November 25th, 2018

As the winter season takes grip of us here in the northern hemisphere with cold gray skies, darkness and diminished sunlight, many of us develop the “winter blues”. If you do, you're not alone. About 15% of the population may struggle with winter blues, a mild version of Seasonal Affective Disorder (SAD). Studies have shown that nearly 10% of people in New Hampshire have been diagnosed with SAD, but it affects only about 1% in Florida, the Sunshine State.

SAD is a form of depression that comes and goes depending on the time of year. There are 2 main types of the disorder. Fall-onset SAD – This type of SAD starts in late fall and goes away in the spring and summer. Some people call it "winter depression." It is the most common form of SAD. Spring-onset SAD – This type of SAD starts in the spring and goes away in the fall and winter. Spring-onset SAD is much less common than fall-onset SAD.

SAD tends to be more common in women, young adults and those who work night shifts. It also has been found to run in families. Common symptoms include:

• Feeling sad, down, hopeless or cranky most of the day, almost every day
• Sleeping more, but not sleeping well
• Feeling unmotivated with low-energy
• Craving junk or comfort food; gaining weight
• No longer enjoying or caring about doing the things one used to like doing
• Not being able to focus
• Avoiding social activities

There are a number of theories as to what causes SAD and winter blues. The reduced level of sunlight in fall and winter may affect circadian rhythms (our biological internal clock) leading to feelings of depression. The change in season ensuing effect on circadian rhythms may disrupt the balance of the body's level of melatonin, which plays a role in regulating sleep patterns and mood. Reduced sunlight can also cause a drop in serotonin, a brain chemical that affects mood, and might play a role in triggering depression. As sunshine decreases so does the body’s ability to make vitamin D. Drops in Vitamin D have also been linked to SAD.

Knowing these possible causes, there are some things you can do try to lift your mood during these cold dark months:

• Open your shades to let in the sunlight.
• Head outdoors on sunny days.
• Include physical activity in your daily routine.
• Adjust your diet to include foods that provide energy.
• Make plans to stay connected on a regular basis with friends, family and other social supports.
• Try light therapy.

Having patients consume key vitamins and supplements have shown to be quite helpful in my practice. I often recommend checking vitamin D3 levels and supplementing to get levels up to 55-75 ng/mL. Most people need 2,000 IU to 5,000 IU daily. Be sure to take vitamin K2 with your vitamin D3 as this helps prevent toxicity from taking too much vitamin D3, but also is needed to push the calcium into your bones and prevent calcification of your soft tissue, like joints (arthritis) and heart (coronary artery disease). Melatonin at 3-6 mg before bed helps restore normal circadian rhythms. Supplementing with the amino acid 5-htp also helps raise serotonin levels and can be quite helpful with depression. Herbs like St. Johns Wort and Rhodiola are my favorites for lifting mood. Don’t forget taking fish oil – most people need 2000 mg or more of omega-3 fatty acids EPA and DHA. Fish oil is essential for lifting depression.

It's normal to have some days when you feel down, but if it continues for multiple days at a time and you can't get motivated to do activities you normally enjoy it is important to see your health care provider. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide.

Dr. Toby