On the 22 October I mentioned the potential use of Vitamin D supplements for helping individuals suffering from the mood disorder SAD (seasonal affective disorder).  This year a number of papers have been published (1,2,3,4) which suggest that vitamin D could potentially be useful for the treatment of other mood disturbances and depressive episodes.

In 2007 a review paper was published (5) which suggested that vitamin D deficiency may play a role in depression and other mood and mental health disturbances, especially in the elderly where low vitamin D levels are commonly found.  The paper highlighted a number of trials that which showed that vitamin D supplementation appeared to be useful in the treatment of depression but expressed a need for further studies.

Vitamin D seems to be a hot topic this year and I have written about it a number of times in my blog posts.  Low vitamin D levels seem to be linked to cancer, heart disease, SAD, chronic fatigue syndrome, migraine headaches and various other diseases, not only bone conditions such as osteoporosis and osteoarthritis.  It is becoming glaringly obvious that this ‘sunshine vitamin’ is more important than we once thought. 

Two studies this year have linked low vitamin D status, as measured by low circulating blood levels of vitamin D, with depressive symptoms.  One study (1) was carried out in overweight and obese individuals and the other (3) in older adults (aged 65 – 95 years).  Both studies found that there was an association between depression status and severity with decreased serum (blood) vitamin D levels.  In the study with overweight/obese participants high-dose vitamin D supplementation led to significant improvements in depressive symptoms, compared to placebo, during the study.  The studies so not prove a causal relationship between low vitamin D and depression but they do add to the mounting evidence which suggests a very real link.  Further, larger studies will be needed to verify the information and investigate this exciting association further.

It is not currently known why vitamin D may be useful in treating mood disorders or why low levels may have a part to play in causing mood problems.  It may be that vitamin D has an effect on hormones linked to mood.  Studies are bound to unravel the mystery over the next few years!

A recent analysis(6) found that there is a global widespread insufficiency of vitamin D and there is evidence from the National Diet and Nutrition Surveys (NDNS) which suggests that in the UK deficiency of this vital nutrient is a real problem (7,8,9,10).  The problem is made worse in the older generations, as we age our bodies find it increasingly difficult to manufacture vitamin D.  In the UK many of us do not get enough sunlight exposure to generate decent levels of vitamin D in our bodies, especially in the autumn and winter months when we cover our bodies up and don’t get out during the daylight hours very often. 

Walking and exercise have also been linked to improved mood, so a lunchtime walk, in daylight, may bring added mood lifting benefits.  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and eggs.  As many of us in the UK are falling short of recommended vitamin D levels, if you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.

You may also want to think about getting a daylight lamp for your work desk to help improve mood.  Some of these lamps produce light that the body can use for vitamin D production (check with the manufacturer of the lamp).

For more interesting information about the benefits of vitamin D and sunlight for health please visit the Sunlight Nutrition And Health Research Centre, the information there is well presented and backed up by significant amounts of good evidence.

(1)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.  J Intern Med. Sep 10. [Epub ahead of print]
(2)Murphy PK & Wagner CL.  2008.  Vitamin D and mood disorders among women: an integrative review.  J Midwifery Womens Health.  53:440-446
(3)Hoogendijk WJ et al.  2008.  Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 65(5):508-12.
(4)Johnson MA et al.  2008.  Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program.  J Nutr Elder.  27:29-46
(5)Berk M et al.  2007.  Vitamin D deficiency may play a role in depression.  Med Hypotheses.  69:1316-1319
(6)Hagenau T et al.  2008.  Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis.  Osteoporosis International May [E publication ahead of print]
(7) Finch S et at.  1998.  National Diet and Nutrition Survey of People aged 65 Years and Over.  London: H. M. Sationery Office.
(8) Gregory L et al.  2000.  National Diet and Nutrition Survey of People aged 4-18 years. Vol 1.  Report of the Diet and Nutrition Survey.  London:  The Stationery Office
(9) Henderson L et al.  2002.  National Diet and Nutrition Survey: Adults Aged 19-64 years.  Vol 1: Types and Quantities of Foods Consumed.  London: The Stationery Office
(10) Hypponen E & Power C.  2007.  Hypovitaminosis D in British adults age 45y: nationwide cohort study of dietary and lifestyle predictors.  Am J Clin Nutr.  85:860-888.

Written by Ani Kowal

Continuing on from from Part I here are some more ideas for SAD (seasonal affective disorder) sufferers, or for anyone wishing to lift their mood in the autumn and winter months.

Exercise
Numerous studies point toward the general mood enhancing effects of exercise.  A 30 minute walk during the day may help to lift the mood.  Studies specifically investigating SAD have found that light therapy in conjunction with daily exercise seems highly beneficial in reducing SAD symptoms (1,2,3).  There seems to be an apparent additive effect of exercise and light on mood and health-related quality of life in individuals suffering with SAD.  Trying to get out for a lunchtime walk, when the light is at its best in the winter, may really help to lift mood.  Walking with a friend can help motivation and provide time for talking which can help clear the mind.

Vitamin D
A review was published earlier this year (4) which looked at the association between vitamin D and mood disorders in women.  The researchers reviewed published study data and found that there was an association between low vitamin D levels and higher incidences of seasonal affective disorder (as well as major depressive disorder).  The authors conclude that further studies are warranted in order to asses the association in more detail.

I have previously mentioned that in the UK many of us do not get enough vitamin D.  Supplementation with vitamin D may be useful to improve mood in SAD sufferers (5,6).  It has been suggested that the seasonal symptoms of SAD may be due to changing levels of vitamin D3, the hormone of sunlight, and that supplementation with vitamin D may lead to positive changes in brain serotonin levels (a ‘feel-good’ brain chemical).  In one study subjects were given 400 IU, 800 IU, or no vitamin D3 for 5 days during late winter.  Results showed that vitamin D3 significantly enhanced positive feeling and there was some evidence of a reduction in negativity (5).  In another study, 30 days of treatment with vitamin D proved highly effective in resolving depression in a group of SAD sufferers (6).  Taking 400-800IU daily may be helpful to SAD sufferers during the winter months when sunlight is scarce.

Good diet, food cravings and blood sugar balance
Carbohydrate cravings are often reported by individuals suffering with SAD.  This could be due to the fact that carbohydrate increases the uptake of an amino acid (building blocks of protein) called tryptophan.  Tryptophan is used in the synthesis of serotonin, the good mood brain chemical.  If serotonin levels are good then appetite is often normalised and cravings are less likely occur. 

Regulating blood sugar levels with diet may also be helpful to SAD sufferers with disordered eating and cravings.  I wrote about this in more depth on the 8th and 10th of September.  Balancing blood sugar levels through eating a healthy diet that provides a slow and steady supply of energy throughout the day may help to prevent cravings and fatigue.  A diet rich in vegetables and fruits, healthy fats (especially omega 3 fatty acids from oily fish, fish oil or flax seed oil supplements) and proteins (from nuts/seeds, eggs, lean unprocessed meats, fish and pulses/beans) may help to minimise blood sugar imbalances and cravings.  Vegetables and fruits are great sources of unrefined carbohydrates as are wholegrains with a low glycaemic index (GI).  Please read my previous posts for more detail on glycaemic index and eating to minimise cravings.  If you feel that your diet is inadequate you may wish to consider taking an omega 3 fatty acid supplement (a fish oil or flaxseed oil supplement) and a good quality multivitamin-mineral supplement (I prefer ‘food state’ supplements).

Women suffering from the eating disorders bulimia or binge eating disorder may find that their conditions are more difficult to control in the winter time.  There is some indication (7) that light therapy can help minimise these symptoms in autumn/winter and aid mood and carbohydrate craving.  Investing in a light box or daylight alarm clock may prove useful.  For help and information on eating disorders please visit the BEAT website.  BEAT is a charity (the working name for the Eating Disorders Association) for people with eating disorders and their families.

Cognitive behaviour therapy / counselling
Finally, if you feel distressed and unable to cope with the depressive/mood symptoms associated with SAD you may well want to look at a form of counselling called Cognitive Behaviour Therapy to help.  There is indication (8) that this form of therapy is very useful in individuals dealing with SAD and low mood in winter.  For more information and useful links please visit the Royal College of Psychiatrists. 

Wishing you all a happy winter!

(1)Leppamaki S et al.  2004.  Drop-out and mood improvement: a randomised controlled trial with light exposure and physical exercise.  BMC Psychiatry.  4:22
(2)Partonen T et al.  1998.  Randomized trial of physical exercise alone or combined with bright light on mood and health related quality of life.  Psychol Med.  28:1359-1364
(3)Leppamaki SJ et al.  2002.  Bright light exposure combined with physical activity elevates mood.  J Affect Disord.  72:139
(4) Murphy PK&Wagner CL.  2008.  Vitamin D and mood disorders among women: an integrative review.  J Midwifery Womens Health. 53(5):440-6.
(5) Lansdowne AT et al.  1998.  Vitamin D3 enhances mood in helathy subjects during winter.  Psychopharmacology.  135(4):319-323.
(6)Gloth FM et al.  1999.  Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.  J Nutr Health Aging.  3:5-7
(7) Lam RW et al.  2001.  An open trial of light therapy for women with seasonal affective disorder and comorbid bulimia nervosa. J Clin Psychiatry.  62(3):164-8
(8)Rohan KJ et al.  2007.  A randomised controlled trial of cognitive behaviour therapy, light therapy and their combination for seasonal affective disorder.  J Consult Clin Psychol.  75:489-500

Written by Ani Kowal

Dwindling sunlight and wintry weather may leave some of us feeling a little less positive and uplifted than we would like.  This shift in mood is common, but for some individuals a real sense of depression can occur in the autumn and winter months.  In such cases Seasonal Affective Disorder, or SAD as it is commonly known, may be diagnosed. 

People with SAD frequently suffer sleep disruption, carbohydrate cravings and weight gain, depression, irritability, loss of libido, lethargy, joint pain, stomach problems and often find that their ability to cope seems to be lowered.  Treatment aims to lift mood and relieve depression.  You will be pleased to hear that there are some simple steps that can be taken to help.

Last week I mentioned The Sunlight Campaign being run by the National Osteoporosis Society which aims to highlight the importance of getting out in the sunlight in order for the body to manufacture vitamin D which is crucial for bone health (and many other health parameters!).  Today I wanted to look at the link between sunlight and mood.

The changing seasons can affect our mood and behaviour, this is a natural process that can clearly been seen in animals – and we are no exception.  Many of us will find that we want to eat a little more and sleep a little more in the winter and that the dark mornings and short days are not to our liking.  For some people these kinds of symptoms are severe enough to disrupt normal daily life and cause real distress.  These individuals are said to suffer from SAD.  SAD is characterised by episodes of depression in autumn/winter and is thought to be caused because of lack of daylight.  Our bodies have an internal 24hour clock or cycle, known as the circadian rhythm.  This cycle of day-night is affected when the daylight hours shorten in autumn/winter.  Sunlight is known to affect certain mood chemicals in the brain such as serotonin and melatonin, if there is less light then less serotonin is produced and this may lead to low mood.

Light therapy
Bright light appears to immediately have an effect on mood via the brain chemical serotonin and the pathways involved in its production (1,2,3).  There have been many studies (too many to list), which show the beneficial effects of light therapy for those suffering with SAD.  Light boxes are available to buy online and in stores and do make a real difference.  Make sure that you follow the manufacturers instructions and if you are also seeing a doctor work with them in order to gain maximum benefit.  Most people find that morning use of the light box, for between 30 minutes to an hour, is most helpful.  The light emitted from these units has a similar spectrum to daylight (it is thought hat the light needs to be at least 2,500 lux in order to be beneficial).  Daylight bulbs are also available to buy.

Bright light may actually help us all in the winter.  A study carried out in the year 2000 (4) found that bright light improved vitality and mood among people with SAD but also in healthy subjects with no SAD but who worked indoors during the winter.  This does not surprise me, if you work indoors during the winter months you are more than likely to arrive at work while it is dark, sit in the office in false light and leave when it is dark outside thus never seeing natural daylight.  Getting out for a lunchtime walk or buying a small daylight lamp unit to sit on your desk at work may make a real impact on your mood.

Dawn simulation
Some studies (5,6,7)  have now been carried out with dawn simulators for SAD.  These simulators (daylight alarm clock) are now widely available to buy and usually consist of a unit with a light that gradually increases in intensity over a 30 minute period until it is at it’s brightest when an alarm usually sounds.  The thinking behind the sunrise alarm clock is that in the winter we often wake up with a start when the alarm goes off, but it is still very dark outside.  Our bodies awake with a shock and then we turn on a bright light, we miss the normal cues to the body that occur with dawn and increasing light.  If we wake up with gradual, dawn light our circadian rhythm / natural body clock, is less disrupted.  The studies have proved very positive with some indication that the dawn simulation sunrise alarm clocks, are as good as light boxes at helping mood in SAD sufferers.

Check back later in the week for more information on SAD.

You may also wish to contact the the 'Seasonal Affective Disorder Association' a registered charity which informs the public and health professions about SAD and supports and advises sufferers of the illness.

(1)Grass F & Kasper S.  2008.  Humoral phototransduction: light transportation in the blood, and possible biological effects.  Med Hypotheses.  71:314-317
(2)Aan het Rot M et al.  2008.  Bright light exposure during acute tryptophan depletion prevents a lowering of mood in midly seasonal women.  Eur Neuropsychopharmacol.  18:14-23
(3)Hoekstra R et al.  Effect of light therapy on biopterin, neopterin and tryptophan in patients with seasonal affective disorder.  Psychiatry Res.  120:37-42
(4)Partonen T & Lonnqvist J.  2000.  Bright light improves vitality and alleviates distress in healthy people.  J Affect Disord.  57:55-61
(5)Terman M & Terman JS.  2006.  Controlled trial of naturalistic dawn simulation and negative air ionization for seasonal affective disorder.  Am J Psychiatry.  163:2126-2133
(6) Avery DH et al.  2001.  Dawn simulation and bright light in the treatment of SAD: a controlled study.  Biol Psychiatry.  50:205-216
(7)Avery DH et al.  1993.  Dawn simulation treatment of winter depression: a controlled studyAm J Psychiatry.  150:113-117

Written by Ani Kowal