Natural Health Advisory

Here in Seattle, I’m really starting to feel the effects of our dwindling daylight hours now that autumn is in full swing. For weeks now, it’s been dark when I go to meet my exercise partner in the early mornings, and the days are becoming cloudier and rainier. For about 10% of people living at northern latitudes like Seattle, the reduction in sunlight that starts in autumn triggers the wintertime blues, or seasonal affective disorder (SAD).1

SAD is a type of depression in which major depressive episodes occur in the fall and winter months but go away in the spring and summer. While it is more prevalent at higher latitudes, people from all over the world suffer from SAD, experiencing a whole range of depression symptoms including sadness, fatigue, low motivation, and carbohydrate cravings.

Preventing SAD

What most people don’t realize about SAD is that not only can it can be effectively treated without drugs, but it can be prevented altogether. Starting every October, I advise my SAD-prone patients not to wait until the middle of winter to decide they need to do something about their seasonal depression, which by then is in full swing. There’s a better way, I tell them, and October is the perfect time to be proactive by using a simple SAD prevention program based on thoroughly researched natural therapies.

Light Therapy

The most effective therapy for preventing and treating SAD, recommended by conventional and alternative practitioners alike, is bright light therapy. This therapy is thought to help repair the circadian rhythm, hormonal, and neurotransmitter abnormalities that play a role in causing SAD. It starts to work within one week of treatment, and completely cures the disorder in up to 80% of cases.2,3

I recommend that SAD-prone patients use a light therapy box starting in October. The most current guidelines recommend a white, fluorescent light source at a standard dosage of 10,000 lux. These may be purchased from online retailers, drugstores, and some hardware stores, with most costing less than $250.

Sit about 12 to 18 inches from the light for 30 minutes per day between 6 and 9 a.m. You must be awake with your eyes open, but you don’t have to look directly into the light. You can eat, read, or do another activity during the treatment as long as the light enters your pupils.

If your symptoms don’t improve at least 50% after two weeks, increase the duration of light therapy in steps of 15 minutes up to a maximum of two hours per day.

If you experience any late afternoon/early evening sleepiness, try reducing the morning duration and adding some evening light therapy. Light therapy needs to be continued on a daily basis for the duration of the winter season.

Cognitive Therapy Exercises

Cognitive behavioral therapy helps you practice identifying and changing your distorted negative thoughts and has been shown to lessen the severity of depression and other SAD symptoms when done in advance of winter.4 Cognitive therapy exercises, such as those in Dr. David Burn’s “The Feeling Good Handbook,” remind you that your thoughts and attitudes—and not external events—play a large role in creating your moods, even when your depression is seasonal.

Take Vitamin D

Have you had your vitamin D levels checked recently? People with low vitamin D levels (serum 25(OH)D levels less than 20 ng/ml [50 nmol/L]) are more likely to have SAD and supplementing with vitamin D may help treat SAD in people with low vitamin D.5
Get your levels checked and work with a doctor trained in natural or integrative medicine to make sure your vitamin D levels become and remain optimal all year. If working with a healthcare provider to test and personally optimize vitamin D is not possible, take 2,000 IUs of vitamin D3 daily, starting now.

Get Physical Activity

Surprisingly few studies have looked specifically at whether exercise is helpful for SAD, but some have found significant benefits.6,7 What’s more, exercise has been extensively studied as a treatment for other kinds of depression and has consistently been found to reduce symptoms and to be equally or more helpful than antidepressant medications.8
Cardiovascular exercise, which improves oxygenation to the brain, is particularly effective. Consider an early morning walk or bike ride to get your exercise and light exposure at the same time. Natural light is helpful for your mood, even when it’s cloudy outside, as is being closer to nature.

Cut Sweets

People with SAD commonly have increased appetites and cravings for sugar and carbohydrates. Unfortunately, they are also more likely to binge and gain weight.
The good news is that the fewer carbs you eat, particularly carbs that quickly raise your blood glucose like sugars, fruit juice, white flour, and white rice, the less you will crave them.
The first couple of weeks after eliminating these foods are the most difficult, but after that carbohydrate cravings typically greatly subside and you feel more satiated by avoiding them. A Mediterranean-style diet that avoids these high-glycemic foods but that includes olive oil and nuts has been shown to lead to less binging and depression.10
If you start a SAD-prevention program using light therapy, cognitive therapy exercises, vitamin D supplementation, physical activity, and a lower-glycemic diet right now, you may be able to avoid SAD altogether. Just doing one or two of these SAD prevention therapies should greatly reduce your chance of the winter blues. You don’t have to suffer.

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1. Am Fam Physician. 2012 Dec 1;86(11):1037-41.
2. Neuropsychopharmacology. 1989 Mar;2(1):1-22.
3. Arch Gen Psychiatry. 2001 Jan;58(1):69-75.
4. Behav Res Ther. 2013 Dec;51(12):872-81.
5. BMC Res Notes. 2014; 7(1): 528.
6. Psychol Med. 1998 Nov;28(6):1359-64.
7. Psychiatry Res. 2000 Apr 24;94(1):29-42.
8. Cochrane Database Syst Rev. 2013 Sep 12;9:CD004366.
9. Psychiatry Res. 2014 Jun 30;217(1-2):47-53.
10. Clin Nutr. 2014 Feb 7. pii: S0261-5614(14)00046-6.

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