About the Winter Blues

An Introduction to Seasonal Affective Disorder

John M. Grohol, Psy.D. 11 Nov 2003 Winter depression (or winter blues) is a common affliction for those who live in our northern climate. Its clinical name is seasonal affective disorder (or SAD) and up to 5% of the population (especially in northern states) may suffer from it. Seasonal affective disorder is characterized by feelings of sadness and depression that occur in the winter months when the temperatures drop and the days grow short. The depression is often associated with excessive eating or sleeping and weight gain and has occurred for both the past 2 years. Women are twice to three times more likely to suffer from the winter blues than men. There are many effective treatments for winter depression, some of which you can do to help yourself. Increasing your daily exposure to as much natural light as possible can be helpful to many. Any time that you have the opportunity to gain access to more sunlight in the winter months, you should try to do so. Taking a walk throughout the day (even if you don't normally do so), sitting next to a south-facing window at your office, in a classroom, or at home will increase your sunlight exposure. Exercising next to a window or outdoors (when possible) is another activity that can help. Although it may be difficult to do, maintaining your schedule and lifestyle will help to keep the depression at bay. A regular pattern of sleep is the most important thing to maintain. It may be helpful, for instance, to have your bedroom lights on a timer to turn on a half-hour before you wake. This may help in waking at a regular time every morning, when it is still dark outside in the winter months. Light therapy has shown to be an effective treatment for seasonal affective disorder. While you can purchase expensive, specialized light therapy lighting fixtures for your home or office, some inexpensive alternatives are also available. Another lighting technique to try is to replace commonly used light bulbs in your home with brighter full spectrum (also known as broad spectrum) light bulbs. While more expensive than regular light bulbs, these bulbs provide light that is similar to natural sunlight. If none of these techniques seem to help your depressive symptoms, you should consider consulting your family physician or a mental health professional. The winter blues are a form of depression and can be readily treated with medications or psychotherapy when other selfhelp methods aren't effective. Don't be afraid to talk about this condition with a professional, it's nothing to be ashamed or afraid of. With a little effort, the winter blues can be beaten.

Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease.
Holick MF.

Source
Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, MA 02118, USA. mfholick@bu.edu

Abstract
Most humans depend on sun exposure to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by 7-dehydrocholesterol in the skin, leading to its transformation to previtamin D3, which is rapidly converted to vitamin D3. Season, latitude, time of day, skin pigmentation, aging, sunscreen use, and glass all influence the cutaneous production of vitamin D3. Once formed, vitamin D3 is metabolized in the liver to 25hydroxyvitamin D3 and then in the kidney to its biologically active form, 1,25dihydroxyvitamin D3. Vitamin D deficiency is an unrecognized epidemic among both children and adults in the United States. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus. Maintaining blood concentrations of 25-hydroxyvitamin D above 80 nmol/L (approximately 30 ng/mL) not only is important for maximizing intestinal calcium absorption but also may be important for providing the extrarenal 1alpha-hydroxylase that is present in most tissues to produce 1,25-dihydroxyvitamin D3. Although chronic excessive exposure to sunlight increases the risk of nonmelanoma skin cancer, the avoidance of all direct sun exposure increases the risk of vitamin D deficiency, which can have serious consequences. Monitoring serum 25-hydroxyvitamin D concentrations yearly should help reveal vitamin D deficiencies. Sensible sun exposure (usually 5-10 min of exposure of the arms and legs or the hands, arms, and face, 2 or 3 times per week) and increased dietary and supplemental vitamin D intakes are reasonable approaches to guarantee vitamin D sufficiency.

The basic physiology and pathophysiology of melatonin

Do humans display a seasonal rhythmicity via the melatonin message? The seasonal alterations of the natural photoperiod at high latitudes have a repercussion on melatonin secretion in humans. Is there a response to this seasonal message? In Finland, Kauppila et al. observed a 2 h extension of melatonin secretion in winter, compared with the summer period.71 A decrease in plasma ovarian steroids ran parallel with the winter increase of the melatonin secretion, in agreement with a variation in conception rate along the year observed at high latitudes, increased fertility being associated with longer days. There is no direct evidence that the changes in duration of melatonin secretion mediate the effect of photoperiod, as occurs in animal models. In temperate areas, the influence of photoperiod on reproduction are less clear. Nutritional and environmental (artificial light and blunting of seasonal changes in temperature) factors could be responsible for the progressive decline in the seasonality of human reproduction.72 Seasonal affective disorders (SAD) of winter type are characterised by recurrent depressive episodes during the short photoperiod. Changes in the duration and/or phase of melatonin secretion during this period were initially hypothesised to play a role in the pathogenesis of SAD and prompted its treatment with phototherapy.73 Although phototherapy is an effective treatment of SAD and could act on some biological rhythms, the beneficial effect of this treatment is not supported by changes in melatonin profiles.74,75

coping sans sunlight

December 21 is officially the shortest day of the year in the Northern Hemisphere. In the extreme northern territories of Canada, Europe and the United States, the sun may not show its face at all. At lower latitudes, the sun is out for about nine hours -- three hours less than during the summer months. All that darkness can have some serious psychological effects. Scientists have linked the depression that coincides with a dearth of sunlight to the hormone melatonin, which regulates sleep. When sunlight fades, some of us produce copious amounts of melatonin, contributing to the drowsy, out-of-sorts feeling that can plague our winter days. About 20% of Americans report feeling more depressed during the chilly season. In parts of Alaska, the sun may not rise at all for months on end. According to a study by The American Journal of Psychology, nearly 10% of the state's residents experiences depression during the dark winter months. Suzanne Womack Strisik, an assistant professor of psychology at the University of Alaska at Anchorage, explains that sable skies can cause lethargy, cravings for carbohydrates, feelings of melancholy, fuzzy thinking, and loss of libido or sociability. Treatment usually includes antidepressants, light therapy and extended vacations. The best way to get over the long Alaskan nights may be to leave them behind. Some residents travel to Hawaii or head south to catch a few rays. A couple of days of sunlight can buoy a sunken mood faster than almost any other treatment.