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Seasonal Affective Disorder (SAD) Self Help

by in Depression, Kitchen Sink, Reader Questions January 22, 2009

Photobucket“Hi Dr. Nicole, my depression is much worse this time of year.  What do you recommend?”

Immediately after the holidays is a great time to have a nervous breakdown…er…”nervous breakthrough.”

We tend to feel even more agitated and moody this time of year especially now that all the excitement of the holidays have died down and there isn’t much to distract us from the winter blahs.

We are also all feeling about ten pounds over weight after likely losing the battle of the holiday bulge.

Whether you just have depression during the winter months, or whether you struggle with depression all year round that is exacerbated by the low light conditions of winter; having a plan in place to better cope with the realities of winter depression is an important preventative measure.

My last name serves as a convenient mnemonic to help remember how to take care of yourself throughout the winter months…

The Sundene Protocol for Seasonal Affective Disorder

  • Sun- for Sunshine or Sun Equivalent
  • D- for vitamin D
  • E- for Exercise
  • N- for Nutrition
  • E- for Everything else. SAD can have debilitating consequences. If you struggle with depression, be sure to share this plan with the family and friends on your “support team” so that if you find yourself in an excessively dark and gloomy place this winter you can easily get some help to pull you out of the “hole”.  Consult with a physician before self treating with natural anti-depressants or natural anxiety aids.

Although severe depression should also improve with this protocol, those experiencing moderate to severe depression should ALWAYS be working with their health care provider. Anyone experiencing thoughts of suicide should be under the supervision of a physician.

The following are the basics for my protocol for seasonal depression.

“Sun” – We need 10,000 lux of light every day in order to produce enough serotonin to feel happy. This can be achieved by 15 minutes outside on a bright blue sky sunny day, or 1 hour outside when it is overcast. You may wonder “What in the world is a lux?” A lux is the light equivalent put off by one candle. So you can light 10,000 candles in your home to cheer yourself up (a bit of a fire hazard!) or you can just invest in a light box.

A light box is an excellent idea for those with seasonal depression and is best used for twenty to forty minutes in the morning depending on the manufacturer’s recommendations to achieve the 10,000 lux equivalent.If you are unable to afford a light box you can simply try full spectrum light bulbs as these often provide enough light for those with mild to moderate seasonal depression.

Keep in mind also that outdoor places near water or snow are great to visit during the gloomy months of winter as the light is intensified as it is reflected back up to our eyes. If you are concerned about protecting your eyes from UV radiation, you can buy sunglasses with a clear lens, but that still provide UV filtration as it is the actual photons of light that our brains use and not the UV radiation to produce serotonin.

Those struggling with seasonal depression need to make an appointment with the sun or the sun’s substitute every single day. Topping off your serotonin levels by day means that more of this neurotransmitter will be available for conversion to melatonin (the hormone that keeps us asleep at night). Using light as a medicine should easily improve your sleep, leaving you more energetic for the following day.

“D” -Vitamin D is no longer considered a vitamin, but a “pro-hormone”. Exciting research about vitamin D is on the horizon, and some evidence supports a link to depression, although some studies do not support this link. Just about every patient I have ever checked in Seattle has been vitamin D deficient.

Vitamin D is produced in our bodies when UV light touches our skin. Most people living in the northern latitudes are easily vitamin D deficient if they do not spend 20 minutes outside each day. Elderly people have thinner skin, and thus produce less vitamin D, they also absorb less dietarily. Until further evidence supports this theory linking depression with low vitamin D levels, it only makes sense to be sure that you are at least not deficient in vitamin D.

The RDA for adults ranges between 200 IU and 600 IU. Food sources of vitamin D are milk, fish, and yeast. I typically recommend 1000 IU of vitamin D for my patients struggling with depression as a cheap and easy insurance policy that they are not deficient in vitamin D.

If you would like to have your levels checked be sure that your physician orders the “25-OH-D” as that is the most reliable indicator of vitamin D stores. Do not ever exceed 1000 IU of vitamin D unless under the care of your naturopathic physician. Dangerous side effects such as hypercalcemia can occur.

“E” -Exercise- is the drug of choice for anyone that is depressed. It is a tough medication to take though when depressed because as best summed up by Newton’s laws of motion: “An object at rest stays at rest until acted upon by another force.”

When you are down in the depressed hole it is tough to get exercising, but stagnation is just going to perpetuate your problem.

Countless studies support the efficacy of exercise for depression. If you struggle with seasonal depression be sure to try to exercise outside EVERY SINGLE TIME the sun is out! Find a walking, running, or cycling buddy and take turns pushing each other out there. Whatever you do…just keep moving! Being cramped up in doors during the winter months is the problem and not the solution.

“N” –Nutrition is fundamental for anyone struggling with depression. When the body does not feel good the mind is soon to follow.Depressed thinking often results in poor dietary choices.

When we are depressed and in a low light setting we crave carbohydrates so that the body can produce more serotonin. However, sugar is exactly what the body does not need in the long term for healing from depression. The best diet for those with depression, anxiety, and bi-polar to follow is the LOW GLYCEMIC INDEX DIET.

Balancing out the blood sugar will help keep the mood at an even keel throughout the day. Be sure to eat protein with every meal and especially foods high in tryptophan such as turkey, cottage cheese, peanuts, fish, eggs, oatmeal, avocados, and bananas.

A high quality multi-vitamin will cover all the bases and ensure that you are not deficient in any of the B vitamins that are coenzymes for producing the neurotransmitters that make us feel happy.

“E” -For Everything Else, such as “Herbal Sedatives.” There are many treatment options for depression. Please do not give up hope.

Counseling, herbs, amino acids, and of course anti-depressants when need be will help keep you out of the “hole”. Naturopathic treatments for depression often take time as they are addressing the whole person and the long term.

As a physician, I give every treatment plan three to six months to determine it’s efficacy. If you are not experiencing improvement you may want to consider other treatment options. Various counseling and therapy techniques are also available, if you find you are not making progress with your therapist, consider a new referral for a different type of therapy.

Remember that aside from physical and mental components, there is also a social component to seasonal depression. Much time spent inside, or repeatedly with the same people inside can contribute to a poor mood.

Schedule weekly activities to get you out of the house and interacting with others. If you live alone, the winter months can feel especially isolating. Find an elderly person that also lives alone to check in on, it will do you both a world of good.

If you enjoyed this post please feel free to leave a comment, share this information with those that might benefit and subscribe to future articles. Thanks for stopping by my “kitchen table!”

~Dr. Nicole Sundene
Naturopathic Physician

2 Comments
  1. […] Seasonal Affective Disorder Self-Help […]

  2. Dr. Sundene,
    Thanks so much for posting this article! I always get S.A.D. during the winter months, even during the holidays. I had a vague concept of all of these remedies, but it helps that you spell them out (using your name!) for all of us. My parents, who I’m living with after college, also get S.A.D. so I’ll be sharing this information with them.
    I’ll check back later in the year to let you know how it’s working!
    -Lizz

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