Seasonal Affective Disorder: Blame It on Sunlight and Serotonin
The winter blues aren’t just a frame of mind; they’re also a state of mind. Seasonal affective disorder (SAD) , also called winter depression, is characterized by a drop in energy level, fatigue, difficulty concentrating, irritability, weight gain, and carbohydrate cravings, among other things. It usually begins by late fall or early winter and ends by late spring or early summer. The neurotransmitter serotonin is believed to play a significant role in SAD. A study in The Lancet provides further evidence for this relationship.
It Is (and Isn’t) All in Your Head
Although scientists have long suspected an important role for serotonin in SAD, concentrations of this neurotransmitter in the cerebrospinal fluid bathing the central nervous system (brain and spinal cord) of SAD patients appear to be normal. In an article published in The Lancet , researchers from the Baker Heart Research Institute in Australia sought to determine whether concentrations of serotonin and other neurotransmitters measured from blood vessels draining the brain (a more accurate measure of serotonin concentrations in the brain than cerebrospinal fluid) would provide evidence for the relationship between serotonin and SAD.
The researchers enrolled 101 healthy men between the ages of 18-79 years old. None of the men included in the study had a history of major illness (including depression) or cardiovascular disease, were currently on any medications, or had previous psychiatric therapy.
Over the course of a year, the researchers gained access to blood draining from the brain of the volunteers by taking samples from their internal jugular veins, which are found in the neck. They then measured the blood concentrations of serotonin and two other neurotransmitters not believed to be directly related to SAD—dopamine and norepinephrine—to use as controls. The neurotransmitter concentrations were then correlated to seasonal factors (measured daily), such as highest and lowest temperatures, total rainfall, and hours of bright sunlight.
As expected, production of serotonin by the brain was lowest in winter and was strongly correlated with the amount of bright sunlight during the day. Other than bright sunlight, no other seasonal factors had an effect on serotonin production. Concentrations of dopamine and norepinephrine were not influenced by these factors.
The major limitation of this study is that it was conducted on healthy volunteers, and it is not known whether environmental factors would affect people with SAD in the same way.
What Does This Mean for You?
By solidifying the link between sunlight, serotonin, and SAD, these study results provide further support for light therapy and certain antidepressant medications to treat SAD.
Light therapy, also known as phototherapy, involves the use of light to stimulate the brain to produce neurotransmitters. You sit a few feet away from a special light box for a prescribed amount of time—usually up to 45 minutes—every day. This light is stronger than ordinary office or household lighting. If light therapy works for you, your symptoms will most likely improve significantly or disappear altogether.
If light therapy does not work for you, or if your depression is very severe, your doctor may prescribe a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the level of serotonin activity in the brain. Though SSRIs are already used to treat SAD, this study further validates their use by supporting the relationship between serotonin and SAD.
***Please note: In March 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor adults, teens, and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts at the beginning of treatment or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. Evidence available through 2006 suggests an excess risk of suicidal thoughts or actions among children and adolescents, but does not yet clearly confirm that risk for adults. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
Please remember that there are several other ways to improve your mood. They seem to be especially useful in cases of mild depression.
- Get regular aerobic exercise.—Numerous studies have shown the influence of regular exercise on mood.
- Eliminate caffeine from your diet.
- Supplement your diet with fish oil.—Preliminary studies have linked omega-3 fatty acids with a healthy mind.
- Talk to your doctor about St John’s Wort.—This herb has been found to help with depression. There needs to be more research, though, on its effectiveness in treating SAD. Always talk to your doctor before taking herbs in supplements. They may interact with other medications. Also, it may not be safe to combine St. John's wort with light therapy because the herb may make you more sensitive to light, possibly causing damage to your skin and eyes.
Mental Health America
National Institute of Mental Health
Canadian Psychiatric Association
Canadian Psychological Association
Lambert GW, Reid C, Kaye DM, et al. Effect of sunlight and season on serotonin turnover in the brain. The Lancet. 2002;360:1840-1842.
St. John's wort. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated June 2008. Accessed August 8, 2008.
Seasonal affective disorder. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated October 2007. Accessed August 8, 2008.
Last reviewed June 2008 by Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing All rights reserved.