Depression, anxiety & mood
Seasonal affective disorder —
getting back to nature
by Marcelle Pick, OB/GYN NP
Here at my clinic in Northern New England, many of my patients tell me that as the
days grow shorter and fall moves into winter, their lives begin to change. They
might count the minutes until the winter solstice, or feel tired and want to sleep
and eat more, or they might simply feel sad. We all notice a shift when the days
get shorter — we spend more time inside, eat heartier foods, and slow down
a little. In fact, many Eastern medical practices recognize that with the changing
of the seasons, our bodies also change and have different needs than they do during
warmer months. But modern society expects us to be upbeat and productive throughout
the four seasons, and for women who suffer from seasonal affective disorder (SAD),
this just isn’t possible.
Seasonal depression was written about as early as the 1840’s, but it was never
studied seriously until the 1980’s. Today it is estimated that 10–20%
of Americans suffer from SAD to some degree. And 70–80% of that group are
women! It’s interesting that the most likely time for a woman to first notice
symptoms of SAD is in her mid-20’s to mid-30s — about the same time
many women begin to note other changes related to hormone imbalance, like PMS and
But whether you are diagnosed with seasonal affective disorder or just feel out
of sorts, the good news is that you don’t have to feel blue every time winter
approaches. There are lots of ways to address the underlying causes of seasonal
affective disorder — many of which require us to simply honor what Mother
Nature intended. Let’s take a look at what SAD really signifies and how you
can make this winter season naturally happier and healthier.
Sadness with a change of season
Seasonal affective disorder, widely referred to as SAD, is the technical name for
the winter blues. It is a formally recognized depressive disorder linked to the
amount of daylight we’re exposed to during the changing seasons. There are
many symptoms associated with SAD and its subclinical forms — including carbohydrate
cravings, a disinterest in social activities, sleepiness, irritability, weight gain
and fatigue. Several of these are similar to symptoms of depression. But I’ve
noticed that women with SAD tend to compartmentalize their lives, distinctly separating
activities and even emotional states with the seasons.
It is this seasonal compartmentalization or cyclical view that separates a diagnosis
of SAD from diagnosis of other depressive disorders. Symptoms of SAD generally show
up as the days grow short in the fall and continue through the darkest months of
winter. Then they begin to lift — either gradually or all at once —
as daylight increases in spring and early summer, and may even be accompanied by
a few days or weeks of intensified activity and exuberance.
For people prone to SAD in the northern hemisphere, November through February are
the hardest months. The symptoms may come on slowly or appear all at once. They
may be mild or severe, short-lived or prolonged. With such wide variation, SAD can
be difficult to diagnose. Even if you do not experience full-blown SAD symptoms
each year, you have probably experienced similar problems adjusting your sleep cycle
when daylight savings reverts to standard time, or when you cross time zones and
suffer jet lag.
If you’re wondering what causes SAD, there isn’t a clear-cut answer.
As with many depressive disorders, there can be a genetic component or it can stem
from a web of imbalances. But I can tell you that there is rarely just one thing
that leads to seasonal affective disorder. There are usually many factors involved.
SAD and vitamin D
One of the first things I look at in my patients, especially when I suspect they
have SAD, is their vitamin D levels. We do this through a simple lab test, and you
can ask any healthcare provider to test you if you think you may fall short. Though
it may be a surprise to you, more and more people are being found to have a vitamin
D deficiency. And some of the symptoms I see associated with a lack of vitamin D
— such as low energy and fatigue, depression and sleep irregularities —
look much like those we see in seasonal affective disorder, leading me to believe
this connection is stronger than we think.
Vitamin D can be readily manufactured in our bodies when our skin is exposed to
the ultraviolet rays of natural sunlight. It is then stored and converted in the
liver, kidneys, and other organs into the active form, D3 (calcitriol),
so it’s available when we need it. During the winter months, however, those
of us who live at latitudes above 40º north or south don’t receive enough
UVB radiation to make the conversion (for reference, Boston lies at 42º north).
By exposing ourselves to the rays of the summer sun, most of us are fully capable
of stocking up enough D to last the winter. But the truth is, for whatever reason,
many of us just don’t get adequate sun, and many of my patients’ vitamin
D stores run surprisingly low, even in the summer months.
That nature designed us with such an elegant conversion mechanism for vitamin D
may explain why foods that are naturally rich in it are scarce. Pink salmon, sardines
and mackerel are good sources, as well as cod liver oil. In the US, most of our
milk is now fortified with D, but it’s not much compared to the amount our bodies
need for optimal wellness.
The best vitamin D is what you make yourself by exposing your skin to natural
sunlight. But this mechanism doesn’t work equally well for everyone, and given the
limitations of our lifestyle and dietary sources, replenishing your stores with
can be helpful in minimizing symptoms of SAD. In fact, a recent study showed that
subjects with SAD felt significantly better after vitamin D supplementation. (For
more specifics, read our full article on preventing
vitamin D deficiency.)
Sleep, light, and the changing seasons
Another element that can contribute to SAD is disruption in your natural circadian
rhythm. This internal rhythm is dictated by a tiny nerve cluster in the brain (the
suprachiasmatic nucleus) that runs our biological clock and is directly
influenced by light. Because the winter months provide less light than the summer
months, our sleep cycles can get disrupted. This can cause many women to feel more
like crawling back to bed than rising and shining on winter mornings.
Melatonin, the hormone that makes us sleepy, is intimately related to light
and darkness. When your brain notices that it’s getting dark, signals from
the suprachiasmatic nucleus prompt the release of melatonin from your pineal gland.
The level peaks during the darkest hours of the night. As light levels slowly increase
with the approach of dawn, melatonin levels go down and your body prepares to awaken.
Studies have shown that patients with SAD tend to have what is called delayed dim-light
melatonin onset (DLMO). This means that when the sun goes down or the lights
are lowered, the brain is delayed in stimulating the release of melatonin. This
pushes the sleep cycle back, which can leave these patients feeling more lethargic
throughout the day.
Fortunately, some people can correct this shift by using morning light therapy during
the darker months of the year. But simply screwing full-spectrum light bulbs into
your lamps at home won’t do the trick. All light rays have both color and
intensity. Regular full-spectrum bulbs are designed to ease eye strain by emitting
all the colors of light, but they lack the necessary intensity to regulate your
hormones. Illumination is sometimes measured in units of intensity called lux.
Household light bulbs emit around 500 lux, while sunshine on a bright day emits
around 100,000 lux. Studies have shown that light therapy can be effective at levels
as low as 2000 lux, but you would need direct exposure to that light for a prolonged
period of time — four hours. Modern light therapy boxes emit around 10,000
lux and require only about 30 minutes of exposure to be effective for most people
suffering from SAD.
Along with color, intensity, and length of exposure, the timing of light therapy
is also important. You can use a light box in the morning or evening to regulate
your sleep rhythms, though many people experience insomnia with evening use. It
may take some experimenting with time of day and duration of treatment before you
achieve the best results. Regardless of timing, though, you should notice symptom
improvement within a week of use (though some cases of SAD may take longer —
and not all individuals will fully respond).
Hormones and SAD
Just as your sleep cycle is regulated by light and the hormone melatonin, your moods
and whole health picture depend heavily on the delicate balance of your hormones.
We know that no one hormone acts on its own. They all work synergistically, affecting
everything from sleep to appetite, mood, growth, and sexual desire. Your body is
a microcosm of the natural world, where all the elements interact to create a balanced
ecosystem. In the case of SAD, the misstep may begin in the suprachiasmatic nucleus,
with disruption of the pineal gland’s secretion of melatonin. From there,
hormone secretion in the pituitary gland may in turn be impacted. And as the body’s
“master gland,” the pituitary regulates hormones that control a host
of bodily functions, including growth and reproduction. The pituitary also regulates
the thyroid and
adrenals, which are essential for healthy metabolism, steady weight, and
Light also affects serotonin, the neurotransmitter responsible for the
production of melatonin. Serotonin levels fluctuate throughout the seasons, reaching
their lowest point during December and January. When one hormone or neurotransmitter
is out of balance, the whole system can get thrown off. Your body will do its best
to compensate — at least to begin with. Low serotonin is frequently fingered
as the primary culprit in depression, but in truth neurotransmitters like serotonin,
dopamine and norepinephine are linked on many levels, so it is never just one thing.
The easiest way for your body to address the imbalance is to send out signals to
“get more now” in the form of intense carbohydrate cravings.
It’s true that foods high in carbohydrates fuel your brain to make and release
serotonin. But problems arise when we take in excess simple carbs, such as white
pasta, bread and sugar. Nearly everyone has experienced the erratic effects of a
sugar buzz, where we feel better for an hour or two then crash when our serotonin
levels drop back down. People whose days are gripped by this devastating cycle of
ups and downs have afternoon grogginess and carb cravings, triggering a rush to
the vending machines. It isn’t long before we start to see the inevitable
weight gain, headaches, guilt, and depression with this pattern.
When you experience PMS or perimenopause
symptoms, you have the added stress of normal hormonal fluctuations. Learning
to deal with these fluctuations early on and getting your body back in balance can
ultimately help you to coast through menopause with relative ease and avoid a host
of hormone-related problems, including SAD.
Mother Nature doesn’t need a Palm Pilot
While we each follow our own natural rhythms and cycles, we do not live in isolation
from one another. Ayurvedic medicine teaches us that humans are a microcosm of nature.
Nature has its own rhythm, and try as we may to deny it, humans are part of that
rhythm. Springtime is the beginning of all things new, when the whole world gears
up for the most intense season — summer. Traditionally, summer was a time
for growing, ripening, and toiling in the long hours of daylight to provide for
a strong body capable of withstanding the harsh days to come. The shorter, crisper
days of autumn are nature’s way of saying, “Finish up, thicken that
blood, it’s almost over.” Winter, at last, is a time for rest, renewal
In our modern world, summer has become the lazy-hazy time of the year. It’s
when we take our vacations, throw more parties, and slack off at work. The kids
are out of school and stay up late, “vegging-out” in front of the TV
and playing video games. Then when fall arrives, instead of slowing down like nature
intended, we get all geared up again — it’s when we’re expected
to be at our most productive because we just finished our resting season. Could
this be why some of us feel so out-of-it when the winter months roll around?
To make matters worse, the deeper we move into fall and winter, the more pressure
we place on ourselves to be active. The holiday season arrives with all its hustle
and bustle, lengthening our to-do lists in an already-too-short day. Then once January
hits, we’re supposed to get cracking on all those self-improvement resolutions.
While the natural world around us lies deep in slumber, we’re rising at the
crack of dawn to fit a workout at the gym into our day. No wonder our systems are
out of whack. We take nature’s carefully drawn-out blueprint and flip it 180
Unfortunately, unless you’re a rural farmer, already living in tune with nature’s
schedule, you have to bear up under the demands that modern society places on us
all. If you’re a parent or a working woman, you’re still going to have
to get the kids ready for school in the fall, take vacations in the summer, show
up at holiday parties, and complete those year-end reports. That said, the single
most significant goal you can set is to get your body back in synch with nature
as much as possible, which means putting it back in proper balance.
Keep the winter blues away — the Women to Women approach
When November arrives, you don’t have to dread the darker days and colder
nights ahead. There are many things you can do to help your symptoms of SAD, or
even resolve them for good. However, let me say very plainly that if you suffer
from severe depression symptoms or if you’ve ever been diagnosed with a major
depressive disorder, you should by all means work closely with your healthcare practitioner
to formulate a strategy that works best for you.
Prescription antidepressants are useful for some people, and we do not recommend
simply abandoning them without the guidance of a trained professional.
On the other hand, there are many safe natural ways to relieve symptoms of seasonal
sadness, irritability, carbohydrate cravings, and lethargy. Trying out one or two
of these alternative treatments for SAD may be adequate. Or, you may need to follow
each and every one to get lasting results. Yes, this approach requires more effort
than popping a pill, but when used mindfully — with the care you certainly
deserve — these methods will not harm you, and they may even be more affordable
If these lifestyle changes seem too overwhelming for you in your current state,
just try them for two weeks. I tell my patients they can do anything for two weeks!
You may be amazed to find how much better you can feel, inside and out.
- Get outside every day. This is one of the simplest ways to quickly ease the
symptoms of seasonal depression. Spending as little as 15 minutes outside during
the warmer months will expose your body to the sun’s healthful rays, helping
you produce your own vitamin D and stave off seasonal depression. Try to connect
more with nature, the ground beneath you and the sky above. At the very least, try
to place your desk near a window so you are exposed to natural light.
- Get vitamin D testing, and supplement your diet with vitamin D. If you’re
dealing with seasonal affective disorder and suspect your vitamin D levels are low,
work with a healthcare provider to test your levels and get them up to optimal.
The reality is, some people may need to take between 2000–6000 IU per day
for several weeks to reach adequate levels and reverse symptoms of SAD. But before
supplementing your diet with high levels of vitamin D, have your levels tested —
vitamin D is fat-soluble and toxic at very high doses, and your body doesn’t
have a way to rid itself of D once it gets too much. So you can’t do this
on your own. That said, people with vitamin D-dependent SAD can transform their
lives by supplementing their diet with D, so this is well worth investigating. (See
our page on vitamin
D testing and treatment for more guidance.)
- Consider neurotransmitters testing and support. If you have significant
symptoms of SAD, you may want to consider the option of neurotransmitter testing
and support. Any neurochemical imbalances identified in your profile can be addressed
with targeted amino acid support and other natural supplemental formulas. In addition
to relieving problems with mood and affect, this approach can greatly benefit all
your body systems. For information on finding a provider near you, visit the NeuroScience website.
- Get some exercise. Daily exercise is vital to your overall well-being, especially
if you are depressed. It’s a healthy way to increase your serotonin levels
without digging into that gallon of Rocky Road in the freezer. The good news is,
you can start small. Try short bursts of intense activity — walking up and
down the stairs or skipping rope for 1–3 minutes (or until you’re tired
out), four times a day, three times a week. These small steps can give you the motivation
to keep going. You can walk, swim, dance, play tag with your kids — the key
is to find something you enjoy and to keep doing it.
- Consider phototherapy. Light therapy has been shown to be
very successful for many people suffering from symptoms of SAD. A recent study performed
in Canada tested light therapy against the commonly prescribed fluoxetine (Prozac)
for SAD patients. The study found that both treatments relieved symptoms equally
well, but the light therapy worked much faster — showing positive results
at less than one week! Phototherapy less likely to cause side effects such as agitation
and sleep disturbance.
- In fact, light therapy has no known side effects, other than the potential for overuse,
which can result in headaches, jitters, insomnia, or unhealthy euphoria. Moreover,
a light box has a one-time cost (around $200, though you can pay more for models
with added features). When you compare that to the cost and multiple known side
effects of prescribed antidepressants, it makes
sense to use the natural alternative.
- Another way to ease SAD symptoms with light is by using a dawn simulator. This is
basically an alarm clock that emits light instead of sound to wake you gently and
naturally. While you are still asleep, the simulator gradually brightens the light
in your bedroom until you are ready to wake up. Depending on the model, you can
program this process to take place in minutes or up to three hours, replicating
a natural sunrise during the brighter months of the year.
- Keep a regular schedule. Since the goal is to establish an internal
rhythm that’s in synch with nature’s own, it’s desirable for people
with SAD to keep a regular waking and sleeping schedule. Research has shown that
people who work extra shifts or split-shifts tend to have an imbalance in their
melatonin cycles, especially if they work at night or have limited access to sunlight.
Try to go to bed and rise around the same time every day, and be sure you are getting
between seven and nine hours of sleep each night.
- Pay attention to the seasons, and eat accordingly. What and when
we eat has such a profound effect on our physical and mental health. When we eat
with the seasons, our energy levels better correspond to the time of year. In the
spring and summer — nature’s active, expansive (yin) time —
fresh greens, brightly colored berries, and water-laden fruits and vegetables are
abundant. When you eat these foods, you feel light and full of energy. Grains ripen
for harvest in the fall, nature’s time for contracting, prompting us to bake
bread and prepare heavier (yang) meals. That extra bulk takes more energy
to digest, so we may feel contented or drowsy after a meal. In winter, nature encourages
us to eat starchy, stick-to-your-ribs foods that store well over time, like potatoes,
winter squashes, and oatmeal. This is how our ancestors survived the harsh winters
when food was hard to come by.
- Today we can eat anything we want in any season. We are blessed with abundance and
a transportation system that bring us kiwifruit in December, but the blessing is
a mixed one. There’s a reason why mashed potatoes and stuffing are Thanksgiving
dishes and watermelon is a Fourth of July treat. By consuming highly processed foods
and out-of-season produce, we are confusing our bodies with mixed signals, throwing
it out of balance and starving it of optimal nutrition. Stick to whole foods, minimally
processed, with little or no artificial ingredients, and as locally grown as possible.
- Choose whole grains and complex carbohydrates. If you have SAD, your body
will crave serotonin, and it’s so easy to reach for refined carbs and sugars
that give you that good feeling. But those foods will only set you on a cycle of
ups and downs with a negative effect on both your mood and your weight. Anything
with white flour, white sugar, or processed chemical ingredients can set you up
for cravings. So, put down the donuts and have a nice hot bowl of vegetable soup
instead. And there are plenty of ways we can make our favorite comfort foods from
healthy ingredients. If you don’t know where to start, our
Personal Program includes delicious healthful recipes that will ease you
off the overly processed carbs.
- Plan a vacation. Give yourself something to look forward to during
those dark months. Book a weekend retreat at a yoga center or health spa, or head
somewhere warm and sunny. You deserve it! If you plan a trip in November and another
in February — even for a few days — it will not only improve your mental
state, but your whole health picture will look brighter. And if you go somewhere
sunny, sitting on the beach will help you refill those vitamin D stores.
- Take high-quality nutritional supplements. Treating the whole body
means giving every system the highest possible level of support. Because the practices
of our modern farming and food processing industries strip our food supply of its
nutritional value, everyone can benefit from taking high-quality vitamin and mineral
supplements. If you suffer from SAD, you may greatly benefit from adding extra vitamins,
minerals, amino acids, and especially fatty acids like omega-3’s, to your
diet. In fact, Harvard Medical School is producing some promising research on omega-3
fatty acids as an effective antidepressant. I provide my patients with high-quality
nutritional supplements tailored to their individual needs. You can take advantage
of these through Women to Women’s
The power of healing yourself
Now that you understand how many factors are involved in keeping your mind and body
healthy, it’s not hard to see why conventional medicine has trouble solving
several of the health problems we see today. Standard medical practice involves
treating one symptom at a time, independent of the entire system. This usually involves
a drug that introduces new man-made chemicals into your delicate system of natural
chemicals. Unfortunately, that often throws off the balance in other places, resulting
in new symptoms.
At Women to Women, we believe the answer to SAD and many other health-related issues
lies in treating the whole body as a unit. We also recognize that each body has
a unique set of rhythms and experiences. As health practitioners, we cannot simply
apply a “one-size-fits-all” diagnosis and treatment protocol. SAD can
have many roots at its core, and you have the power to find them. Listen to yourself
— physically, mentally and emotionally — and find your own answers.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Related to this article:
References & further reading on seasonal affective
Last Modified Date: 04/18/2011
Principal Author: Marcelle Pick, OB/GYN NP