SAD Light treatment seasonal affective disorder, natural Therapy, vitamins herbs supplements by Ray Sahelian, M.D.
March 1 2016

The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Visit these web pages for natural ways to treat depression and natural ways to improve sleep.

Seasonal  affective disorder treatment
SAD is a common variant of recurrent major depressive disorder or bipolar disorder. Treatment with bright artificial light box and lamp has been found to be effective in this condition. However, for patients who do not respond to light therapy or those who lack compliance, conventional drug treatment with antidepressants also has been proposed. Substances with selective serotonergic or noradrenergic mechanisms should be preferred over older antidepressants. Although not much research has focused on natural supplements, there are several that are worth exploring as a natural means of treating SAD.

Natural therapy for SAD
There are a few nutrients and herbs that could potentially be helpful. These supplements could be used at the same time as light therapy. These include:

St. John's wort is an herbal antidepressant that improves mood.
SAM-e, which enhances brain levels of several neurotransmitters. Keep the dosage to 100 mg daily or every other day.
5-HTP, or 5-hydroxytryptophan, which converts into serotonin.
Vitamin D may be helpful.

SAD Symptom
The symptoms of SAD usually recur regularly each Winter, starting between October and November and continuing until March or sometimes April. Some of the symptoms include sleep problems, lethargy, overeating, lack of social interaction, low mood, inability to tolerate stress, loss of libido and sexual interest.

SAD Cause
Many people experience changes in their sleep patterns, energy levels and mood in the autumn and winter. Indeed, many people can feel 'low' now and then. But when these problems become so severe that they interfere with daily functioning, a more serious condition, such as SAD may be present. The exact mechanism of SAD is unknown, although there are many theories. SAD may be related to changes in the amount of daylight during the autumn and winter months. One theory suggests that people with SAD respond to this decrease in light by secreting a hormone called melatonin which slows down the body clock, and affects sleeping and mood patterns. Another theory, which is gaining popularity, involves chemicals in the brain, such as dopamine or serotonin, which play a role in controlling sleeping, eating and moods. It is thought that people with SAD may have abnormal levels of these chemicals. A third theory proposes that people with SAD may have a lower eye sensitivity to light. A fourth theory is that people during the winter end up staying home more, being less social, being less physically active, eating more, and just feeling sluggish from a number of reason all combined to cause depression.

Diagnosis of SAD
There is much more seasonal difference in higher latitudes than in lower latitudes. In a significant portion of the population of the northern United States, the shorter days of fall and winter cause a syndrome that includes depression, fatigue, sleepiness, overeating, carbohydrate craving, weight gain, and loss of libido. If these symptoms persist in the winter, and are reduced as the days grow longer, and disappear in the summer, the diagnosis of seasonal affective disorder (SAD) can be made.

SAD Light Therapy
Bright light therapy for SAD has been investigated and applied for over 20 years. Physicians and clinicians are increasingly confident that bright light therapy is a potent, specifically active treatment modality. Indeed, the domain of light treatment is moving beyond SAD, to nonseasonal depression (unipolar and bipolar), seasonal flare-ups of bulimia nervosa, circadian sleep phase disorders, and more. Light therapy is simple to deliver to outpatients and inpatients alike, although the optimum dosing of light and treatment time of day requires individual adjustment. Light therapy provides a compatible adjunct to antidepressant medication, which can result in accelerated improvement and fewer residual symptoms.

Prog Neuropsychopharmacol Biol Psychiatry. January 2014. The influence of light administration on interpersonal behavior and affect in people with mild to moderate seasonality. Bright light is used to treat winter depression and may also have positive effects on mood in some healthy individuals. However, there is little information on how bright light treatment influences social behavior. We performed a cross-over study in winter comparing the effects of morning bright light administration with placebo (exposure to negative ions) on mood and social behavior in 38 healthy people with mild to moderate seasonality. Each treatment was given for 21days with a washout period of 14days between treatments. An event-contingent recording assessment was used to measure mood, and social behavior along two axes, agreeable-quarrelsome and dominant-submissive, during each 21-day treatment period. During treatments, participants wore a combined light-sensor and accelerometer to test this method for adherence to light treatment self-administered at home. Data were analyzed using multilevel modeling. Bright light improved mood but increased quarrelsome behavior and decreased submissiveness. Data from the light monitor and accelerometer suggested that 21% of the participants did not adhere to bright light treatment; when this group was analyzed separately, there was no change in quarrelsomeness or mood.

Review article
Depress Res Treat. 2015. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as "winter blues." Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counseling.

Questions
Q. I had decided to try rhodiola herb following a suggestion in the SAD Association's newsletter that it might be helpful for fatigue and so forth which I've been having big problems with this winter. Since my GP noted that I appeared to suffer from depression worse during winter some years ago I did some research into SAD, concluded that I do appear to suffer from this and therefore joined the UK SAD Association and purchased a light box which I do find helpful. I'm mentioning this, as my previous orders for SAM-e and 5-HTP have also stemmed from recommendations by other sufferers in the newsletter and I've found they do appear to help to some degree, so thought you might like to be aware of this! Perhaps Dr Sahelian might be interested in looking at formulating a combined remedy aimed at alleviating SAD symptoms; I suspect there could be quite a market for such a product as the condition is quite widespread and more actively acknowledged to be 'real' these days. He might also be interested to hear that the SAD Association also actively advise against the use of St John's wort for this condition due to some unpleasant interactions experienced when used in conjunction with light therapy, which the majority of sufferers do find beneficial. I thought I'd mention the above as your website and newsletter seem to indicate an interest in and open-ness to feedback. I'd also thought it would be polite to say 'thanks' for your newsletters, which I often find interesting.