January 23, 2006

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Surviving Seasonal Affective Disorder

Sick and tired of winter yet? I am. And when I say “sick and tired” I mean sick and tired! I, like many other folks, suffer from Seasonal Affective Disorder – fatigue and depression caused by the lack of sunlight during the winter months.

It’s been particularly fierce for me this year, because we’ve had a warm but gray winter here in Southern Indiana. I like the warm, but the gray part has me ready to weep. I’m sure that winter used to involve frigid but brilliantly clear days, the sun sparkling off the snow with near-blinding intensity. Instead we’ve had a long run of days in the 40s and 50s, damp, with heavily overcast skies. Okay, so I like not shoveling snow. But I’d trade the warmth for some sun!

Why am I bringing up Seasonal Affective Disorder (SAD)? Because one of the common symptoms is serious carb cravings, and that’s of special concern to us.

Let’s look at all the symptoms of SAD. They include:

  • regularly occurring symptoms of depression (excessive eating and sleeping, weight gain) during the fall or winter months.
  • full remission from depression occur in the spring and summer months.
  • symptoms have occurred in the past two years, with no nonseasonal depression episodes.
  • seasonal episodes substantially outnumber nonseasonal depression episodes.
  • a craving for sugary and/or starchy foods.
  • Fatigue, difficulty getting out of bed in the morning.
You begin to wonder if bears have the right idea – just sleep all winter.

Oddly enough, I have all of these except the craving for sugary and/or starchy foods. I attribute this to having been low carb for so long that my brain just doesn’t run on that track anymore. But the reason for carb cravings during Seasonal Affective Disorder is simple, and it’s the same reason you may get carb cravings in any stressful or depressing situation – carbs cause a rush of serotonin in the brain, and serotonin makes you feel more cheerful. (As many of you no doubt are aware, antidepressant drugs like Prozac and Paxil work by increasing levels of serotonin in the brain.)

So here you are, full of good intentions after the New Year – and faced with biochemically driven carbohydrate cravings. What can you do?

The standard treatment for Seasonal Affective Disorder is light therapy, also called phototherapy, using a full-spectrum light box that gives off 10,000 lux. Please don’t ask me to define a “lux.” I looked it up, and the explanation went into “lumens per meter squared.” Which would be useful if I knew how much a lumen is, but I don’t. Just know that this is a considerably more intense light than you’ll get from your average light bulb.

Anyway, a couple of hours exposure to a light box – for instance, putting one on your desk first thing in the day as you work – is the most commonly recommended treatment for Seasonal Affective Disorder. I am seriously considering investing in a light box. However, after some shopping around on the internet, the least expensive one I can find, called the HappyLite, runs $170. This is considerably cheaper than the $350 the local medical supply store wanted.

Still, I just bought a new house, and the budget’s stretched pretty thin right now. So I did a little poking around for cheaper measures that would still be effective.

Cheapest, and good for us in numerous ways, is to take a walk outside on any day that’s not utterly frigid or stormy. As I mentioned, here in Southern Indiana our winter’s been quite mild, but depressingly gray – not really inviting weather for a hike to the end of the road and back. I keep reminding myself that even on the grayest day I’ll get more full-spectrum light during a 45 minute walk than I would from any electronic device, and walking in itself is an antidepressant.
Not to mention an aid to weight control and general health. Score!

Of course, I work at home, on my own time, which gives me the freedom to walk out the door in the middle of the day. But if you’re having serious mid-winter blues, I urge you to get outside for at least a little while any day the weather’s not ridiculously harsh, even if you just go walk around the parking lot at work for 15 minutes during your lunch break.

A search on the PubMed database turned up a very interesting study of the effects of vitamin D supplementation on SAD. Vitamin D is, of course, the vitamin/hormone that is created in your skin during exposure to sunlight. It makes all kinds of sense that SAD would be caused, at least in part, by low vitamin D levels.

Sure enough, in this clinical study, subjects who had Seasonal Affective Disorder and were given a single whopping dose of vitamin D – 100,000 IUs – were found to have improved significantly on all “outcome measures” – all the tests that the researchers were using to quantify their depression and fatigue. Excitingly, the subjects given vitamin D improved far more than those who were given the standard phototherapy.

I read this study when my SAD was really at a low point – getting out of bed was an exercise in will, and focusing on writing was near-impossible. As soon as I read about the vitamin D study, I ran to my health food store and bought a bottle of 1000 IU vitamin D capsules. I swallowed five of them as soon as I got home, and another three that evening. I felt noticeably better by the end of the day, and with continued doses of 3000 to 4000 IUs of vitamin D per day, I have been improving ever since. Okay, so I’m still longing for spring. But at least I can get up in the morning, and get some work done during the day. That’s a big improvement, and I’m grateful for it.

(Worried about overdose? Don’t be. It’s estimated that a scantily-clad (ie, bathing suit-wearing) white person spending five to ten minutes in the summer sun will create at least 4000 or so units of vitamin D. Taking a few thousand IUs of fish oil D per day during the winter will not create an overdose.

Speaking of which: Black folks create far less vitamin D in their skin than white folks do, which is why the rates of rickets – weak bones from vitamin D deficiency – have long been higher in black folks in northern regions than they are in white folks in the same regions. I urge my black readers to take vitamin D supplements year ‘round, and to give them to their children.

Too, there is growing evidence that our national obsession with sun screen is causing more health problems than it prevents, because of reduced vitamin D formation. Some researchers are now claiming that for every case of skin cancer we prevent we are causing ten cases of breast, prostate, and colon cancer.)

Interestingly, there are very few food sources of vitamin D, which is why I referred to it as a hormone earlier. It appears that we were not meant, for the very most part, to get our vitamin D from food, but rather by creating it in our bodies from regular exposure to the sun.

Milk and other dairy products contain vitamin D, but only because synthetic D has been added to them; these are not sources of vitamin D in their natural state. Oily fish like sardines, mackerel, tuna, and salmon have some D, as do egg yolks, mushrooms, and liver. You’ll notice something interesting about these few food sources of vitamin D: They’re all low carb. If you’re fond of chicken livers – I love them – sauteing some mushrooms and onions with some chicken livers, then pouring in beaten eggs and scrambling the whole thing together would be about as high-D a meal as I can think of. (Now I’m making myself hungry!)

The very best source of vitamin D is fish liver oil, which is why people from far northern climes have taken cod liver oil for centuries – what with getting so little sun half the year, they learned that they were healthier, and their children grew better, if they took that magical fish liver oil every day. This is a very smart idea, and I take cod liver oil all year ‘round, both for its vitamin content, and for its healthy EPAs. The 1000 IU capsules I’ve been adding to my cod liver oil are also from fish liver oil, but they’re more concentrated.

Some doctors prescribe antidepressant drugs for SAD, to increase levels of serotonin in the brain. Most antidepressants fall into the class of SSRIs – Selective Serotonin Uptake Inhibitors. What this means is that they slow the removal of serotonin from the teeny gaps between brain cells (known as synapses) so that the effects of the serotonin are felt more.

Instead, I’ve been taking 5-hydroxytryptophan, also known as 5-HTP. Extracted from an African seed, this supplement is the immediate chemical precursor to serotonin, so taking it actually increases levels of serotonin available in the brain. Be aware that 5-HTP is still being studied and is controversial; it’s up to you whether you want to try it. However, do not try 5-HTP if you are already taking antidepressants. It’s a potentially bad combination.

You can increase your serotonin levels to a lesser degree by eating plenty of foods that are high in the amino acid tryptophan. High tryptophan, low carb foods include poultry, fish, cheese, avocados and nuts. Milk is also a good source; it’s not low carb – 12 grams of lactose per cup – but it is a low impact carb, so many of you should be able to tolerate it. Plain yogurt is another good high tryptophan food (flavored yogurt has tryptophan, but is loaded with sugar.) Add your favorite flavoring extracts and the sweetener of your choice.

Some people find that St. John’s Wort, which appears to have a similar action to the SSRI drugs, is helpful for SAD. If you try St. John’s Wort – and again, don’t combine it with pharmaceutical antidepressants – be aware that it increases your sensitivity to sunlight, making sunburn much more likely. Not a problem for most of us right now, but if you use a tanning bed or are going on a winter vacation, be careful.

(By the way, any of these approaches can be helpful in dealing with emotional carb craving in general.)

Of course, the ultimate treatment would be a two-week vacation in the Caribbean, but I can’t afford either the money or the time, can you? I have vowed, however, that if I have another best-seller, I’m buying myself a winter place in Mexico.

I hope this info helps my fellow SAD sufferers to shake their winter blues without a major carb binge. And here’s a cheerful thought: Groundhog Day (February 2) is just around the corner – and that’s halfway to spring!

Posted by HoldTheToast at January 23, 2006 10:03 AM