Category Archives: SAD

Battling the Winter Blues

If the short, cold, dark winter days leave you feeling lethargic and energy-depleted, then you may be suffering from the winter blues, or its more severe form, seasonal affective disorder (SAD). Other symptoms include carbohydrate cravings, irritability, weight gain and the desire to avoid social situations.

The winter blues are triggered by a lack of sunlight – as the number of daylight hours decreases, levels of ‘feel-good’ hormones in our body begin to drop. The symptoms can appear in late autumn and don’t normally lift until the brighter days in early spring. Fortunately there are simple measures that can help to alleviate these troublesome symptoms.

There is certainly a link between low Vitamin D levels and seasonal affective disorder, although it is unclear whether there is a causal connection. A recent review of existing studies concluded that treating Vitamin D deficiency offers a simple way to improve mental health (1). It would seem sensible for those feeling the effects of the winter blues to test their Vitamin D levels, and to address any deficiency. Sunlight and supplementation are likely the fastest way to address deficiencies, although fatty fish, fortified milk and egg yolks will also help to boost levels.

Other studies have shown that omega-3s appear to help maintain healthy levels of the ‘feel-good’ brain chemicals dopamine and serotonin. Healthy cells membranes, which require good levels of omega-3 fats, are required for the brain to respond to serotonin and dopamine. A recent large double-blind trial of more than 400 adults supports its use in treating depression (2). Based on these results, ensuring adequate omega-3 intake is certainly a sensible approach for those affected by seasonal changes.

Studies investigating the effectiveness of supplements such as St John’s Wort and 5-HTP have had mixed results, though some studies have found that supplementation improves symptoms such as fatigue, sleep problems, anxiety and lethargy in those with SAD (3,4).

Dietary changes may also help to relieve symptoms. According to Judith Wurtman, Ph.D., co-author of The Serotonin Power Diet, a well-timed snack can help to relieve symptoms. Dr Wurtman led a study looking at the SAD-carb connection, concluding that a low-protein snack providing about 30 grams of carbohydrate was enough to provide a serotonin boost. A warm bowl of leek and potato soup in the evening might well provide that much-needed serotonin-boosting carbohydrate.

Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD
Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD

The most effective natural intervention, however, is probably light therapy. Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD. Specially designed light therapy devices mimic the effects of sunlight to regulate levels of melatonin and serotonin. A recent meta-analysis concluded that light therapy works as an effective treatment for SAD no matter what time of day it is used, so long as it is used at least once daily (5). Dawn simulation is especially useful, and studies have found that this approach is more effective in alleviating SAD symptoms that standard bright light therapy or placebo, alongside additional benefits such as less morning drowsiness (6).

Those looking for a natural way to address the winter blues may benefit from the following approach:

1. Ensure that you are getting sufficient amounts of omega-3 and Vitamin D. You can have your levels checked by a nutritional therapist.

2. Exercise regularly. Try a 30-minute run or brisk walk in the daylight.

3. Start the day with a protein-rich breakfast, but try a carbohydrate-rich meal or snack in the evening. Good options are sweet potato, brown rice, lentils, rye bread and butternut squash.

4. Try a light therapy lamp or a dawn simulation device, making time to use the device at least once each day for the best results.

References

1. Anglin RES et al (2013) Samaan Z, Walter SD and McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br-J-Psych 2013, 202:100-107.

2. Lespérance F, Frasure-Smith N, St-André E, et al. (2011) The efficacy of Omega-3 supplementation for major depression: A randomized controlled trial. J Clin Psychiatry. 72:1054-1062.

3. Ghadirian AM et al (1998) Efficacy of light versus tryptophan therapy in seasonal affective disorder. J Affect Disord 50:23-7.

4. Wheatley D. (1999) Hypericum in seasonal affective disorder (SAD). Curr Med Red Opin 15:33-7.

5. Golden RN et al (2005) The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence. Am J Psychiatry 162(4):656-62.

6. Avery DH et al (2001) Dawn Simulation and Bright Light in the Treatment of SAD: A Controlled Study. Biol Psychiatry. 50:205-216.

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Beat the autumnal blues…

The nights are now well and truly drawing in and becoming colder and darker, so it’s common to feel low in mood.

Here are some helpful tips to keep you feeling upbeat:

Vitamin D
This sunshine vitamin has been getting more and more press coverage in recent months and it’s an important vitamin in supporting immunity amongst other things. Getting natural daylight is the best way to generate Vitamin D in your body; however in countries like the UK, the sun’s strength is not high enough between October and March to do this adequately. It’s important to eat foods containing vitamin D such as oily fish (mackerel, sardines etc), eggs, fortified breads and cereals. Supplementation is popular at this time of year with varying options of strengths (500iu – 5000iu) and types (tablets, capsules, sprays, sublingual) available. The UK Government now recommends that Vitamin D supplements should be taken by under 5’s, women who are pregnant or breast-feeding, everyone over 65 and anyone who has little sun exposure.

Omega 3
Continuing with the importance of fish and omega 3’s, it has been shown that those with diets high in fish and omega 3 fatty acids have been shown to have better moods. As well as other potential benefits such as improved skin quality, cardiovascular health and joint mobility.

Exercise is good for the mood
Exercise is good for helping to improve the mood during Autumn and Winter.

Natural Daylight
Balancing your circadian rhythm is important in balancing your mood and hormone levels. Try and get some natural daylight every day to avoid feeling low in energy and depressed – although it’s not easy if you work a in a 9-5 office environment. Go for a walk on your lunch break or offer to go to the shop for a colleague – any reason to get outside. Growing evidence also suggests sunshine can help protect against cancer, diabetes and heart disease. Having a SAD lightbox on your desk or at home can help beat the blues – opt for a lightbox with a 10,000 lux output from a respected manufacturer like Lumie or the Sad Lightbox Company.

Exercise
That lunch break walk suggested previously can have a double effect on your mood – gentle exercise can increase endorphins which are those “feel good factors” keeping your looking on the bright side of life. Green Exercise (i.e. not in a gym) has been found to have more significant improvements in mood.

5 HTP
This supplement is well known for its mood-boosting properties. If you feel you still need some support then this may be a good option. Speak to your GP or Health Practitioner first though, as it can interfere with other medications.

Written by Katie Guest

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Are you SAD or just Grumpy?

In the summer can you take on the world and work all day, with buckets of energy? But in autumn and winter do you feel lethargic and eat more, especially carbs, and feel irritable or overly anxious? It could be that you are just lacking in light. These are some of the symptoms of Seasonal Affective Disorder or SAD. Worse still, if your office has no windows or has tinted glass then you may be suffering all year round, as you are not getting the light that your body craves.

SAD Lightbox
Using a lightbox can be useful for SAD sufferers, but also those in need of more energy during the winter months.

The answer is simple – put a lightbox on your desk and then get on with your day. As you sit doing your tasks, your eye will automatically pick up the light. Within 7-10 days you will start to feel the benefits of using a lightbox, feeling more alert and having more energy.

So how does it work? The light goes into the eye, through the retinohypothalamic tract and into the brain. That’s the detail – what you need to know is that the light has a double effect. It ‘cuts off’ the body’s production of melatonin, the hormone which makes you sleepy and triggers hibernation in animals. It also increases levels of serotonin, ‘the feel good’ hormone.

So why are we seeing this problem now? When you think about it, it is only a little over a century ago that we got electric light. Before that about 75% of the population worked the land and kept to the rhythms of the seasons, getting up with the light and going to bed when it got dark – they weren’t trying to stretch the day the way we do now. So this is a man-made problem with a man-made solution – the lightbox.

Lightboxes are even VAT exempt, in recognition that SAD is a significant, debilitating condition. So if you feel tired all the time and can’t seem to pinpoint why, try using a lightbox to bring some light into your life.

Written by Carol Barksfield at the SAD Lightbox Co.

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An Introduction to Seasonal Affective Disorder and the Winter Blues

About SAD

Seasonal Affective Disorder, or S.A.D., is now officially recognised as a medical condition thought to affect over 2 million of the British population.

SAD can affect people of any age but most commonly it starts between the ages of 18-30. At one time it was thought that four times as many women as men suffered from SAD, but now increasingly men recognise the symptoms and seek treatment. SAD is also known as the Winter Blues, and about 10% of the population suffer to some degree with 2-3% suffering with clinical depression.

Typical symptoms include:

  • Depression, feelings of gloom and despondency for no apparent reason.
  • Lethargy, lacking in energy, unable to carry out a normal routine.
  • Anxiety, inability to cope.
  • Social problems, irritability not wanting to see people.
  • Sleep problems, finding it hard to stay awake during the day, but having disturbed nights.
  • Loss of libido, not interested in sex or physical contact.
  • Craving for carbohydrates and sweet foods, leading to weight gain.
  • Recurring symptoms year after year at about the same time of year (Autumn / Winter).

The Cause

SAD has a lot in common with the hibernation cycle of animals and research showed that this was triggered by a response to decreasing light levels. As the days grow shorter and the light becomes less intense, it increases the desire to ‘hibernate’.

Light intensity is measured in ‘lux’ the Latin word for light. On a summer’s day at our latitude we may have up to 16 hours of daylight at 100,000 lux. In winter an 8 hour dull day will give less than 5,000 lux and indoor lighting rarely exceeds 500 lux.

The Treatment

LitePod
Lights from trusted brands like the SAD Lightbox Co. have medical certifications and quality assurances.

Historically, treatment for depression involved the use of drugs, however, in recent years research in the USA and UK showed that SAD sufferers responded, often quite dramatically, to Bright Light Treatment. Fully proven lightboxes from trusted brands such as the SAD Lightbox Co. (carrying ISO 13485 / 9001 and Medical CE Mark 0120) have been specifically designed for and are a recognised method of alleviating S.A.D.

Lack of light causes an increase in the production of Melatonin (the hormone that makes us sleepy at night), and a reduction of Serotonin, a lack of which causes depression. The exposure to bright light therapy reverses the process, with the additional benefit of being drug free. You should start to feel the benefit within 4-10 days of using a lightbox.

By providing summertime levels of light during the winter you can successfully alleviate the symptoms of SAD with the result that former sufferers can lead a normal, happier life and beat the Winter Blues.

Studies have also shown that bright light therapy can prove beneficial with Pre-menstrual syndrome, Jet lag, shift work, insomnia and with some cases of MS and ME. The Light Therapy Institute have also been successful in treating children with dyslexia and specific learning difficulties; even children and students without these problems can benefit and work better by using the lightbox as a desk top working light.

 

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Beat the winter blues: Supplements and SAD

In Parts 1 and 2, I wrote about the impact of light therapy and diet on managing the symptoms of seasonal affective disorder (SAD) and its milder form, the ‘winter blues’. In Part 3 we’ll look at further nutritional support for this common disorder.

Doctor's Best Vitamin D3 2000iu
Evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Vitamin D

As there are fewer daylight hours in the winter months, levels of Vitamin D in the body can drop. While light boxes represent a promising treatment option for SAD, they do not provide UV light and so will not boost Vitamin D levels. Researchers have tested whether Vitamin D supplementation can improve mood during the winter months. A double-blind study found that mood improved in healthy people without SAD who received 400 or 800 IU per day of vitamin D for five days in late winter (1).

Another study tested the effects of supplementation with either 600 or 4000 IU of vitamin D every day for six months (2). Both dosages led to improved mood and general well-being in the participants, with those on the higher dose experiencing greater benefits.

Although additional research needs to be done before any conclusions can be made, the available evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Magnesium

The Western diet, high in animal produce and refined carbohydrates, leaves us vulnerable to deficiency in the mineral magnesium. This may affect mood, because conversion of tryptophan to mood-enhancing serotonin is dependent on sufficient levels of magnesium. Studies indicate that an insufficient level of magnesium can alter also levels of melatonin and upset the body’s biological clock, a pattern that is seen in SAD (3).

Supplementing with magnesium can be recommended to those with insufficient intake. I prefer the forms magnesium citrate or magnesium taurate, which are bioavailable, well-absorbed forms.

Omega-3

I wrote about the importance of omega 3 in optimising serotonin levels in Part 2. These oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied. While omega-3 can be supplied through oily fish in the diet, those who are concerned with levels of mercury in fish might want to try supplementing with a fish oil that has been screened for contaminants.

Omega 3
Omega 3 oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied.

St John’s Wort

St John’s Wort is widely recognised as an effective supplement for mood disorders, and one small randomised study has investigated its benefit for those with SAD (4). The blinded study tested the effects of a daily dose of 900mg of St John’s Wort over 4 weeks. It concluded that the supplement may be an efficient therapy for those with SAD, though further research is needed.

This herb is thought to increase serotonin levels by inhibiting serotonin reuptake, working in a similar way to conventional selective serotonin reuptake inhibitor (SSRI) antidepressants. If you are using a light box to relieve SAD or the ‘winter blues’, then you should check with your GP before taking St John’s Wort, as this herb can make your eyes more sensitive to light.

As winter approaches, the short days and long nights of the season can make life difficult for those with SAD. Even in its milder form, the ‘winter blues’, symptoms of low mood, fatigue and weight gain can make life miserable. The good news is that some fairly simply lifestyle adjustments can make a positive difference. Using a sunrise alarm clock in the mornings for instance can also help you get out of bed on the “right side”. The evidence for bright light therapy with an approved light box is compelling, and coupling this with nutritional support might just help you to banish those winter blues for good.

 

Written by Nadia Mason

References

1. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl) 1998.135:319–23.

2. Vieth R, et al. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal 2004. 3:8

3. Wester PO. Magnesium. Am. J. Clin. Nutr. 1987. 45 (5 Suppl): 1305–12. PMID 3578120

4. Durlach J, Pagès N, Bac P; Bara M, Guiet-Bara A, Agrapart C
Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock. Magnesium research : official organ of the International Society for the Development of Research on Magnesium 2002.15(3-4):263-8.

5. Kasper S. Treatment of seasonal affective disorder (SAD) with Hypericum extract. Pharmacopsychiatry 1997. 30:89-93.

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Light therapy for SAD: Looking on the Bright Side

While many look forward to the crisp and clear autumn and winter months, others find that they struggle through these months feeling tired and low. Seasonal Affective Disorder, also known as SAD, is a form of depression that is brought on when levels of natural sunlight are reduced. Symptoms tend to begin as the days get shorter and winter draws in, only lifting completely during the summer months. A milder form of seasonal depression – often called sub-syndromal SAD (S-SAD) or simply ‘the winter blues’ – affects around 1 in 10 adults.

Bright Light Therapy
SAD is a form of depression that is brought on when levels of natural sunlight are reduced

I was interested to read a recent Swedish study that tested a treatment called ‘bright light therapy’ on individuals with SAD and with S-SAD (1). Bright light therapy is a treatment that involves exposure to a special light that mimics natural outdoor light.

The study tested the effects of the light therapy on 49 individuals who had been diagnosed with either SAD or S-SAD.

When the individuals began to experience winter depressive symptoms, some of the group were either given a 10-day course of bright light therapy, or were put onto a 3-week waiting list, after which they were given the 10-day treatment course. The group of people on the waiting list were used as the ‘control’ group for this study.

The study found that bright light therapy was linked to improvements in a number of symptoms. The researchers had conducted an earlier randomised clinical trial which found that bright light therapy did indeed have a positive effect on depressive mood in those with SAD and S-SAD (2). This new study, however, also measured the effects of bright light therapy on other symptoms, such as tiredness, fatigue, sleep problems and health-related quality of life. All of these symptoms had improved after the 10-day course of light therapy. Symptoms were then measured again, a month after the treatment had finished, and it was found that the symptom improvements had lasted.

The study suffers because, although a control group was used, strictly speaking there was no placebo group. If the second group had been exposed to a ‘placebo’ light rather than the therapeutic bright light, then this might have served as a better comparison group. The study is nevertheless very interesting because it indicates that light therapy can help not just depressive mood, but that it can bring about improvement in a number of symptoms including milder symptoms of depression and daytime sleepiness.

Despite the design flaw in the study, light therapy does appear to be a promising treatment for the ‘winter blues’. Systematic reviews have reported that light therapy represents an effective and well-tolerated treatment for SAD (3). A home light box may therefore be a wise investment for those who need a boost during these darker months. Using a light box for between 30 minutes to an hour in the morning is considered to be an effective approach, and the light should be at least 2500 lux to be beneficial. Some individuals also use a Sunrise Alarm Clock as well to help balance their circadian rhythm and ensure they wake naturally in the morning rather than to the sharp, shrill noise of a standard alarm clock. These Wake-Up Lights simulate the “sunrise” so the brain wakes gradually.

Seasonal affective disorder, or the milder ‘winter blues’ can mean months of misery for those affected. With an estimated 1 in 20 adults affected by SAD, and a further 1 in 10 suffering from its milder form S-SAD, it is certainly an approach worth considering.

Written by Nadia Mason

References
1. Rastad C, et al. Improvement in Fatigue, Sleepiness, and Health-Related Quality of Life with Bright Light Treatment in Persons with Seasonal Affective Disorder and Subsyndromal SAD. Depression Research and Treatment. 2011:543906
2. Rastad C, Ulfberg J, Lindberg P. Light room therapy effective in mild forms of seasonal affective disorder—a randomised controlled study. Journal of Affective Disorders. 2008. 108(3):291–296.
3. Lee T M, Chan C C. Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatrica Scandinavica 2000. 99(5): 315-323

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Moving the clocks back an hour might not be great for our health

The clocks went back an hour this weekend and although I enjoyed the extra hour in bed there has been a recent report (1) which argues the health benefits of not putting the clocks back in winter but still putting them forward in the spring.  The report, published in the British Medical Journal says this would be a simple and effective way to vastly improve our health and well-being.

 

Putting the clocks back means it is lighter by the time most people get up to start their day, however it also means that we are deprived of an hour of daylight in the afternoon and this may impact health by limiting our time for outdoor activities.  It is thought that leaving clocks alone as winter approaches would allow an extra hour of daylight in the afternoon and could boost levels of vitamin D as well as encouraging people to exercise more.  Many people in the UK have lower than optimal levels of vitamin D and deficiency has been linked to many health problems (please read my previous blog posts for more information about vitamin D).

The author of the report (1), Mayer Hillman, found that switching to Central European Time, which is Greenwich Mean Time plus one hour (GMT+1) in the winter and GMT+2 in the summer, would give most adults around 300 extra hours of daylight a year.  Hillman writes that research shows people feel happier, more energetic and have lower sickness rates in the longer, brighter days of summer, whereas moods and health decline during duller days of winter.  For more information about mood and the autumn/winter months please read my previous blog posts on Seasonal Affective Disorder (SAD) 

In the report Hillman highlights that “Lack of exercise is a major public health problem in the United Kingdom, contributing to the incidence of chronic illness”.  These illnesses include diabetes, obesity and heart disease.  Not putting the clocks back means more accessible daylight hours which could impact measures to increase the amount of physical activity that the public engage in.  The report states that (2)Adults are recommended to engage in at least 30 minutes of moderate or vigorous activity daily and children at least an hour. However, surveys have shown a trend towards declining fitness, on the basis of which it has been predicted that more than half the population will be clinically obese by 2050”.  “Health experts have proposed urgent action to remedy this situation, and the government now aims to get far more of the inactive population walking or gardening regularly or, preferably, taking up more vigorous physical activity, such as sports, aerobics, or cycling (especially as a means of travel). Although most people are aware of the benefits—a lessened risk of coronary heart disease, obesity, diabetes, hypertension, and some cancers—routine physical activity features in few people’s everyday lives. Only a small proportion of adults are motivated to undertake it throughout the year(1)

Mayer Hillman is Senior Fellow Emeritus at the Policy Studies Institute.  Two studies published by the Policy Studies Institute also point to a wide range of advantages of the clock change proposal.  It is surprising therefore that there has been a consistent oversight of the role that increasing the number of ‘accessible’ daylight hours in this way could play in the promotion of physical health and well-being.  Taking account of the typical daily patterns of adults and children, the clock change “would considerably increase opportunities for outdoor leisure activities — about 300 additional hours of daylight for adults each year and 200 more for children.” (2)  Adopting the clock change proposal “is an effective, practical and remarkably easily managed way of achieving a better alignment of our waking hours with the available daylight during the year,” Hillman argues in a press release.  He goes on to say “It must be rare to find a means of vastly improving the health and well-being of nearly everyone in the population — and at no cost. Here we have it. All it requires is a majority of MPs walking through the ‘Ayes’ lobby in the House of Commons,”(2).

To read more about Vitamin D and mood/energy in the darker autumn and winter months please read my blog posts on vitamin D and SAD

Perhaps next year will be the year that our clocks won’t go back?!

(1)Hillman M.  2010.  More daylight, better health: why we shouldn’t be putting the clocks back this weekend.  Personal View.  BMJ 2010; 341:c5964 doi: 10.1136/bmj.c5964

(2) Press release.  BMJ-British Medical Journal (2010, October 29). Not putting the clocks back this weekend would improve health, says expert. ScienceDaily. Retrieved November 1, 2010, from http://www.sciencedaily.com­ /releases/2010/10/101029075801.htm

Written by Ani Kowal

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As autumn and winter draw in can we do anything to boost our morning energy levels?

Days are getting shorter and there is just over a month before British Summertime ends on 31st October.  Some people in the UK suffer from Seasonal Affective Disorder, SAD, and find the darker months incredibly difficult (please read my previous posts for more information about SAD).  Many more individuals exhibit symptoms, in autumn/winter, such as tiredness, lethargy and sleep problems without the depression and anxiety felt by SAD sufferers.  There is evidence that some kind of seasonal changes in mood impact much of the general population (1,2) 

SADA Seasonal Affective Disorder Association is the UKs only support organisation that is dedicated to SAD.  SADA say that(1) “ SAD is a type of winter depression that affects an estimated 7% of the UK population every winter between September and April, in particular during December, January and February.  It is caused by a biochemical imbalance in the hypothalamus [part of the brain] due to the shortening of daylight hours and the lack of sunlight in winter.  For many people SAD is a seriously disabling illness, preventing them from functioning normally without continuous medical treatment.  For others, it is a mild but debilitating condition causing discomfort but not severe suffering. We call this subsyndromal SAD or ‘winter blues.’ It is estimated that a further 17% of the UK population have this milder form of condition”.

Even those of us who do not suffer with SAD will often find getting up when it is still dark challenging.  Energy levels may be low and springing out of bed with motivation can be hard.  In the spring and summer the light increases from early morning and stimulates a gradual wake up call, this is absent in the autumn and winter.  The lack of dawn awakening seems to have an impact on our natural, internal body clock – also known as the circadian rhythm.  The circadian rhythm is associated with many biological responses in the body including hormonal release.  Disruption to our body clock may play a part in our feelings of morning lethargy in the autumn and winter months.

Previously when writing about SAD I mentioned the sunrise alarm clocks, or bodyclocks, that are available.  These sunrise alarm clocks usually consist of a unit with a light that gradually increases in intensity over a 30 minute period until it is at its brightest when an alarm usually sounds.  If you find yourself struggling to feel energised in the mornings you might want to think about purchasing one of these bodyclocks.  The thinking behind the system is that if we wake up gradually our circadian rhythm, internal body clock, is less disrupted.   Use of these dawn simulator in individuals with SAD has been positive and studies are beginning to find that they may also be helpful for individuals who don’t suffer from the condition (3,4). 

In addition to light there are many things that can impact how we feel during the darker months.  Please read my previous posts on SAD for more information.  One important factor is breakfast.  Eating a nutrient dense breakfast may well help to prevent feelings of fatigue.  It is tempting to reach for caffeine in order to wake up but this may impact blood sugar levels and lead to further feelings of fatigue and irritability.  In order to keep blood sugar levels balanced a breakfast that is low in sugar and low in processed food is preferable.  Choosing food with a low glycaemic index may be helpful and including a source of protein (e.g. eggs, beans, nuts/seeds) is important e.g.  berries with yoghurt, sprinkled with nuts/seeds or poached eggs on wholegrain toast are two breakfast ideas.  Eating a healthy diet rich in vegetables, fruits, unprocessed wholegrain carbohydrates, unprocessed meats/fish (especially oily fish), beans, eggs, nuts/seeds and other unrefined foods will help to fuel the body through the day and prevent feelings of lethargy and fatigue.  Specific vitamins, minerals and essential fats may also be helpful, especially to those individuals suffering with SAD, please read my previous posts for more information.

1.Rosen LN & Rosenthal NE.  1991.  Seasonal variations in mood and behavior in the general population: a factor-analytic approach. Psychiatry Res.  38(3):271-83.

2.Kasper S et al.  1989.  Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Arch Gen Psychiatry.   46(9):823-33

3.Leppamaki S et al.  2003.  Effect of simulated dawn on quality of sleep, a community based trial.  BMC Psychiatry.  3:14

4.Thorn L et al.  2004.  The effect of dawn simulation on the cortisol response to awakening in healthy participants.  Psychoneuroendocrinology.  29:925-930

Written by Ani Kowal

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Sunrise alarm clocks may help us wake with energy during the dark winter months

This Autumn I wrote about Seasonal Affective Disorder (SAD) and light therapy.  Many people, myself included, find that waking up in the dark is difficult since the body doesn’t seem to have time to adjust to the start of the day.  In the spring and summer it seems easier to get up and start the day energetically since the light steadily increases from early morning – this allows for a gradual wake up.  This dawn awakening seems to be important in controlling our internal body clocks, or circadian rhythm.  This internal ‘body clock’ is associated with hormonal release and other physiological responses.  It may well be that disruption in morning waking during the dark autumn/winter months plays a part in SAD for some sufferers.



For years I used a timer switch on my bedside lamp, it was set so that the light went on 15minutes before my alarm clock so that my body started to be ready to wake.  The problem here was that the light was bright straight away and there was no ‘dawn effect’.  There are now some fabulous dawn simulators available such as the Lumie Bodyclock, these sunrise alarm clocks 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. 



SAD is often associated with hypersomnia, excessive amounts of daytime feelings of sleepiness.  People with hypersomnia often have difficulty waking up in the mornings and can feel disorientated for the first few hours in the morning.  Other symptoms which are related to SAD include anxiety, irritation, reduced energy, restlessness, slow thinking, slow speech and memory difficulty.



The thinking behind the Lumie Bodyclock is that if we wake up with gradual, dawn light our circadian rhythm / natural body clock, is less disrupted.  Increasing numbers of studies (e.g.1,2,3,4)  have now been carried out with dawn simulators for SAD, 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.  One study (1) concluded that: Naturalistic dawn simulation was an active antidepressant that does not require the effort of post-awakening bright light therapy. The authors say that dawn simulation can be considered as an alternative to bright light therapy or medication.



Another study (2) took place in 50 medication-free patients with SAD that was associated with hypersomnia (excessive amounts of daytime feelings of sleepiness).  The individuals received either 1 week of dawn simulation or a dim placebo signal.  The participants assessed their level of drowsiness upon awakening using a scale called the Stanford sleepiness scale (SSS),a psychiatrist then rated difficulty awakening after the treatment week.  Dawn simulation lowered both the difficulty awakening score and the ‘sleepiness scale’ score compared to the placebo dawn signal.


If you have been diagnosed with SAD or feel that you suffer from some of the symptoms of SAD, which you can read about in my previous blog post, you may want to consider purchasing a sunrise alarmclock such as the Lumie Bodyclock to see if it brings relief, especially if you suffer from difficulty waking and getting up in the mornings.  This is a convenient form of light therapy which, as mentioned above, may be as effective as light box therapy. 


(1)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
(2) Avery DH et al.  2001.  Dawn simulation and bright light in the treatment of SAD: a controlled study.  Biol Psychiatry.  50:205-216
(3)Avery DH et al.  1993.  Dawn simulation treatment of winter depression: a controlled studyAm J Psychiatry.  150:113-117
(4)Avery DH et al.  2002.  Is dawn simulation effective in ameliorating the difficulty awakening in seasonal affective disorder associated with hypersomnia? J Affect Disord. 69(1-3):231-6.
Written By Ani Kowal

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More evidence backs the use of St John’s Wort in treating depression


At the beginning of September I wrote a piece about light therapy in the treatment of seasonal affective disorder (SAD).  A common feature of SAD is low mood and depression and many individuals suffering from these kinds of symptoms would really prefer to take a natural alternative to conventional anti-depressant medications.  One option to consider is the herb, St John’s wort (Hypericum perforatum). 



Historically St John’s wort has been used as a remedy for the treatment of depression and there is now quite a bank of medical and scientific evidence(1) confirming the effectiveness of this herb for aiding various mood disturbances.  St John’s wort is a shrubby perennial plant with bright yellow flowers, named after St John the Baptist.  Ancient Greeks and Romans believed that the herb could deter evil spirits but today it is mainly used as a natural, alternative to antidepressants.  The herb has been routinely used in Germany for many years where doctors and health practitioners frequently prescribe supplements for the treatment of depression.  The available supplements are made from the dried flowers of the plant. 



Last year I wrote about a well carried out review which concluded that for people suffering from mild to moderate depression, St John’s wort can provide effective relief, similar to that of standard antidepressants but with fewer side effects.



Last month a paper was published (2) which commented on the above mentioned review paper, the author wanted to delve into assessing whether St John’s wort was also an effective treatment for major depression.  The author concluded that “Hypericum (St John’s wort) extracts are more effective than placebo in people with major depression. They are similarly effective to standard antidepressants but with fewer side effects”.  This is really interesting data as it now seems that St John’s wort can be used effectively in mild, moderate and major depression.  The author comments that evidence for the use of this herb has been steadily increasing over the years and that most studies have shown that the herb is superior to placebo in alleviating depression.  He also states that this research suggests “good evidence to assume that the risks associated with this herbal medicine are significantly less than those of synthetic antidepressants. This conclusion is also supported by data from observational and other non-randomised studies.  The implications of all this are clear. St John’s wort extracts are effective antidepressants. Provided herb–drug interactions can be avoided, they are also safer than conventional drugs. Considering the current debate about the value of synthetic antidepressants, one wonders why they are not used more widely”. 


I wonder about the same thing!   The ‘herb-drug interactions’ that the author mentions are important to note – St John’s wort interacts with certain medications so it is vital to ALWAYS CHECK WITH YOUR DOCTOR BEFORE STARTING ST JOHNS WORT SUPPLEMENTS.



The antidepressant properties of St John’s wort are thought to be ascribed to the compounds hypericin and hyperforin that are contained within the herb.  It is not entirely known how the herb works to lift the mood but it seems to act on certain ‘feel-good’ brain chemicals (known as neurotransmitters) such as dopamine, serotonin and noradrenaline.



The typical recommended dose is usually around 300mg of St John’s wort extract three times a day for supplements standardised to contain 0.3% hypericin.  One a day supplements containing 900mcg hypericin are also available – but always check the manufacturers dosage instructions an ALWAYS check with a doctor before taking the herb.  It may take 4 weeks before you see any benefit.  Side effects are uncommon, however in people with fair skin it is advisable to avoid prolonged exposure to sunlight whilst taking the herb.



St John’s Wort also seems useful for the treatment of other mood disturbances such as anxiety, apathy, insomnia, stress and SAD, if you think you could benefit from taking St Johns wort I would suggest chatting with a health professional prior to undertaking a supplementation regimen.



Obviously depression is a multifactorial condition, if you are suffering with depression or low mood you may want to seek psychological help from a counsellor or therapist, look into relaxation techniques and read about other nutritional aids.  A key nutrient that can be very effective in treating depression is the omega 3 essential fatty acid EPA (eicosapentaenoic acid) which I hope to discuss in relation to depression soon.



(1) Linde K et al.  2008.  St John’s wort for major depression.  Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3
(2)Ernst E.  2009.  Review: St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects. Evid Based Ment Health.  12(3):78.
Written by Ani Kowal

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