Winter Blues?
We're looking into scientific articles we find interesting!
Winter Type Seasonal affective disorder, is a type of mood disorder that happens at the same time every year.
Lifestyle modification as intervention for seasonal affective disorder: A systematic review
Max Rothenberg, Barbara Nussbaumer-Streit, Edda Pjrek, Dietmar Winkler
It is frequently associated with symptoms like loss of drive and energy, prolonged sleep, increased food intake, cravings for carbohydrates and weight gain.
It is abbreviated as S.A.D. or SAD [which, was that on purpose?] and researchers also call it “fall-winter depression”.
The specific causes of S.A.D. haven’t been completely figured out but there are many suspected contributing factors.
The researchers listed
- having a genetic predisposition
- a phase shift of the circadian rhythm due to a decrease in light and
- a dysfunction of several monoaminergic neurotransmitter systems (Monoaminergic means "working on monoamine neurotransmitters", which refers to serotonin, dopamine, norepinephrine, epinephrine, and histamine)
If diagnosed, treatment usually starts with bright light therapy or BLT (another great acronym) and/or pharmacological therapies.
Bright light therapy tries to rectify the shift in circadian rhythm.
According to current guidelines, (bright) light therapy is the therapy of choice for SAD due to the known influence of insufficient light exposure in the winter months and its effectiveness has been proven by numerous studies.
In addition to light therapy, SAD treatment and prevention also includes pharma intervention that seeks to address dysfunction in the neurotransmitter system.
This review looked at the effectiveness and safety of lifestyle modifications as alternatives or supplemental treatment for SAD.
The researchers were looking for a reduction in depressive symptoms using psychiatric scales after implementing a lifestyle modification. Some of the lifestyle modifications they were looking at was
- Nutrition
- Exercise
- Outdoor time and
- Sleep
However, the researchers didn’t find strong enough results from a statistical standpoint.
This doesn’t mean the modifications didn’t have positive results in these studies or that these modifications were disproven to be effective but there are certain statistical measurements you can perform on data groups that strengthen the confidence of your conclusions based on that information
But if you have too small of a data group to pool from, the strength of your conclusions would be considered lower.
Some people disregard studies that come to that conclusion, but in my opinion it can be exciting to see the possibilities in the grey. Is there really a strong correlation between improved SAD and this lifestyle modification? What would make you believe it without a shadow of a doubt? What would convince YOU that a lifestyle modification would be effective? Would it have to work on every person at your job or school? In your country? In the world? Or would you believe one person’s personal experience? Where is your line of confidence? It’s an interesting question to ask yourself with any topic
These researchers would like to see bigger sample sizes to make sure results aren’t by chance. They would also like to see reports of adverse events in these studies. Because safety wasn’t addressed, even negatively, the researchers don’t feel comfortable making a quote unquote “safe” statement. This doesn’t stop them from letting us know what the found though! It’s like an actually helpful disclaimer before we look at their findings.
They suggest that people might prefer lifestyle modifications as opposed to bright light therapy, psychotherapy or pharmacological/drug therapy because it gives the patients a feeling of empowerment and control like they are actively contributing to their therapeutic process.
With lifestyle modifications, there is less fear of side effects in comparison to pharmalogical therapy.
Nutrition changes generally included protein-rich, vegetable-containing food combined with complex carbohydrates and as few “processed” products as possible which honestly sounds like any good nutrition changes.
Another study suggests a mediterranean diet increased fish and antioxidant intake or ketogenic diet.
There is conclusive evidence on physical activity and its positive impact on mental health. So the researchers were wondering is it the same specifically for SAD?
In one study, daily morning training sessions helped with reducing depressive symptoms as well as phase shifting the circadian rhythm. And these effects lasted 7 days or longer
Other studies looked at training in normal light (400–600 lux) vs bright light (2500–4000 lux) and the bright light was more effective in reducing SAD symptoms.
Assessment or impact can be difficult as well because a lot of these suggestions exposes the patient in combination. For example sports programs, studies have shown a positive result but is this because of the increased light from being outside or is the light no effect or is it an added bonus? It can be hard to tell! This lends itself to experimental design how would you set up a test to make sure you could compare the effects of a sports program and light therapy?
Sleep deprivation is considered an effective treatment for non-seasonal depression and a study concluded that it could be as effective for SAD. Sleep deprivation causes a short term boost in dopamine, but this effect cannot be sustained long term.
Music therapy, mindfulness based therapy, strengthening social life or reduction of environmental pollution are all possible lifestyle modifications that the researchers would like investigated more so they can make sound treatment recommendations.
This interest in lifestyle modification is motivated by their great therapeutic potential. These modifications, tend to be safe and have good patient adherence.
And they're an easy add on to conventional forms of treatment.
What do you do to alleviate the winter blues?
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