dose and that use of vitamin D is now considered very one dimensional.  Vitamin D (in the D3 form known as cholecalciferol) should be taken by Canadians, on average, at 1-2000iu/day. Blood levels can be regularly assessed by your doctor using a simple blood test known as serum 25OHD.  Vitamin D3 is now known to be useful for not only bone health, but also immune system health, inflammation, against all forms of cancer, and of course mood.

HERBAL SUPPLEMENTATION

The conventional pharmacological treatment of S.A.D includes the class of drugs called Selective Serotonin Reuptake Inhibitors, or SSRI’s. These drugs are postulated to work by keeping serotonin – a feel good brain chemical – “alive” longer to induce “feel good” messages in the brain. But, in natural medicine it is commonly believed that in the case of S.A.D., people don’t produce enough serotonin to begin with (or run out of stores in the winter months). Grifonia seed contains a high amount of an amino acid called 5-HTP which can be supplemented orally in order to increase the amount of available serotonin in the brain to contribute toward improved mood (rather than to prevent the breakdown of a suboptimal amount – as in the action of drug SSRI’s).  Simply put, 5-HTP increases the production of serotonin and has been used successfully to treat depression and S.A.D.

HOMEOPATHIC DILUTION MEDICINE

Homeopathic medicines used for mood balancing can be very effective, but it is always advisable to seek a professional’s advice when selecting the right remedy for your condition.
Aurum metallicum can be used if you are experiencing a depression and loathing of life after having worked through the holidays (high stress) and are aggravated mostly at night.
Arsenicum should be taken when you have deep-seated insecurities with restlessness and anxiety, extreme weakness, fear of being alone, and you are really chilly with frequent thirst for small quantities and a strong craving for bread and other carbohydrates.
Pulsatilla may be your best bet if you are emotional, overly sympathetic, and cry easily because of a feeling of being forsaken (and where many symptoms you experience could be related to hormonal fluctuations).
Nat-mur is administered for extreme emotional vulnerability leading to introversion. It is a great remedy for symptoms of ailments from grief and an intense craving for salt.

MINDFULLNESS AND OTHER CONSIDERATIONS

To maintain a healthy mood, it is also important to maintain a healthy diet with lots of dark green vegetables, nuts and seeds, and mangoes. A natural chemical constituent found in mangoes actually increases good mood. In addition, supplement with a good vitamin B complex (high in B6, B12, and folic acid), and magnesium. Take no less than 5 grams of omega-3 essential fatty acids daily. Last but not least, remember to exercise – high intensity – during the winter months. And, at this point, it should go without saying, you should exercise under bright lights to offset the lack of the golden summer sun.
Cognitive behavioral therapy (CBT) also has been studied as an effective treatment for SAD. The University of Vermont has published research showing that CBT is effective at preventing SAD.  In the study, CBT proved effective after only a few weeks compared to light therapy that must be continued throughout the winter season. The use of light therapy, CBT and vitamin D compliment very well together.
St. John’s wort is an herbal remedy that has proven as effective as Prozac in the treatment of mild to moderate depression.  You may want to consider a dose of 300 mg of an extract standardized to 0.3 percent hypericin, three times a day. It takes about 2 months before you feel the full effect. (Do not use St. John’s wort together with anti-retrovirals, birth control pills, or antidepressant medications, especially SSRIs like Prozac or Celexa.
Another interesting aid may be SAMe (S-adenosy-L-methionine). This works pretty quickly – especially compared to St. John’s wort. Find the butanedisulfonate form in enteric-coated tablets, or in capsules at 400-1,600 mg a day between meals.
Speak with your physician before combining any of the above recommendations with prescription medications.