Seasonal Affective Disorder (SAD)


Seasonal affective disorder (SAD) is a form of depression that occurs during the same months of the year, each year. The majority of those with SAD experience this depression during the autumn and winter months, but SAD may also affect persons in spring or summer months.

 
  • Overview
  • Action Plan
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Overview


Seasonal affective disorder (SAD) is a common phenomenon seen all around the world, but a slightly higher risk is seen in higher latitude areas of the world. The prevalence of SAD is approximately 5% in the U.S.,1 but subclinical levels of SAD are much more prevalent. The main hypothesis for the cause of SAD is the decreased sunlight exposure leading to a decrease in serotonin activity, which affects mood. Symptoms of SAD may include a seasonal pattern of:

  • Sadness
  • Emotional sensitivity
  • Increased sleep
  • Increased appetite (particularly to carbohydrate-rich foods)
  • Increased weight (from overeating)
  • Physical fatigue
  • Decreased appetite and insomnia (in those with spring or summer SAD)

Too much sunlight may be potentially harmful, but we now know that not getting enough outdoor sunlight decreases our vitamin D levels in our body and can affect our mood, however, there are natural strategies that may help individuals with SAD. Even a poor diet could worsen the depression associated with SAD, as fast-food and commercial baked goods have been linked to depression.2 A Nutritarian eating style is supportive for those with SAD.

 
References
  1. Kurlansik SL, Ibay AD. Seasonal affective disorder. Am Fam Physician 2012, 86:1037-1041.
  2. Sanchez-Villegas A, Toledo E, de Irala J, et al. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 2012, 15:424-432.

Action Plan


Diet

  • The Nutritarian eating style, high in micronutrients and other healthy fats, supports brain function and may reduce symptoms of depression, including seasonal depression.  Phytochemical-rich foods, such as greens, berries, and nuts are linked to better brain health, largely because carotenoids, flavonoids, cruciferous-derived isothiocyanates, and other phytochemicals have antioxidant, anti-inflammatory, and other effects that protect the brain. Oxidative stress and neuroinflammation are thought to contribute to depression and other brain disorders.1-6
  • A vegetarian diet or greater consumption of whole plant foods is associated with lower levels of depression and anxiety, plant-rich dietary interventions have improved depression scores, and fruit and vegetable intake is associated with better mood scores.7-11 
  • In some cases, deficiencies in B vitamins (including folate and vitamin B12) or omega-3 fatty acids may cause or worsen depression symptoms, so a Nutritarian eating style in conjunction with a supplement regimen that includes sufficient amounts of zinc, iodine, vitamin B12, vitamin D, and DHA and EPA (omega-3 fatty acids) is recommended.
  • Avoiding high-glycemic processed foods, fast food, and other junk food is recommended, as these foods are linked to a greater risk of depression.12 

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:
  • Additional notes:
    • Supplementation with higher doses of omega-3 fatty acids (DHA and EPA), EPA in particular, have been shown to improve depression symptoms.13-16
    • Several studies have found saffron to be either similarly effective to an antidepressant, or superior to placebo in mild to moderate depression or major depressive disorder.17-20
    • 5-hydroxytryptophan, a form of the amino acid tryptophan, which is converted to serotonin in the brain, may help reduce depression symptoms as a supplement.21
    • S-adenosylmethionine (SAMe), produced from the amino acid methionine, is involved in producing neurotransmitters in the brain, and several studies reported SAMe supplementation improved depression symptoms.22-25 Note SAMe is not appropriate for people with bipolar disorder.

Exercise

  • Studies have shown that exercise helps alleviate symptoms of depression, especially if done regularly.26,27 Exercise is likely helpful for seasonal as well as non-seasonal depression.

Other Considerations

  • Light therapy is the preferred treatment for SAD, as it is a safe and effective method to normalize circadian rhythms and help reduce depressive symptoms.28-31 This light may be from careful exposure to sunlight or from a specialized lamp. Morning light exposure is most effective.
  • Just as in any form of depression, therapy or counseling may be important, depending on the severity and circumstances, in conjunction with these lifestyle changes to get the best results.

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References
  1. Tsuboi H, Shimoi K, Kinae N, et al. Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids. J Psychosom Res 2004, 56:53-58. doi: 10.1016/S0022-3999(03)00567-1S0022399903005671 [pii]

  2. Dias GP, Cavegn N, Nix A, et al. The role of dietary polyphenols on adult hippocampal neurogenesis: molecular mechanisms and behavioural effects on depression and anxiety. Oxid Med Cell Longev 2012, 2012:541971. doi: 10.1155/2012/541971

  3. Nabavi SM, Daglia M, Braidy N, Nabavi SF. Natural products, micronutrients, and nutraceuticals for the treatment of depression: A short review. Nutr Neurosci 2017, 20:180-194. doi: 10.1080/1028415X.2015.1103461

  4. Hritcu L, Ionita R, Postu PA, et al. Antidepressant Flavonoids and Their Relationship with Oxidative Stress. Oxid Med Cell Longev 2017, 2017:5762172. doi: 10.1155/2017/5762172

  5. Spencer JP. Flavonoids and brain health: multiple effects underpinned by common mechanisms. Genes Nutr 2009, 4:243-250. doi: 10.1007/s12263-009-0136-3

  6. Lai JS, Hiles S, Bisquera A, et al. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr 2014, 99:181-197. doi: 10.3945/ajcn.113.069880

  7. Beezhold BL, Johnston CS, Daigle DR. Vegetarian diets are associated with healthy mood states: a cross-sectional study in Seventh Day Adventist adults. Nutrition Journal 2010, 9:26. doi: 10.1186/1475-2891-9-26

  8. Blanchflower DG, Oswald AJ, Stewart-Brown S. Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Social Indicators Research 2012. doi:

  9. Beezhold BL, Johnston CS. Restriction of meat, fish, and poultry in omnivores improves mood: A pilot randomized controlled trial. Nutr J 2012, 11:9. doi: 10.1186/1475-2891-11-9

  10. Francis HM, Stevenson RJ, Chambers JR, et al. A brief diet intervention can reduce symptoms of depression in young adults - A randomised controlled trial. PLoS One 2019, 14:e0222768. doi: 10.1371/journal.pone.0222768

  11. Molendijk M, Molero P, Ortuno Sanchez-Pedreno F, et al. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J Affect Disord 2018, 226:346-354. doi: 10.1016/j.jad.2017.09.022

  12. Sanchez-Villegas A, Toledo E, de Irala J, et al. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 2012, 15:424-432. doi: 10.1017/S1368980011001856

  13. Mocking RJ, Harmsen I, Assies J, et al. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry 2016, 6:e756. doi: 10.1038/tp.2016.29

  14. Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr 2009, 28:525-542. doi: 28/5/525 [pii]

  15. Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry 2011, 72:1577-1584. doi: 10.4088/JCP.10m06634

  16. Grosso G, Pajak A, Marventano S, et al. Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One 2014, 9:e96905. doi: 10.1371/journal.pone.0096905

  17. Shafiee M, Arekhi S, Omranzadeh A, Sahebkar A. Saffron in the treatment of depression, anxiety and other mental disorders: Current evidence and potential mechanisms of action. J Affect Disord 2018, 227:330-337. doi: 10.1016/j.jad.2017.11.020

  18. Lopresti AL, Drummond PD. Saffron (Crocus sativus) for depression: a systematic review of clinical studies and examination of underlying antidepressant mechanisms of action. Hum Psychopharmacol 2014, 29:517-527. doi: 10.1002/hup.2434

  19. Hausenblas HA, Saha D, Dubyak PJ, Anton SD. Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials. J Integr Med 2013, 11:377-383. doi: 10.3736/jintegrmed2013056

  20. Khazdair MR, Boskabady MH, Hosseini M, et al. The effects of Crocus sativus (saffron) and its constituents on nervous system: A review. Avicenna J Phytomed 2015, 5:376-391. doi:

  21. Shaw K, Turner J, Del Mar C. Tryptophan and 5-hydroxytryptophan for depression. Cochrane Database Syst Rev 2002:CD003198. doi: 10.1002/14651858.CD003198

  22. Galizia I, Oldani L, Macritchie K, et al. S-adenosyl methionine (SAMe) for depression in adults. Cochrane Database Syst Rev 2016, 10:CD011286. doi: 10.1002/14651858.CD011286.pub2

  23. Mischoulon D, Fava M. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr 2002, 76:1158S-1161S. doi:

  24. Williams AL, Girard C, Jui D, et al. S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med 2005, 28:132-139. doi:

  25. Nahas R, Sheikh O. Complementary and alternative medicine for the treatment of major depressive disorder. Canadian Family Physician 2011, 57:659-663. doi:

  26. Schuch FB, Vancampfort D, Richards J, et al. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. J Psychiatr Res 2016, 77:42-51. doi: 10.1016/j.jpsychires.2016.02.023

  27. Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev 2013:CD004366. doi: 10.1002/14651858.CD004366.pub6

  28. Kurlansik SL, Ibay AD. Seasonal affective disorder. Am Fam Physician 2012, 86:1037-1041. doi:

  29. Miller AL. Epidemiology, etiology, and natural treatment of seasonal affective disorder. Altern Med Rev 2005, 10:5-13. doi:

  30. Maruani J, Geoffroy PA. Bright Light as a Personalized Precision Treatment of Mood Disorders. Front Psychiatry 2019, 10:85. doi: 10.3389/fpsyt.2019.00085

  31. Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry 2005, 162:656-662. doi: 10.1176/appi.ajp.162.4.656

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I suffer from Seasonal Affective Disorder, which seems to be at its worst during the winter months. I know not to ingest stimulating foods, such as coffee and tea, as they do play a part in my melancholia, but what other foods should I avoid? And, do you have any other tips for overcoming SAD during particularly hard times of the year?

A.

As far as foods to avoid, it comes down to eating a high nutrient diet and avoiding the processed, refined foods, including sugar and caffeine, and minimizing animal products to less than 10 percent of total calories. Take the supplements I recommend to avoid deficiencies in B12, Vitamin D, and DHA, and get plenty of sunshine. It is important that the exposure to sunshine occur at the same time each day, first thing in the morning. When this is not an option, I recommend light therapy with a therapeutic light designed for this purpose.