Feeling SAD? LIGHTen Up!

While everyone around you is humming Christmas songs, lighting their menorahs or making ski vacation plans , are you left feeling sad? Perhaps it's not the holiday blues, but SAD- Seasonal Affective Disorder. This depressive disorder was formally named only a few decades ago, in the 1980's. It affects over half a million people each winter, including some symptoms in up to a third of patients seeing their primary care physicians during this season.

Who gets seasonal affective disorder? It's most common in women (3:1 over males) and young adults 20-30 years old, but it is seen in across the board. January and February are the most common months that SAD is diagnosed.

What are the complaints? Often fatigue, weight gain and recurrent illness are the primary issues, rather than simply "sadness". The symptoms range from a mild case of "winter blues" to serious depression.

What is the cause? There are different theories, most of which are linked to hours of sunlight. There is disruption in our circadian rhythms as well as decreased seratonin secretion during winter months, and of course, less Sunshine vitamin (Vitamin D).

Prevention? Light therapy (using full spectrum light bulbs in your home and work) or consciously spending more time outside in the sunlight can help prevent S.A.D. Of course, moving to a more southern location can help, especially if you are far north, but that is not typically feasible for most people.

Treatment? Light therapy is the treatment of choice. Anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's such as prozac are also used), and Vitamin D replacement (if low) have also shown effectiveness in improving symptoms.

What is "light therapy"? Light therapy aims to artificially increase your exposure to light during the time of year when our natural daylight is limited. Typically light therapy is performed by sitting in front of a light therapy box, which simply gives off bright light that is similar to natural outdoor daylight (rather than standard light bulbs). During the session, the person may read, write or even eat- he or she does not need to focus on the light.  Although most people with SAD will require the therapeutic intensity of a light therapy box, many people with mild symptoms will respond to simple full spectrum light bulbs replacing their normal light sources at home.

Does light therapy work for other depressive disorders? Maybe. More studies are needed as we try to find depression treatments that do not carry large side effect profiles, and light therapy is a perfect example. One such study (Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression) published this year started looking at the effects of light therapy in bipolar disorder, but this small study (44 patients) did not yield statistically significant differences. However, bright light therapy has been effectively used to improve symptoms in chronic depression, post-partum depression (baby blues), premenstrual depression (PMS) and in disorders in the sleep cycle. 

BOTTOM LINE: If you recognize a pattern of feeling sluggish every winter and perking up in the spring and summer, consider purchasing some full spectrum lights and talk to your doctor and see if together you can change "S.A.D." to glad this year!

Vitamin D- the Sunshine Vitamin!

Vitamin D has long been known as the "Sunshine" vitamin, because we literally can obtain Vitamin D from the sun (it is converted to an active form in our skin.) We also are realizing that Vitamin D appears to play a role in MOOD- so that if you are deficient in Vitamin D, you may be more prone to depression.

A large study was done in England a few years ago and recently published: Relationship Between Vitamin D Levels and Depressive Symptoms in Older Residents From a National Survey Population. They looked at over 2000 adults over the age of 65, and assessed the incidence and prevalence of depression by use of a depression inventory scale- a set of survey questions. They also checked blood levels of Vitamin D. It turns out that in people with severe Vitamin D deficiency (levels less than 10ng/ml), there was a 35% prevalence of depression, while in the whole sample, the prevalence was only 25%.
So, does taking Vitamin D prevent depression? Well, we can't tell from this study, but it certainly looks promising enough to investigate.

BOTTOM LINE: Low Vitamin D levels play a role in a variety of medical problems, and now we can add depression to that list. Check your level and see if you need a little more "SUNSHINE" in your life!

The Sunshine Vitamin

Do you remember which vitamin we get from the sun? It's Vitamin D, and it is front and center in the news these days. We used to think that Vitamin D deficiency only existed in the geographical areas where there was less sunshine- think Seattle or or the Northeastern states in the winter. I was taught that a mere fifteen minutes per day of sun exposure to your face and arms would do the trick to supply your daily needs of the sunshine vitamin.
Surprisingly, in the past several years, studies have consistently shown that Vitamin D deficiency is widespread in the United States, even in the Sun Belt! In fact, I have been screening my adult patients in sun-filled Austin, Texas, for the last year, and I have found that only one out of ten patients have NOT been deficient!
What are the symptoms of Vitamin D deficiency? Many people know that Vitamin D is linked to bone health, and deficiency puts you at greater risk of fractures. However, there are many other potential symptoms of Vitamin D deficiency that may be subtle, can including fatigue, low energy, decreased immunity, depression, muscle weakness, cramps or altered sensation.
If it's not enough incentive to know your Vitamin D level to avoid those symptoms, consider this: recent studies show that having good levels of Vitamin D correlates with lower levels of colon, breast and prostate levels.
If your level is super low, you will need a prescription dose of Vit D replacement for a few months (50,000IU tablet once per week), but many people simply need to take an over the counter dose of 2000 IU per day.
BOTTOM LINE: Talk with your doctor about checking your vitamin D level (ask for "25 OH Vitamin D" level) and get some sunshine in your life!