Seasonal Affective Disorder SAD, herbs, supplements, vitamins by Ray Sahelian, M.D.
February 19 2016

Seasonal affective disorder (SAD) is a type of depression associated with the winter season. It is related to the changes in the amount of daylight that fluctuates with the seasons. In people with seasonal affective disorder, the same symptoms tend to return and ease every year at about the same times. The typical symptoms 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.

Decreased amounts of daylight during the winter may trigger SAD by disrupting the body's internal clock, causing a drop in levels of a mood-affecting chemical called serotonin, or by altering levels of melatonin, which plays a role in sleep patterns and mood.

Seasonal  affective disorder treatment
Light therapy in combination with natural supplements could be of significant benefit. Seasonal affective disorder 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 seasonal affective disorder. If you are interested in natural ways to lift mood, see this depression article.

Natural Therapy for Depression and Seasonal Affective Disorder 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

5-HTP, which converts into serotonin
SAM-e, which enhances brain levels of several neurotransmitters. Sam-e is available as a supplement for sale. Dosage should not exceed 200 mg every other day.
St. John's wort herbal natural antidepressant.

Melatonin use
The findings from a new study lend further support to the "circadian phase-shift hypothesis" as the basis for winter depression, also known as seasonal affective disorder (SAD). According to the phase-shift hypothesis, the authors explain, SAD is caused, at least in part, from a mismatch between circadian rhythms related to the sleep/wake cycle and rhythms more closely associated with the body's own "circadian pacemaker." For most patients with SAD, depression occurs in winter because of the late sunrise, "causing their circadian rhythms to delay with respect to clock time and with respect to the sleep/wake cycle." r. Alfred J. Lewy, from Oregon Health and Science University in Portland, tested the hypothesis by giving low-dose melatonin or placebo to 68 patients with SAD. If the phase-shift hypothesis were correct, giving melatonin in the afternoon to the typical SAD patient would cause a shift in their wake cycle to earlier in the day, resulting in an improved mood. By contrast, giving melatonin or placebo in the morning would not be expected to improve mood. The authors found that a low dose of melatonin could be given safely to the subjects and did not cause sleepiness. As anticipated, in typical SAD patients, treatment with melatonin in the afternoon worked best at alleviating their depression. Conversely, in the smaller group of patients with phase-advanced disease (possibly triggered by the earlier winter dusk), treatment in the morning appeared to be optimal. Proceedings of the National Academy of Sciences, April 24th early edition, 2006.

Disturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating melatonin secretion. Melatonin is secreted at night and is a stable marker of circadian rhythms. The timing of its secretion can be changed by exogenous melatonin, agonism of specific melatonin receptors in the suprachiasmatic nucleus, its suppression by light and by sleep deprivation. Acta Psychiatr Scand Suppl. 2013.

Symptom
The most common symptoms of seasonal affective disorder include feelings of depression, fatigue, craving for starchy foods and weight gain as the specific season approaches. The symptoms of seasonal affective disorder 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.

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 Seasonal affective disorder may be present. The exact mechanism of seasonal affective disorder is unknown, although there are many theories. Seasonal affective disorder may be related to changes in the amount of daylight during the autumn and winter months. One theory suggests that people with Seasonal affective disorder 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 seasonal affective disorder may have abnormal levels of these chemicals. A third theory proposes that people with seasonal affective disorder 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.

Seasonal affective disorder Light Therapy
Bright light therapy 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 seasonal affective disorder, 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.

Eur Rev Med Pharmacol Sci. 2013. Role of serotonin in seasonal affective disorder. This review was prepared with an aim to show role of serotonin in seasonal affective disorder. Seasonal affective disorder, which is also called as winter depression or winter blues, is mood disorder in which persons with normal mental health throughout most of the year will show depressive symptoms in the winter or, less commonly, in the summer. Serotonin is an important endogenous neurotransmitter which also acts as neuromodulator. The least invasive, natural, and researched treatment of seasonal affective disorder is natural or otherwise is light therapy. Negative air ionization, which acts by liberating charged particles on the sleep environment, has also become effective in treatment of seasonal affective disorder.

Drug Approved to Treat Seasonal Affective Disorder
FDA has approved Wellbutrin XL to prevent major depressive episodes in patients with a history of SAD, which usually coincides with the seasonal decrease in daylight during fall and winter. The agency emphasizes that the drug should be used only in those who meet strict diagnostic measures of seasonal depression.

Seasonal Affective Disorder SAD questions
Q. I had decided to try the 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 Seasonal Affective Disorder, 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.