Feeling SAD?
By Elaine Pomfrey
Lily reluctantly moved one summer from Los Angeles to Minneapolis when her husband wanted to be closer to his family. Lily adjusted quickly. She landed a good job, placed her kids in a great school, and made new friends. But when the leaves started changing, she began to feel lethargic and lost interest in her work. She caved in to her cravings for carbohydrates and gained twenty pounds. Come springtime, however, she regained the energy to work out and the pounds melted away with the spring rains. Her depression was forgotten until the next fall when it crept back in with the cold air. She abandoned her tennis shoes and slumped in front of the TV again for another long winter. What she didn't know was that her body literally missed the sunshine of Southern California.
Many people will recognize Lily's symptoms as reflective of Seasonal Affective Disorder or SAD, a type of depression that affects people during the same season each year. Other relevant symptoms are more sleep at night, intense drowsiness during the day, social withdrawal and feelings of despair. In most cases, SAD occurs in the fall/winter, but some experience it when summer starts. In either case, the symptoms intensify as the season progresses.
Lily consulted with her doctor who interviewed her and also used the Seasonal Pattern Assessment Questionnaire (SPAQ) to determine that she had SAD. The diagnosis of SAD only applies if someone has experienced depression during the same season for two consecutive years and has had no episodes of depression in-between. In addition, no other explanation for the depression exists, like the loss of a loved one or an illness.
In 1984, SAD was first labeled by Norman Rosenthal, MD, the author of Winter Blues and the medical director of Capital Clinical Research Associates. About 4-6% of the population experience SAD. Women are more prone to it than men, although men's symptoms are typically more severe. It is more common in people who have relatives with SAD and it is more prevalent in countries significantly north or south of the equator.
This last fact lends a clue to a possible cause of SAD – the lack of sunlight during certain seasons. In the northern hemisphere, the production of serotonin, a neurotransmitter, falls to its lowest levels during the winter when sunlight is reduced and rises to its highest levels during summer. Serotonin deficiency is linked to depression. Less sunlight also affects the production of melatonin, a hormone which affects sleep and mood. However, researchers have not yet pinpointed an exact cause of SAD.
Although Lily's doctor could have prescribed cognitive-behavioral therapy or anti-depressant medication, she recommended three natural treatment modalities:
- Stress management – Lily needed a stress management technique to reduce the level of stress in her body and to smooth her emotions year round, not just in the winter. Like many physicians, Lily's doctor suggested the Transcendental Meditation (TM) technique because of the extensive research supporting its benefits to the mind, body and emotions. Several of the over 380 studies demonstrate that TM reduces depression. For example, the Journal of Counseling and Development published a study where subjects with post-traumatic stress disorder who learned the Transcendental Meditation technique showed significant reduction in depression after four months. The control group who received psychotherapy did not demonstrate a significant decrease in depression.
Another reason her doctor recommended TM is because Dr. Rosenthal, who first described SAD, recommends it to his patients saying it "soothes and settles down the nervous system." 
Light Therapy – Because Minneapolis has limited sunlight in the winter, Lily's doctor suggested that she sit in front of a light box for thirty minutes daily during the winter. Light boxes are 10-20 times brighter than normal indoor light with the intensity of light ranging from 2,500 to 10,000 lux. The theory is that the light restores the circadian rhythms, rebalances the body's production of hormones and stimulates the body to produce Vitamin D.- Vitamin D – Vitamin D is emerging as the preferred treatment for SAD. Recent research showed that subjects with SAD who took Vitamin D over one month's time experienced a reduction in depression while those who participated in light therapy showed no reduction. There is evidence that major depression is associated with low vitamin D levels and that depression has risen in the last century as vitamin D levels have most certainly fallen.
Vitamin D is known as the sunshine vitamin, but in fact, it is actually a hormone. The body manufactures Vitamin D with the aid of sunlight. In the summer, you need exposure between 10 am and 2 pm for 20 – 120 minutes to form adequate Vitamin D. However, during the winter, people who live in northern climates do not get enough sunshine to produce sufficient amounts of Vitamin D because the sun's rays are weaker and they avoid the outdoors. Lily's doctor mentioned that the body cannot store up Vitamin D from the lazy days of summer so she asked Lily to beef up on Vitamin D rich foods, such as salmon, cod liver oil, fortified dairy products, and to supplement with good quality Vitamin D3 .
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