Winter Depression :: Emotional and Mental Health :: Seasonal Affective Disorder (SAD)

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Winter Depression
by author David Saul, MD

Over the course of a lifetime, up to 12 per cent of men and 20 per cent of women will suffer from a depressive illness. It is a highly recurrent illness where 80 per cent of patients who have had one depressive episode will experience another one. Depression, when it hits, can be crippling to the individual and to the supporting family members.

Depression has a high incidence of successful suicides. Fifteen percent of patients hospitalized with a depressive illness will take their own lives.

We are supposed to feel sad when we lose a loved one or when a business deal turns sour. However, depression can also arise spontaneously.

For the majority of patients, they will "snap out of it" in a short while.

However, there is a one in 10 likelihood for developing a chronic state of despair and anguish (clinical depression). Depression is twice as common in women than in men and there is the additional burden of severe social stigma.

By asking a few targeted questions, the family doctor can quickly establish a diagnosis of clinical depression:

Prolonged sadness, often with frequent crying spells

Lack of desire or, motivation

Disturbances in appetite

Disturbances in sleep (up or down)

Disturbances in sex life (usually down)

Frequent thoughts of suicide

Treatment with medications, specifically the Selective Serotonin Re-uptake Inhibitors (SSRIs) over the past 10 years has yielded the following results.

A consistent lag period (around three weeks) before any noticeable improvement. Inadequate response in 30 to 40 percent of patients. Difficulties in compliance due to side effects for many patients--fatigue, gastrointestinal, sexual dysfunction. Clinical guidelines suggesting long term use for patients with recurrent depressions.

In a significant number of cases, patients simply refuse to accept a pharmaceutical approach. I have found a number of alternative (drug-free) treatments, which are effective, rapid and long-lasting. Compliance is often better due to fewer (or even no) side effects. Finally, many patients prefer the natural approach, whenever possible.

Natural Smiles
Specific wavelengths of light, especially those wavelengths mimicking an early morning sunrise, can influence brain serotonin (the precursor to melatonin). This photoreceptor system in the eyes can adjust the body’s circadian rhythms, thereby correcting sleep patterns (early to bed, early to rise). Dramatic improvements have been reported for Seasonal Affective Disorder (SAD) (see sidebar) with the use of bright light therapy. These are now commercially available in the form of light boxes, light bulbs or portable light visors worn like a pair of eyeglasses.

Repetitive and regular exercise routines have been shown to raise the brain’s serotonin levels. This is partly due to serotonin’s role in facilitating bodily movement and also in brain cooling functions. Next, vigorous exercise can increase the brain levels of dopamine and noradrenalin, which will both improve depression. In addition, exercise improves endorphin levels. Endorphins are linked to pain reduction, as well as providing a general state of well-being (and sometimes even euphoria).

Serotonin is a major neurotransmitter involved in depression. The brain levels of serotonin are directly influenced (up or down) by other hormones, such as eicosanoids. Re-balancing eicosanoid ratios can easily be achieved via nutritional means. There is a simple, yet very effective nutritional program to follow--fewer carbohydrates and more proteins with every meal. This nutritional plan will rapidly lead to the following scenario--a lowering and stabilizing of insulin levels, which in turn, will re-balance eicosaniod ratios, which will then improve serotonin levels. Finally, by lowering carbohydrate intake, there is less chance for hypoglycemia and the resulting elevation of cortisol levels. Depression has been associated with higher blood cortisol levels.

The full list of alternative therapies is actually quite long and includes vitamin B6, St John’s wort, aromatherapy, meditation and acupuncture. Any of these therapies have adequate, supporting scientific data for alleviating depression. See your natural health care practitioner for the remedy that is best for you.

References:
1. Quinn Brian, The Depression Sourcebook, 1997.
2. Robertson Joel. Natural Prozac. 1997
3. Wolpert, Lewis. Malignant Sadness: The Anatomy of Depression, 1999.
4. Zuess, Jonathan, MD. The Wisdom of Depression, 1998

David Saul is a family doctor and the director of the Depression Treatment Program at the Specialty Medical Clinic in Toronto.

Source: alive #208, February 2000

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