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Don't Let the Winter Blues Get You Down

The beginning of the year is the perfect time to take on new habits. Exercising, eating well, and reducing stress are all typical New Year’s resolutions—and taking these on just may also help with a common form of seasonal depression. A cold and dark winter can trigger depression in people who suffer from seasonal affective disorder (SAD). According to research or other evidence, the following self-care steps may help you weather the storm and beat your blues:

  • Add more D to your diet—See a qualified health practitioner to find out if you are low in vitamin D, and if you should take large amounts under medical supervision to help improve mood and well-being
  • Soak in the sun—Spend more time outdoors to help improve the regulation of important brain chemicals that affect mood
  • Try light therapy—Reduce symptoms by using a full-spectrum fluorescent light during dark mornings or evenings
  • Check out St. John’s wort—This well-known herbal remedy may improve mild to moderate depression; take 900 mg a day of a standardized extract
  • Work in a workout—Get an hour of aerobic or anaerobic exercise three times a week in bright light to improve mood

What are the symptoms?
SAD is characterized by typical symptoms of depression, such as sadness, hopelessness, thoughts of suicide (in some cases), and “atypical” depressive symptoms such as excessive sleep, lethargy, carbohydrate cravings, overeating, and weight gain. The symptoms usually occur the same time of year, typically fall and winter, and disappear with the onset of spring and summer. How seasonal changes cause depression is unknown, but most of the research into mechanisms and treatment has focused on changes in levels of the brain chemicals melatonin and serotonin in response to changing exposure to light and darkness.

Light exposure research and treatment measures in “lux” units. For example, the intensity of light on a high mountain at the equator at midday is greater than 100,000 lux, compared with less than 11 lux generated by a moonlit night. A well-lit kitchen or office may be around 500 lux.

Lifestyle changes that may be helpful
Exercise can ease depression and improve well-being, in some cases as effectively as antidepressant medications. One study found that both one hour of aerobic exercise three times per week and the same amount of anaerobic exercise were significantly and equally effective in reducing symptoms of depression. In a preliminary study of women with SAD, exercise while exposed to light was more likely to be associated with fewer seasonal depressive symptoms than was exercise performed with little light exposure. A controlled study of 120 indoor employees used relaxation training as the placebo in a study of fitness training, light exposure, and winter depressive symptoms. Fitness training was performed two to three times per week while exposed to either bright light (2,500 to 4,000 lux) or ordinary light (400 to 600 lux). Compared to relaxation, exercise in bright light improved general mental health, social functioning, depressive symptoms, and vitality, while exercise in ordinary light improved vitality only.

Vitamins that may be helpful
Vitamin D is well known for its effects on helping to maintain normal calcium levels, but it also exerts influence on the brain, spinal cord, and hormone-producing tissues of the body that may be important in the regulation of mood. A double-blind study found that mood improved in healthy people without SAD who received 400 or 800 IU per day of vitamin D for five days in late winter.

In another study, people with SAD were randomly assigned to receive either 100,000 IU of vitamin D one time only or two hours of bright-light therapy every day for one month. After one month, researchers observed a significant improvement in depression in the group that received vitamin D, but not in the group given light therapy. Although additional research needs to be done, the available evidence suggests that people with SAD who have marginal or deficient vitamin D levels might benefit from supplementation. This treatment should be supervised by a doctor to assure that the amount of vitamin D used is high enough to be effective, but not so high as to cause adverse effects.

Herbs that may be helpful
St. John’s wort is an herb well known for its antidepressant activity. In a preliminary trial, patients with seasonal depression were given 900 mg per day of St. John’s wort in addition to either bright light (3,000 lux for two hours) or a dim light (300 lux for two hours) placebo. Both groups had significant improvement in depressive symptoms, but there was no difference between the groups. The authors concluded that St. John’s wort was beneficial with or without bright light therapy, but a placebo effect from the herb cannot be ruled out in this study. Another preliminary study asked 301 SAD patients to report the changes in their symptoms resulting from the use of St. John’s wort at 300 mg three times daily. Significant overall improvement was reported by these patients. Some of the subjects used light therapy in addition to St. John’s wort. They reported more improvement in sleep, but overall improvement was not significantly different from those using St. John’s wort alone. Double-blind research is needed to confirm the usefulness of St. John’s wort for treating SAD.

Holistic approaches that may be helpful
Diminished sunlight exposure in winter contributes to changes in brain chemistry and plays a role in seasonal mood changes. Artificial lights have been widely used to increase light exposure during winter months. Many studies show the effectiveness of light therapy in improving mood. In a controlled trial, 96 patients with SAD were treated with light at 6,000 lux for 1.5 hours in either morning or evening, or with a sham negative ion generator, which was used as the placebo. After three weeks of treatment, morning light produced complete or near-complete remission for 61% of patients, while evening light helped 50%, and placebo helped 32%. Another study similarly found morning light to have more antidepressant activity than evening light for people with SAD. This study also found that patterns of melatonin production were altered in seasonal depression, and that morning light therapy shifted this pattern toward those of control subjects who did not have seasonal depression. Blood flow to certain regions of the brain was measured after light therapy and was increased in seasonal depression patients who benefited from the light therapy. The increase in regional brain blood flow did not occur in those patients who did not respond to the light therapy. Light therapy begun prior to the onset of winter depression appears to have a preventive effect in people susceptible to SAD.

A review of clinical trials of light therapy for SAD concluded that the intensity of the light is related to the effectiveness of the treatment. A higher response rate was seen in trials where light intensity was greater, compared with trials that used light therapy of lower intensity. Red and potentially harmful ultraviolet wavelengths are not necessary for a response to light therapy.

A study of the adverse side effects from high-intensity light therapy found them to be common, mild, and brief. Among people who underwent brief treatment with 10,000 lux, 45% experienced side effects such as headaches and eye and vision changes. Described as mild and temporary, they did not interfere with treatment.

Dawn simulation is a form of light therapy involving gradually increasing bedside light in the morning. In a comparison study, dawn simulation using 100 to 300 lux for 60 to 90 minutes every morning improved symptoms of SAD similarly to bright light therapy using 1,500 to 2,500 lux for two hours every morning.

 


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