Seasonal Affective DisorderNatural Tips and Therapies

Seasonal affective disorder (SAD) is a type of depression that is only present during the winter months. This differs from clinical depression, which has no seasonal pattern. SAD also tends to improve when the springtime occurs.[1]

SAD can be quite limiting and cause impairments in work, relationships, and everyday functioning.

Symptoms may include:[2]

∙ less energy;

∙ trouble concentrating;

∙ fatigue;

∙ increase appetite (which contrasts from summer depression, that has less appetite);

∙ desire to be alone;

∙ increased sleep; and

∙ weight gain.

Conventional treatments:[3]

∙ Traditional antidepressants (commonly buproprion); and

[1] WebMD. Seasonal Depression (Seasonal Affective Disorder). · https://www.webmd.com/depression/guide/seasonal-affective-disorder#1 · Reviewed 2018-04-13.[2] WebMD, op. cit.[3] Miller, A.L. “Epidemiology, Etiology, and Natural Treatment of Seasonal Affective Disorder.” Alternative Medicine Review, Vol. 10, No. 1 (2005): 5–13.[4] Miller, op. cit.[5] Harrer, G. “[Hypericum and Phototherapy]” (article in German). Praxis, Vol. 89, No. 50 (1994): 2123–2129.

∙ Early-morning light exposure or light therapy (phototherapy).

Antidepressant therapy, light exposure/therapy, and psychotherapy are the most common conventional SAD treatments. Naturopathic therapies have both complementary and other alternative therapies such as dietary interventions, supplements and herbal medicine. Mind-body practices and Chinese medicine philosophy can also be supportive during this time of the year.

Natural TreatmentsThe following natural treatments may support SAD due to their interaction with regulating the neurotransmitter serotonin—which coordinates a proper sleep-wake cycle: l-tryptophan, melatonin, and St. John’s wort (Hypericum perforatum).[4]

A study showed that natural agents such as l-trypothan, melatonin, and St. John’s wort may support symptoms. Of note is the fact that Hypericum increases the impact of light UV treatment. Although the photosensitizing effect may be undesirable normally, in this case it would be preferred by increasing the amount of UV light absorbed.[5]

by Kaitlyn Zorn, NDhttps://drkaitlynzornnd.wixsite.com/naturopath

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Vitamin DDue to the fact that vitamin D exposure is less in the winter than in the summer, this deficiency is a key factor in the development of SAD.[6] Vitamin D, or 1,25-hydroxycholecalciferol (soltriol), mediates endocrine effects in the brain related to nuclear receptor cells for autonomic, sensory, and motor components of the brain stem and spinal cord. A clinical trial found that supplementation of 400 IU and 800 IU led to improvements in self-reported affect and reductions in negative affect.[7] Other studies have found similar beneficial findings.

Fish OilThere have been mixed results on fish oil and depression and other “affective” disorders, but some studies do suggest a positive benefit.[8] It has been shown, though, that fatty acid metabolism is shifted in those with depressive disorders, producing a more inflammatory shift towards omega-6 fatty acids in the body. Theoretically, supplementing with omega-3 fatty acids may help dampen this response, leading to less inflammation and, therein, depressive symptoms. In addition to this, both vitamin D and fish oil may lead to increased serotonin production, which is a contributing factor to mood disorders. Vitamin D is an important factor in brain serotonin

[6] Stumpf, W.E., and T.H. Privette. “The Steroid Hormone of Sunlight Soltriol (Vitamin D) as a Seasonal Regulator of Biological Activities and Photoperiodic Rhythms.” The Journal of Steroid Biochemistry and Molecular Biology, Vol. 39, No. 2 (1991): 283–289.

[7] Lansdowne, A.T., and S.C. Provost. “Vitamin D3 Enhances Mood in Healthy Subjects During Winter.” Psychopharmacology, Vol. 135, No. 4 (1998): 319–323.[8] van Strater, A.C.P., and P.F. Bouvy. “[Omega-3 Fatty Acids in the Treatment of Affective Disorders: An Overview of the Literature]” (article in Dutch). Tijdschrift voor Psychiatrie, Vol. 49, No. 2 (2007):

85–94.[9] Hennebelle, M., et al. “Altered Soluble Epoxide Hydrolase-Derived Oxylipins in Patients With Seasonal Major Depression: An Exploratory Study.” Psychiatry Research, Vol. 252 (2018): 94–101.[10] Patrick, R.P., and B.N. Ames. “Vitamin D and the omega-3 Fatty Acids Control Serotonin Synthesis and Action, Part 2: Relevance for ADHD, Bipolar Disorder, Schizophrenia, and Impulsive Behavior.”

FASEB Journal, Vol. 29, No. 6 (2015): 2207–2222.[11] Strong, R.E., et al. “Narrow-band Blue-Light Treatment of Seasonal Affective Disorder in Adults and the Influence of Additional Nonseasonal Symptoms.” Depression and Anxiety, Vol. 26, No. 3 (2009):

273–278.[12] Palinkas, L.A. “Nutritional Interventions for Treatment of Seasonal Affective Disorder.” CNS Neurosience & Therapeutics, Vol. 16, No. 1 (2010): 3–5.

production. This is related to the transcriptional activation of trytophan hydroxylase-2 by vitamin D, which produces tryptophan—the precursor to serotonin. Omega-3 fatty acid from fish oil is then thought to improve serotonin release via increasing cell-membrane fluidity.[9][10]

Light TherapyIts recommended that exposure to light early in the day would be an easy intervention to help manage SAD symptoms through upregulating the daytime circadian rhythm. Along with increased exposure to actual daytime light is to artificial light sources. Phototherapy using narrowband blue-light treatment and 10,000-lux visible-spectrum light tends to be most commonly used and found to improve HAMD-17 symptoms (SAD version of questionnaire).[11]

Work UpIt’s important to properly work up SAD as other conditions may have similar symptoms or are related. For example, hypothyroidism and adrenal fatigue have similar symptoms and have naturopathic testing methods involving TSH, T3, T4, antiTPO, and serum cortisol levels. Along with these lab tests are questionnaires such as the Hamilton Depression Rating Scale or the Seasonal Pattern Questionaire (SPAQ) as well as the Beck Inventory. Other conditions associated with SAD are depression, bipolar disorder, and premenstrual disorder.

Lifestyle [12]Lifestyle recommendations include dietary recommendations, exercise, and basic living modifications. This may be reducing caffeine, simple sugars, and alcohol, as these can worsen symptoms of depression. Caffeine has been shown to lower serotonin levels over time, along with simple sugars spiking blood sugar which can worsen moods.

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Alcohol is also a depressant, so is not recommended when there is depression.

Research does suggest that serotonin dysregulation could be supported by a higher carbohydrate diet. A study found that a carb-rich diet reduced scores on the HAM-D scale by 50 to 76%. This being said, the carbs should be complex type such as quinoa, brown rice, and whole grains. Diets rich in tryptophan can also support this. These foods are turkey, pumpkin seeds, eggs, and cheese.

Exercise for a minimum of 30 minutes, three times a week, such as strength-training, biking, brisk walking, and jogging to involve aerobic activity. Along with dietary and movement recommendations, other suggestions like keeping blinds open, gazing out windows, and bright lights on cloudy days can help. Another study found CBT to be superior to light therapy.[13] With treatment one year prior to winter, SAD symptoms were less severe with CBT.

HERBAL MEDICINEHypericum perforatum (St. John’s wort)This herb has been widely studied for the treatment of depression; therefore, it is of use for seasonal affective disorder. A study found that after 6–12 months of treatment with Hypericum, significant antidepressant effects were observed.[14] These effects are due to the antidepressant effect of hyperforin along with suggested inhibitor of norepinephrine and dopamine reuptake, as well as an affinity for the calming GABA receptors and regulator of hypothalamic-pituitary-adrenal axis function.[15][16]

Lavender [17]There have been no specific studies with lavender and seasonal affective disorder; however, there have been many with depression and anxiety in general.

[13] Meyerhoff, J., and K.J. Rohan. “Treatment Expectations for Cognitive-Behavioural Therapy and Light Therapy for Seasonal Affective Disorder: Change Across Treatment and Relation to Outcome.” Journal of Consulting and Clinical Psychology, Vol. 84, No. 10 (2016): 898–906.

[14] Di Pierro, F., P. Risso, and R. Settembre. “Role in depression of a multi-fractionated versus a conventional Hypericum perforatum extract.” Panminerva Medica, Vol. 60, No. 4 (2018): 156–160.[15] Butterweck, V. “Mechanism of Action of St John’s Wort in Depression: What is Known?” CNS Drugs, Vol. 17, No. 8 (2003): 539–562.[16] Hearm, S. “Hypericum perforatum.” The Naturopathic Herbalist. · https://thenaturopathicherbalist.com/2015/09/14/hypericum-perforatum/ · Posted 2015-09-14.[17] Koulivand, P.H., M.K. Ghadiri, and A. Gorji. “Lavender and the Nervous System.” Evidence-Based Complementary and Alternative Medicine, 2013 (2013): 681304.

Lavandula augustofolia is very calming to the nervous system but can also be helpful for depression symptoms, especially its essential oil.

The compounds contained in the volatile oils are linalol and limonene.

Lavender can be used in the form of dried herb (dried flowers) in an infusion, or added to a bath. The essential oil is very useful as it can be used either as an inhalation or massage oil. The oil form allows the therapeutic compounds to be quickly received by the nervous system through the olfactory glands of the limbic system—which is directly corelated to emotions.

A review study found that administration of lavender aromatherapy accompanied with tea tree and rosemary lowered psychological distress in long-stay neurology patients. In addition to these findings, a 2% lavender dilution in aromatherapy led to significant improvement on the Edinburgh Postnatal Depression Scale following a four-week administration. A study using a lavender tincture (1:5 in 50% alcohol: 60 drops/day) in combination with imipramine antidepressant (100 mg/d) had positive improvements on mild-moderate depression, with less side effects such as dry mouth and urinary retention. This is quite favourable, as unlike with Hypericum, there are no interactions between lavender and antidepressants.

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Mind-Body Medicine and Chinese Medicine [18]The winter months involve slowing down, retreating, or a state of dormancy. Chinese medicine acknowledges this change and also uses it as a wellness practice for oneself, honouring these cyclical changes seen in nature. It takes time for nature and plants to go inward, to produce their blooms in the spring. This analogy can be useful for individuals experiencing SAD and use it to do more regenerating practices, honouring the natural slower pace of it all.

At this time, it’s useful to consume cooked foods to nourish the spleen. This is because there is a lack of digestive qi, so eating raw, cold foods will injure the qi and cause even more of a deficiency. The organ of the kidney is also a focus during the winter time, which is the element of water. Foods that nourish the kidney are cooked foods as well, but also black or dark green vegetables/foods (black beans, seaweeds, winter greens), whole grains, and bone broths. Winter is the most “Yin” time of the year, which honours the kidney that is also Yin. Yin is associated with slowing down and less energetic than the summer Yang energy. So it is only natural to experience feelings of being slowed down, lower moods, and apathy. The kidney also houses the “willpower.” It is well-known in depression that willpower is a common struggle.

As opposed to wanting to completely rid ourselves of these feelings, we can utilize Yin and other Chinese medicine practices to honour this pace. Yin-building activities involve resting more, slow walking, going to bed earlier, journaling, meditating, and other soothing or nurturing activities.

[18] Suttie, E. “Living According to the Winter Season with Chinese Medicine.” Chinese Medicine Living.org · https://www.chinesemedicineliving.com/nutrition/seasons/winter/

ConclusionThere are a variety of treatments for SAD, both conventional and naturopathical. These include adjunctive pharmaceutical management with antidepressants, light therapy, along with fish oil and vitaminD supplementation to reduce inflammation and improve serotonin regulation, herbal therapies (lavender and St. John’s wort), tryptophan-rich foods, light therapy, and mind-body therapies. A full work-up of other issues that could lead to depressive symptoms is warranted. These include suboptimal thyroid function and impaired cortisol function (high cortisol is associated with depression, yet low cortisol is related to adrenal burnout symptoms and sluggishness). An assessment of hormonal function may also be useful, as low testosterone can contribute to depression in males and imbalanced estrogen in females.

SAD management is multifaceted; therefore, an integrative approach is most beneficial. •NC