Between the Winter and the Deep Blue zzz's

Gary Piscopo, ND, LAc 
“Better to light a candle than to curse the darkness”

~ Chinese Proverb

While the winter season is a source of excitement and delight for many people, there are significant number of people who find this time of the year dark, difficult, and depressing. I remember going to my relatives house for Christmas and being aware of my gloomy uncle who always sat on the periphery of the holiday events, speaking little and participating even less. There are many reasons for the fluctuation of people’s moods, but one cause that is particularly relevant to the winter season is Seasonal Affective Disorder or SAD.

There are two types of SAD, one that happens in the spring and one that happens in the winter, but the “winter depression” is far more common. This form of SAD begins in October and usually subsides by April or May. In adults, symptoms of SAD include: lethargy, fatigue, ravenous appetite, weight gain, carbohydrate craving, withdrawal from relationships, inability to concentrate or focus, problems at work, anxiety and despair. SAD also has been observed in children, who may exhibit signs of irritability, difficulty getting out of bed and problems in school, particularly during the fall and winter. In the authoritative diagnostic manual used by psychiatrists (the DSM-IV), SAD is not considered an “official” syndrome but rather a “specifier” that can be applied to other mood disorders such as major depression or bipolar disorder.

According to Norman E. Rosenthal, M.D., chief of the NIMH’s Clinical Psychobiology Branch on environmental psychiatry, diagnosis is based on a seasonal pattern of mood changes determined from a patient’s history. Most (75 to 80 percent) of SAD sufferers are women, for whom the illness typically begins in their thirties. The prevalence of SAD in the United States has been found to increase as one moves further north and has been estimated to range from 1.4 percent in Florida to 9.7 percent in New Hampshire.

Medically, the most interesting thing about this condition for me is how it validates the naturopathic perspective. In working with their patients, naturopathic physicians are always thinking in terms of how to balance and support the dynamic ecosystem that is the human person. The approach that is most favored is the one that is the least invasive and the most natural, using substances such as water, food, light, clean air, herbs and so on. Faced with a patient with the winter form of SAD, the naturopathic physician would think, “This person is better in the summer but worse in the winter. What is it about the summer that makes this person better and how can I re-create those conditions for this individual?”

The answer, of course, rests in the light. People struggling with this form of SAD appear to have a disturbance of a brain chemical called serotonin. This imbalance seems to be connected to the amount of light they are exposed to each day. Though the mechanism of why this happens is still not known, Dr. Rosenthal theorizes that the amount of light coming through the eyes regulates brain chemistry by controlling the levels of the neurotransmitter serotonin and the hormone melatonin. In people with the winter form of SAD, the disturbance in serotonin regulation seems to be linked to a decreased responsiveness to light.

Given this information, it is important to recognize how conventional medicine, naturopathic medicine, and Chinese medicine would approach SAD. Because of its philosophical orientation, the conventional medical system tends to be more pharmaceutically-focused and thus would be more inclined to give the patient an anti-depressant such as Prozac in order to address the underlying serotonin disturbance. Naturopathic physicians, on the other hand, are more ecologically-focused. They would be more inclined to either tell the patient to take a vacation to a sunny climate or to use light therapy – that is, exposing the patient to scheduled amounts of full spectrum lighting in order to influence (not dominate) brain chemistry. As it turns out, phototherapy, as it is called in medical circles, has now become the treatment of choice by most doctors for many SAD patients.

You should be aware that phototherapy is not without side effects, however. There is an unfortunate perception on the part of the public that natural substances such as water, light, supplements, and herbs are without side effects because they are “natural”. Nothing could be further from the truth. The human system rests in a delicate state of balance or homeostasis. Anything taken in extremes can be toxic to the body and this is true as well of something as “innocuous” as light. Side effects of light therapy include headache, fatigue, irritability, and insomnia (if light therapy is used too late in the day). One also needs to be careful of the type of light source and its intensity – for example, the lights used in tanning beds are not appropriate for phototherapy and the UV radiation from these machines can damage the eyes. For these reasons, you should consult your physician about the use of phototherapy.

Chinese medicine takes a more measured view of the whole SAD phenomena. In the Chinese world view, winter is the time of Yin – the more internal, feminine, less active principle. Therefore, it is appropriate that people sleep more, are less active, and are more introspective. Their qi or life force is also more subdued. If a person is having trouble dealing with the wintertime, a Chinese physician might educate them about working against their own seasonal rhythm. He or she might also advise a change of diet to include less raw foods (which are more Yin) and more cooked foods (which have more Yang or active principle). Given that access to full spectrum lighting, vacations, and Prozac was limited 4,000 years ago, Chinese physicians relied on tonic herbs such as Ginseng in order to introduce “sunlight” – in the form of Yang energy – into the body. In the United States, ginseng is prescribed less frequently because of the negative effects it can sometimes have on the American physiology. It is thought that this is because many Americans are sleep deprived and thus qi deficient, which makes it difficult for them to handle the strong Yang effects of the ginseng. For this reason, gentler tonics such as St. John’s Wort and Dang Shen are typically used.

For more information on SAD, Dr. Rosenthal has written a book called Winter Blues (New York: Guilford Press; 1993). Support groups, which can be quite helpful, are available in the state of Washington as well on the Internet.