Avoiding the Winter Doldrums

by Jason E. Barker, ND

While modern human activity patterns are for the most part ungoverned by seasonal light variations, levels of sunlight can have a decisive effect on a person’s mood during the winter months.¹ Commonly referred to as “the winter doldrums,” individuals who are affected by seasonal light variation experience a range of low moods when daylight is in short supply. Accordingly, the most disconsolate time of year for those affected are the months of November, December, January and February.²

This phenomenon of despondency during the winter affects numerous people. Characterized by ongoing or recurrent episodes of melancholy that are associated with changing seasons into the winter months, with symptoms subsiding during the spring and summer months, these feelings of “the blues” are associated with seasonal light variations.

This seasonal effect on mood typically first appears in younger people (ages 20-30) with mild to moderate symptoms such as social withdrawal, sadness, nervous tension, and irritability. Some also experience lethargy, somnolence and carbohydrate cravings with attendant weight gain.³ For reasons unclear, women are more often affected than men.⁴

This seasonal effect of a lack of sunlight on mood is relatively common, occurring in 11 percent of individuals that have preexisting mood issues, or “the blues”³ with an incidence of 1 percent in North America⁵ and a prevalence of 1-3 percent in Canada, 1.3 to 3 percent in Europe, and 0.9 percent or less in Asia.⁶ Seasonal mood changes also appear to be common in families, as 13-17 percent of first degree relatives of individuals who experience this effect, also have symptoms.⁷

Symptoms may include:

• Regular occurrences of lethargy, occasional fatigue, nervous tension, inability to cope, subpar sleep quality and social avoidance.
• Polyphagia, somnolence, and weight gain during late fall and winter months.
• Resolution of symptoms in the spring and summer months.
• Loss of libido and no interest in physical contact.
• Craving for carbohydrates and sweet foods.
• Experiences have occurred during the past two years, without episodes of non-seasonal low moods.

Not all people experience signs to this extent; periods of foul winter weather can certainly have their effect on nearly everyone but without the extensiveness of symptoms noted above. It is a rare person who has not felt some effect from the weather (be it cold, cloudy or just short winter days) on their mood.

While the exact causative factor(s) for seasonal mood changes are not entirely known, most speculation centers on the effects of decreased sunlight exposure during the winter months as the primary etiologic reason. Exposure to sunlight is known to affect the manufacture of melatonin, a neurotransmitter produced in the pineal gland deep within the brain.

Melatonin secretion is increased during hours of darkness, and decreases with sunlight exposure. Previously, excessive melatonin production was indicated as a main causative factor for this effect on mood, partially because of the hypnotic, or sleep-inducing effects of it when administered exogenously and because it is produced in higher amounts during times of darkness. However, investigations into the role of melatonin as a solitary causative factor of seasonal mood changes have revealed conflicting results.

Timing and levels of melatonin become altered in people with season-specific mood concerns, with bright light exerting a suppressive effect.⁸ Other studies have revealed a non-significant correlation between low mood prevalence and latitude (and thereby sunlight exposure).⁹ The authors of this study conclude the influence of latitude on mood is relatively small in comparison to other factors such as climate, genetic susceptibility, and social-cultural context.

Season-specific mood imbalances are ultimately considered a recurring type of the blues with a predictable onset in the late fall and winter and rapid resolution in the spring and summer. This phenomenon is complex and in all likelihood the result of many factors acting on circadian rhythms, neurohormones (namely the serotonin system) and seasonal light variation coupled with genetic and environmental influences. These include climate, latitude and neurotransmitter changes.¹⁰

The phase-delay hypothesis maintains that individuals who experience this effect of season on mood have delayed circadian rhythms in relation to seasonally altered sleep/wake and or rest/activity cycles;⁴ the effectiveness of light therapy demonstrates the validity of this hypothesis.

Mood Enhancing Strategies

The predictive annual recurrence of this phenomenon allows for those who experience it to ideally prepare for the eventual decline in mood they will suffer as daylight shortens each year. Barring frequent trips to sunny beaches and/or relocation to warmer climates, there are several ways to elevate mood during the dreary winter months including the use of light therapy, exercise, and natural supplements.

Phototherapy, also known as light therapy, is the use of certain wavelengths of artificial light to enhance mood. Phototherapy has been shown to exert a positive effect on mood.^11-12 Phototherapy is typically prescribed in terms of “lux,” a unit of luminance as perceived by the retina, and descriptors such as intensity, wavelength, and duration of daily exposure are included in the prescription. Typically, indoor lighting emits 500 lux, a cloudless summer day can emit 50,000 lux, while cloudy days may range from 1,000 to 5,000 lux. Light therapy is received, and the effects are mediated through the eyes. Therefore, tanning lights (which emit ultraviolet light) should generally be avoided due to their negative effects on skin (and retinal) health.

Exercise may also help to boost mood in the wintertime, and even more so when combined with light therapy.¹³ Specifically, strength training and aerobic exercise exert the greatest mood-elevating effects.¹⁴ In a study designed to measure various moods following exercise bouts, low mood scores were significantly reduced.¹⁵ Several other studies have shown the benefits of exercise for improving mood.^16-18

Nutritional Mood Balancers

5-HTP (5-hydroxytryptophan) is a naturally occurring amino acid that supports the production of the neurotransmitters serotonin and melatonin. 5-HTP has been shown to have mood supportive effects, among others,¹⁹ and can be very effective in doing so.²⁰ It is thought to have few side effects when used for mood supportive purposes.²¹

SAMe (S-adenosyl methionine) is a form of the amino acid methionine that is required for the synthesis and maintenance of several neurotransmitters, especially those indicated in mood maintenance.²² SAMe is effective, well-tolerated and safe for elevating mood.²³ SAMe has been extensively studied for its role in supporting mood.²⁴

Vitamin D is a fat-soluble vitamin produced in the skin when exposed to ultraviolet light (sunshine). Newer research points to an insufficiency of vitamin D and increased risk of several central nervous system conditions including season-dependent sadness.^25-26 Supplementation with vitamin D during winter months was associated with a decrease in low mood scores, equating to enhanced mood.²⁷

Given the fact that vitamin D is synthesized via exposure to sunlight, and sadness during winter months is associated with low levels of sunlight, it makes sense to strongly consider the link between low levels of vitamin D and sunshine and low mood.

Micronutrients such as vitamin B6, folic acid and vitamin B12 can all support healthy mood. An association between low levels of these vitamins and higher prevalence of sadness have been reported in epidemiologic studies.²⁸ And, higher intakes of B vitamins, especially folate and vitamin B6 are associated with lower prevalence of mood concerns.²⁹ Vitamin B6 is needed for the manufacture of monoamine neurotransmitters, while folic acid and vitamin B12 act as methyl donors and are necessary for the synthesis of S-adenosyl methionine (SAMe).

The amino acids L-Tyrosine and L-Phenylalanine (as found in SynCholamine™) also play a role in healthy neurotransmitter production and balanced mood. Tyrosine is a precursor for the neurotransmitters epinephrine, norepinephrine and dopamine; it has been used historically for mood imbalances and provides mood support, without the side effects.³⁰ Phenylalanine is a precursor to tyrosine; supplementing with it can elevate mood and has also shown effective for people with mood imbalances.³¹

St. John’s Wort (Hypericum perforatum) is one of the most thoroughly researched natural substances for boosting mood and benefiting people who experience winter blues as well.^32-33 St. John’s Wort is effective and has a low incidence of side effects.³⁴

Conclusion

Seasonal mood changes have widespread prevalence with many contributing factors. Chief among them are limited daylight in the winter hours, climate and genetic predisposition. It causes diverse symptoms impacting mood, depleting energy, contributing to a bleak outlook, weight gain and somnolence, among others. There are numerous natural compounds that can effectively support mood in those affected by the winter blues.

References

1. Park DH, Kripke DF, Cole RJ. More prominent reactivity in mood than activity and sleep induced by differential light exposure due to seasonal and local differences. Chronobiol Int. 2007;24(5):905-20.

2. Winkler D, Willeit M, Praschak-Rieder N, et al. Changes of clinical pattern in seasonal affective disorder (SAD) over time in a German-speaking sample. Eur Arch Psychiatry Clin Neurosci. 2002 Apr;252(2):54-62.

3. Levitt A, Boyle M, Joffe R, et al. Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample. Can J Psychiatry 2000;45:650-4.

4. Magnusson A, Boivin D. Seasonal affective disorder: an overview. Chronobiol Int. 2003 Mar;20(2):189-207.

5. Blazer DG, Kessler RC, Swartz MS. Epidemiology of recurrent major and minor depression with a seasonal pattern. The National Comorbidity Survey. Br J Psychiatry. 1998;172:164-7.

6. Lam R, Levitan R. Pathophysiology of seasonal affective disorder: a review. J Psychiatry Neurosci 2000;25:469-80.

7. Sheer L, Goldman D, Ozaki N, Rosenthal N. The role of genetic factors in the etiology of seasonal affective disorder and seasonality. J Affect Disord 1999;53:203-10.

8. Srinivasan V, Smits M, Spence W, et al. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138-51.

9. Mersch PP, Middendorp HM, Bouhuys AL, Beersma DG, van den Hoofdakker RH. Seasonal affective disorder and latitude: a review of the literature. J Affect Disord. 1999 Apr;53(1):35-48.

10. Attar-Lévy D. Rev Prat. Seasonal depression. 1997 Nov 1;47(17):1899-903.

11. Strong RE, Marchant BK, Reimherr FW, et al. Narrow-band blue-light treatment of seasonal affective disorder in adults and the influence of additional nonseasonal symptoms. Depress Anxiety. 2009;26(3):273-8.

12. Prasko J. Bright light therapy. Neuro Endocrinol Lett. 2008 Nov;29 Suppl 1:33-64.

13. Leppämäki S, Partonen T, Lönnqvist J. Bright-light exposure combined with physical exercise elevates mood. J Affect Disord. 2002 Nov;72(2):139-44.

14. Paluska SA, Schwenk TL. Physical activity and mental health: current concepts. Sports Med. 2000 Mar;29(3):167-80.

15. Lane AM, Crone-Grant D, Lane H. Mood changes following exercise. Percept Mot Skills. 2002 Jun;94(3 Pt 1):732-4.

16. Leppamaki SJ, Partonen TT, Hurme J, et al. Randomized trial of the efficacy of bright-light exposure and aerobic exercise on depressive symptoms and serum lipids. J Clin Psychiatry. 2002 Apr;63(4):316-21.

17. Partonen T, Leppamaki S, Hurme J, Lonnqvist J. Randomized trial of physical exercise alone or combined with bright light on mood and health-related quality of life. Psychol Med. 1998 Nov;28(6):1359-64.

18. Pinchasov BB, Shurgaja AM, Grischin OV, Putilov AA. Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light. Psychiatry Res. 2000 Apr 24;94(1):29-42.

19. Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998 Aug;3(4):271-80.

20. Zmilacher K, Battegay R, Gastpar M. L-5-hydroxytryptophan alone and in combination with a peripheral decarboxylase inhibitor in the treatment of depression. Neuropsychobiology. 1988;20(1):28-35.

21. Byerley WF, Judd LL, Reimherr FW, et al. 5-Hydroxytryptophan: a review of its antidepressant efficacy and adverse effects. J Clin Psychopharmacol. 1987 Jun;7(3):127-37.

22 Levkovitz Y, Alpert JE, Brintz CE, et al. Effects of S-adenosylmethionine augmentation of serotonin-reuptake inhibitor antidepressants on cognitive symptoms of major depressive disorder. J Affect Disord. 2011 Sep 10. [Epub ahead of print]

23. Papakostas GI, Mischoulon D, Shyu I, et al. Am J Psychiatry. 2010 Aug;167(8):942-8. Epub 2010 Jul 1. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial.

24. Mischoulon D, Fava M. Am J Clin Nutr. 2002 Nov;76(5):1158S-61S. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence.

25. Tuohimaa P, Keisala T, Minasyan A, et al. Vitamin D, nervous system and aging. Psychoneuroendocrinology. 2009 Dec;34 Suppl 1:S278-86.

26. Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008 Dec;264(6):599-609.

27. Shipowick CD, Moore CB, Corbett C, Bindler R. Vitamin D and depressive symptoms in women during the winter: a pilot study. Appl Nurs Res. 2009 Aug;22(3):221-5.

28. Sánchez-Villegas A, Doreste J, Schlatter J, et al. J Hum Nutr Diet. 2009 Apr;22(2):122-33. Association between folate, vitamin B(6) and vitamin B(12) intake and depression in the SUN cohort study.

29. Murakami K, Miyake Y, Sasaki S, Tanaka K, et al. Dietary folate, riboflavin, vitamin B-6, and vitamin B-12 and depressive symptoms in early adolescence: the Ryukyus Child Health Study. Psychosom Med. 2010 Oct;72(8):763-8. Epub 2010 Aug 17.

30. Banderet LE, Lieberman HR. Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Brain Res Bull 1989;22:759-62.

31. Fischer E et al. Therapy of depression by phenylalanine. Arzneimittelforsch 1975;25:132.

32. Wheatley D. Hypericum in seasonal affective disorder (SAD). Curr Med Res Opin. 1999;15(1):33-7.

33. Martinez B, Kasper S, Ruhrmann S, et al. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatry Neurol. 1994 Oct;7 Suppl 1:S29-33.

34. Miller AL. St. John’s Wort (Hypericum perforatum): clinical effects on depression and other conditions.Altern Med Rev. 1998 Feb;3(1):18-26.