Two hormones, serotonin and melatonin primarily control our circadian rhythm or sleep-wake cycle. Serotonin is produced in the gastrointestinal tract and the brain. Its job is to make us “feel good.” A drop in light causes reduced production of this neurotransmitter causing some people to feel depressed. In addition, melatonin, responsible for making us fall asleep at night, is produced by the lack of light and onset of nightfall. In the winter we have less sunlight, which may actually increase our melatonin production causing us increased sleepiness and depression.

1. About YOUR Health from The Dispensary Online
An informed patient makes intelligent decisions about their healthcare
Seasonal Affective Disorder and Six Tips to Beat the Winter Blues
by Dr. Mona Fahoum
Darkness Falls
Fall and winter bring holidays, hot cider, fires and skiing. They also bring darkness
that, for some, can be unbearable. Feelings of low energy, fatigue and loss of
motivation are common to many people. But for others, it can progress into a near
debilitating condition called Seasonal Affective Disorder (SAD).
Why is winter so hard?
With the advent of electricity, our modern lives no longer follow the rising and
setting of the sun as they did in earlier, simpler times. Historically, with shorter
days, our activities were fewer in the winter. In the 21st Century, our “days” can
go on all night thanks to electricity and our busy schedules. The change in rhythm
from the natural rhythm of day and night with seasonal changes is new to our
bodies in the scheme of biology, having only been an option for the last few
hundred years.
According to many cultures winter is a time to rest, to become insular and not
exert oneself. In the Ayurvedic tradition (East Indian), it is the time of Kapha. In
Traditional Chinese Medicine, it is the time of Yin. In both, it is the time to repair the body, rest, take comfort, stay warm and
relax. Just as a bear would hibernate, we need to slow down and take a break.
Rarely do we find that an easy option. The holidays, work, and school pre-occupy our time. These activities don’t stop and nor
do we just because the day is shorter. The cold weather also takes its toll on our immune system as the low light depletes our
vitamin D stores and increases our melatonin levels making us more tired and susceptible to influenza viruses and respiratory
illnesses. With the shorter days, there are literally not enough hours in the day to get everything done.
What is SAD?
The medical diagnosis of Seasonal Affective Disorder was first formalized in 1984 as research proved the ‘winter blues’ were
more than just blues in some individuals. It is a biologic change in mood that begins in the winter and clears on its own in
summer months only to return again the next year. The onset of fall and winter bring with them an increased desire for sleep, a
sense of hopelessness, lack of motivation, food cravings (primarily for carbohydrates and sugar), social withdrawal, weight gain
and difficulty concentrating. Occasionally these symptoms and others, like insomnia and anxiety, can happen in the spring and
summer and form another type of SAD, but are beyond the scope of this article.
The diagnosis of SAD is made after an individual has been evaluated by a licensed health care practitioner who has ruled out
other causes of depression such as hypothyroidism, major depressive disorder or the more common symptoms of low energy
commonly associated with winter. SAD is the clear onset of depressive symptoms at a predictable time each year for two or
more consecutive years that resolves, leaving no depressive symptoms in other seasons.
What causes SAD?
While no one knows for certain why some individuals experience SAD and the major depressive symptoms that occur with it,
we do believe it is an interplay of genetics, age, mental health, and your body’s individual chemical makeup. We have many
different chemicals in our body that work in response to light and are affected by the change in seasons. Emerging research
suggests SAD to be associated with low vitamin D levels due to less sun exposure and production of vitamin D.
december 2010 Dr. Mona Fahoum http://thedispensaryonline.com

2. About YOUR Health from The Dispensary Online
An informed patient makes intelligent decisions about their healthcare
Two hormones, serotonin and melatonin primarily control our circadian rhythm or sleep-wake cycle. Serotonin is produced in
the gastrointestinal tract and the brain. Its job is to make us “feel good.” A drop in light causes reduced production of this
neurotransmitter causing some people to feel depressed. In addition, melatonin, responsible for making us fall asleep at night,
is produced by the lack of light and onset of nightfall. In the winter we have less sunlight, which may actually increase our
melatonin production causing us increased sleepiness and depression.
How can we treat SAD?
One mainstay of therapy and treatment for SAD and the winter blues is light therapy. There is a growing body of research
supporting the use of either bright-light boxes or “dawn simulation” light boxes in the treatment of SAD. It is important to
make sure the light box emits at least 10,000 lux (measure of light) for maximal results. These boxes come in many forms from
tabletop boxes you sit in front of for 20 to 30 minutes a day to head visors you can wear for a specified period of time.
Dawn simulators are another option for those experiencing SAD or milder winter blues. These are light boxes designed with a
timer to start a “false” sunrise in your bedroom as you wake for your day. This may be especially helpful in turning off the
production of melatonin in the dark winter months.
Beyond light therapy, it is very important to get your Vitamin D levels checked by your health care practitioner to ensure they
are adequate. I recommend levels between 50 and 60 ng/ml to prevent fatigue, boost immunity and improve calcium
utilization. (Our earlier article on Vitamin D should provide supplementary information.)
It may also be important to supplement omega-3 oils in your diet as they have been clearly shown in clinical studies to reduce
depression and improve brain function. Melatonin supplementation can also help regulate sleep-wake cycles and
supplementation with 5-hydroxytryptophan (the precursor to serotonin) can be helpful in mitigating SAD and winter fatigue.
You should seek the guidance of a licensed health care professional when treating any form of depression. A practitioner can
help you get the proper nutrition, exercise, supplements, psychotherapy and even pharmaceutical treatment you may require
depending on your particular situation.
Six Tips for a Successful Winter
Below you will find my most useful tips for a happy, healthy winter. Many are free and only require your effort to become a
healthier you.
Ensure adequate sleep.
Winter is a time for hibernation and restoration. We can respect that fact while maximizing our productive hours of daylight.
Think about quality sleep… maybe a couple more hours during the winter or just more “down time” in the evening. Turn off the
TV and read a book.
Hydration.
We forget that indoor heating and staying indoors for months is very drying. We’re not hot, so we forget to drink water. Our
body relies on water for all of its functions, skin health to brain function. Coffee doesn’t count!
Food.
Whether it’s western, Chinese or Ayurvedic traditions, all these traditions put an emphasis on root vegetables. These complex
carbohydrates are full of nutrients; satisfy the comfort food craving without the calories; and increase energy, metabolism and
vitality through the winter. (See Winter Food List.)
december 2010 Dr. Mona Fahoum http://thedispensaryonline.com

3. About YOUR Health from The Dispensary Online
An informed patient makes intelligent decisions about their healthcare
Exercise.
It is imperative to get your body moving in the winter whether you brave the cold for a walk, ski every weekend or get to the
gym. Movement will improve your mood and energy.
Supplementation.
Everyone has varying health concerns and their own individual biochemical makeup. Therefore, consulting your physician about
supplements is always recommended. Some basic suggestions for winter include: a good multi-vitamin, a good source of
essential fatty acids such as flax or fish oil, Vitamin D, and possibly melatonin or 5-HTP to assist in battling the blues.
Light Therapy.
Bulbs need to be in the mid-spectrum (blue/green/yellow). Make sure the harmful UV rays are absent or blocked by a filter.
Therapeutically you need 2500 lux for 2 hours a day or 10,000 lux for 30 minutes a day. Light boxes are becoming more
available and cost-effective. But even simple full-spectrum bulbs in regular lamps may work for milder symptoms.
**
Winter Food List
from: TheDispensaryOnline.com
for: a Healthier Happier YOU
Spices: Ginger, Cinnamon, Fennel, Nutmeg, Garlic/onion, Cardamom, Cumin, Coriander, Mints, Parsley, Rosemary, Mustards,
Turmeric
Winter Fruits: Blue/blackberries, Apples, Pomegranate, Pumpkin Root Vegetables: Winter Squashes, Yams, Turnips, Parsnips,
Carrots, Beets
Leafy Greens: Kale, Collards, Mustard greens, Broccoli, Chard
Desserts: Baked Apples/Pears, Pumpkin/Sweet Potato pies, Carrot cake
**
References:
1. Lurie, Stephen J.; et al. (November 2006). "Seasonal Affective Disorder". American Family Physician 74 (9): 1521–4.
2. “Seasonal Affective Disorder” by the Mayo Clinic.
3. Terman, M.; Terman, J.S. (2006). "Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective
Disorder". American Journal of Psychiatry 163 (12): 2126–2133.
4. "Properly Timed Light, Melatonin Lift Winter Depression by Syncing Rhythms" (Science Update). National Institute of Mental Health. 2006-05-
01. Retrieved 2009-08-30.
5. Leppämäki, Sami; Haukka J, Lonnqvist J, Partonen T (2004). "Drop-out and mood improvement: a randomised controlled trial with light
exposure and physical exercise". BMC Psychiatry 4 (22): 22.
6. Lansdowne, AT; Provost, SC (1998). "Vitamin D3 enhances mood in healthy subjects during winter.". Psychopharmacology 135 (4): 319–23.
7. Cott, Jerry; Joseph R. Hibbeln (February 2001). "Lack of Seasonal Mood Change in Icelanders" (Letter to the Editor). Am J Psychiatry
(American Psychiatric Association) 158 (158): 328
december 2010 Dr. Mona Fahoum http://thedispensaryonline.com