Seasonal Affective
Disorder: Beat the
Winter Blues the
Scandinavian Way

Nov 19, 2017 | The Rewire

Anecdotes abound that seasonal affective disorder (SAD) is an oppressive plague in the North. Just look at memes posted on your average Canadian Facebook friend profile by late February. Social media laments might include “when will the misery end,” “why winter, why,” or perhaps a gratuitous “I hate my life” caption crowning photos of a snow bank blanketing an unrecognizable car.

Even southern latitude dwellers in countries like South Africa [1], which barely see snowfall outside of mountainous terrains, reportedly experience a mood dip, albeit in June, July and August when winter hits the southern hemisphere as northern countries, in glaring contrast, soak up their sunniest days.

What people who hate winter see.

(Photo courtesy of Pixabay)

None of this is new insight, though. Traditional Chinese medicine, for example, has been saying for millennia that the seasons affect all living things [2], as did Hippocrates over 2,000 years ago: “whoever wishes to investigate medicine properly, should proceed thus: in the first place consider the seasons of the year, and what effects each of them produces for they are not at all alike.” [3]

According to the Mood Disorders Association of Ontario [4], roughly one in 20 Canadians experiences SAD, which is essentially a full-blown depression, in their lifetime. Another 1+ Canadian out of 7 faces the winter blues, a milder form of SAD. Across the pond in the UK [5], as many as 1 person in 5 gets the winter blues. A similar story unfolds in northern states in the U.S. and across assorted north European nations, notably Russia [6].

Meanwhile, researchers who argue that SAD might not even exist suggest bad weather and perhaps the dip in sunlight hours is simply worsening pre-existing psychological conditions [7]. Either way you spin it, the forecast seems dreary.

Depressing, ennit.

But what if it doesn’t have to be?

What people who love winter see.

(Photo courtesy of Pixabay)

The Winter Happiness Paradox

According to the World Happiness Report produced annually by the United Nations since 2012, the three happiest countries in 2017 are Norway, Denmark, and Iceland [8]. All Scandinavian nations. All northern countries which happen to experience the shortest days on Earth courtesy of their distance from the Equator and proximity to the Arctic Circle.

Considering that SAD research commonly associates winter blues with the drop in sun exposure typical of winter’s shorter days and longer nights, the World Happiness Report presents a paradox. How could Earth’s most sun-deprived citizens also be its most content?

From top left going clockwise: the aurora borealis in Norway, hot springs in Iceland, backcountry alpine skiing in Norway, and winter in Copenhagen, Denmark.

(Photos from top left going clockwise: Pixabay, Flickr user Emin Bayramov (CC BY-NC 2.0), Pixabay, and Flickr user Mikael Colville Andersen (CC 1.0))

Take the Svalbard Islands and its dark season. The sun disappears completely from view mid-November through late January, with its Norwegian residents seeing at most the colors of dawn and dusk as the sun stays below the horizon anywhere from two to six hours a day. By late December, day and night are indistinguishable. And yet in spite of this “Polar Night,” studies discovered that the people of Svalbard are remarkably resilient, resistant to the alleged effects of sun deprivation [9,10]. Mental distress, in particular, wasn’t any more prevalent during the dark season than in the summer when the islands are flooded with 24 hours of sun days on end.

What could be happening here?

(Photo courtesy of Pixabay)

Oily Fish

A quick look at Scandinavian culture reveals a dietary staple especially pertinent to mood regulation: oily fish [11]. Pickled and smoked herring, salmon gravlax, trout, sardines, and mackerel are a common sight at the Nordic dinnerand lunch, and even breakfast—table.

And perhaps the most important sleep hygiene recommendation put forth in Sleep Aids That Work published here on Where’s Your Head is the fishy one. Consuming fatty fish on a consistent basis, at least 3 times a week, isn’t just about absorbing the brain-boosting treasure trove of omega-3 fatty acids they provide, but for their rich vitamin D content.

As detailed in the sleep aids piece, men located in Wisconsin who ate farmed Atlantic salmon three times a week for six months (September through February) slept better at night and functioned better during the day than men fed meat instead [12]. It was as if the fish protected them from experiencing the winter blues. Incidentally, their Vitamin D levels were near optimal while their meat-eating counterparts showed significant Vitamin D deficiencies by the end of the study.

This is as bright as Svalbard gets in the winter months. By late December, it’s 24 hours a day of pitch black.

(Photo courtesy of Pixabay)

The Vitamin D Connection

Vitamin D deficiency is a global health problem, even in countries near the Equator with sun-filled days year round [13]. Differences in skin absorption efficiency and sun avoidance lifestyles aside, the possibility that even regions with abundant sunshine hours still feature prevalent Vitamin D deficiencies only adds to the winter sun problem. Yet getting enough of the “sunshine” vitamin could drastically improve health. Promising research on the subject points to cancer, heart disease, stroke, bone loss, autoimmune disease, the flu, common colds, infection, and mood disorders being mitigated and possibly prevented altogether with sufficient vitamin D intake [14].

And in relation to SAD and the winter blues, a 2013 meta-analysis confirmed the significance of 14 studies revealing a clear association between low levels of Vitamin D and depression [15]. One popular theory is that Vitamin D is involved in optimal serotonin production and release. Furthermore, evidence suggests that Vitamin D is involved in an array of critical brain processes, from the production of new neurons in adulthood to protecting the brain from neurodegenerative disease, standing to reason that optimal Vitamin D levels are crucial to psychological well-being.

Supplementation is often recommended since vitamin D food sources are limited. Apart from fatty fish, good to excellent sources of Vitamin D include cod liver oil, beef liver, shrimp, oysters, and eggs from chickens fed with vitamin D (check the nutrition label when in doubt).

Natural vegetarian and vegan options are even more limited. Mushrooms treated with UV rays contain Vitamin D, but otherwise, look for fortified soy products, orange juice, and non-dairy substitutes and eat them copiously. Compared to fish and seafood, Vitamin D content per vegan serving is significantly lower.

(Photo courtesy of Pixabay)

Bright Light Therapy

In spite of oodles of studies emerging on the subject of SAD and winter blues over the last 30 years, researchers still aren’t clear on what causes the mood dip, if winter depression, or SAD, is indeed a thing.

The leading theory in the running is the phase-shift hypothesis [16], the idea that a drop in sunlight hours throws off circadian rhythms, the human sleep-wake cycle. See, sunlight doesn’t just stimulate Vitamin D production. Sunlight’s absence (and presence) signals the body to increase (or decrease) melatonin release, the so-called sleep hormone which regulates the body’s 24-hour clock. Wake up at 6 a.m. on a January morning to pitch black darkness? The body still thinks it’s nighttime since it looks like it. So melatonin is still being released when, if it was summer, it would have slowed down to a trickle or stopped altogether at the sight of the sun, making way for hormones like serotonin that promote wakefulness.

While most people feel the downer effect of morning darkness, it’s especially pronounced in those diagnosed with SAD.

Then, when winter darkness descends in the afternoon, the body is compelled to release melatonin hours before it does in the summer, hours before actual bedtime. Lethargy and weariness aren’t far behind.

Getting serotonin levels to rise is believed to be critical in mitigating this arguably maladaptive phase shift. As hinted earlier with relation to Vitamin D, researchers believe that the rate of production of serotonin, the neurotransmitter coined as a major mood-regulating hormone in the body, is “directly related to the prevailing duration of bright sunlight” [17], conclusions that echoed postmortem brain analyses conducted decades earlier, in 1980, showing higher levels of serotonin in humans who died in the summer than in humans who died in the winter [18].

Low serotonin levels are commonly associated with anxiety, depression, and SAD. And since the body needs serotonin in order to produce melatonin, the sleep hormone, sleep disruption isn’t far behind if the body is releasing too little.

Now what’s emerged from dozens of clinical trials and subsequent meta-analyses is the idea of mimicking the effects of sunlight in the comfort of home. Or at work. Evidence has been piling up since 1984 [19] that sitting in front of a bright light for up to a 60-minute stretch per day relieves SAD patients and people with milder winter blues [20].

And if anyone was an early adopter, it was winter sun-deprived countries like Sweden, among the first to integrate bright light therapy into the fabric of local communities, installing specialized light systems in schools and medical clinics [21]. It even occurred to book-keeper Oscar Kittilsen in 1913, decades before seasonal affective disorder became a subject of study in science journals, that giant mirrors placed in just the right spot overlooking the Norwegian town of Rjukan could reflect the sun just enough to lift spirits [22].

But does bright light therapy work? Ask anyone who counts the days to summer.

But to get back to the research, skeptics point out that the problem with bright light research is the difficulty in blinding participants no pun to whether they’re in the experimental group or the control group. It’s firmly embedded in public consciousness that bright light therapy is a first-line defense against SAD. So how do you control for the placebo effect and prove once and for all that the bright lights really are working and not the result of patients wishfully thinking they’re working?

Think about it. Clinical trials typically involve duping half of the participants into taking sugar pills that look identical to the real treatment pills. That way, any possibility of subjects willing themselves better is eliminated. The whole point is they’re not supposed to know what they’re taking. But with bright therapy studies, you’re either being treated with a bright light. Or you’re not. The best a researcher can do is have control subjects stare at a less bright light. But even then, they’re still staring at a light, confounding results.

In spite of the difficulty in removing that bias, mounting evidence points to bright light therapy not only alleviating SAD, but helping depressive disorders unrelated to winter. A 2016 meta-analysis compared 20 bright light studies addressing non-seasonal depression and found that, notwithstanding the bias problem which was painstakingly emphasized, light therapy appears to be doing something to alleviate depressive symptoms. Authors went as far as to say that bright light therapy may actually “be most effective when applied as a stand-alone treatment” rather than in conjunction with medication, at least when looking at out-patients with less severe symptoms than hospitalized in-patients [23].

So what kind of bright light is best? Aim for one that illuminates 10,000 lux. Use it preferably in the morning. A minority might find symptoms alleviated more if used later in the day, but try it out in the morning first, the closer to when you wake up, the better. For how long? Start with 20 minutes and gradually increase it to 30 minutes, and then 60 minutes if possible. Set up it up on the breakfast table, or on your desk at work and go on with your day. Start in the fall if possible and make it a daily habit until spring.

Neuroscience Hacks

So you’re eating the fish (or vegan alternatives). And you’ve got your bright light. But it can take a couple of weeks or longer to feel the cumulative effects of the serotonin boost those lifestyle changes are supposed to engender. What if you need some kind of relief right now? Try these 7 neuroscience hacks for feeling better [24]. Some of these tricks make a difference in a matter of seconds.

(Photo courtesy of Pixabay)

Work It

I can almost hear the moans and groans, echoes of tell-me-something-I-don’t-know as the next sentence is read out. But you can’t deny it: exercise is good for you. Really, really good for you. A formidable mood regulator to boot.

Research on the subject is especially praiseworthy of aerobic exercise‘s role in producing and releasing more of that glorious depression-rectifying serotonin into the brain [25]. Cardiovascular activity is also brilliant for memory and cognition [26]. And who knows? You might end up with a six-pack.

Incidentally, winter activities popular in Scandinavian nations and assorted cold-weather countries like my native Canada are aerobic boons. Ice skating, hockey, cross-country skiing, alpine skiing, snowshoeing, and snowboarding are all aerobic activities. And they’re fun. They’re a big part of the reason I get excited about winter. They also offer the added benefit of warming you up when it’s cold outside. I’ve been known to break a sweat cross-country skiing or snowshoeing, having to keep my down-filled parka open in -20°C (-4°F) weather to cool down.

For optimal results, gradually work up to 3 hours of aerobic exercise a week. Every little bit makes a difference. Even brisk walks and quick 10-minute bouts of anything that gets the heart pumping count, activities like, say, shoveling snow.

Suddenly loving winter when you enjoy the season as much as contracting a contagious disease is, how can I say it, a challenge? I get it. You’re talking to a recovering pessimist. So focus on this instead.

Hygge Your Mind

The Danish dub it hygge, the Norwegians call it koselig, and considering both nations the two happiest in the world, remember?swear by the concept in darker, colder months, one can’t help but wonder if they’re onto something.

Both words refer to coziness and the pleasures of little things.

From top left going clockwise: a creamy, sunny matcha latte; the cozy joy of reading wrapped in a blanket; swiss cheese fondue, the quintessential winter comfort food; and the simple, sensual delight of a candlelit room.

(Photos from top left going clockwise: Pixabay, Pexels, Flickr user Paul Joseph (CC BY 2.0), and Pexels)

A comforting bowl of homemade soup on a freezing day. Marshmallows drowning in a café au lait cup of hot chocolate with a side of pistachio biscotti, decadent evening rewards after a tough workout or leisurely ice skate?earlier in the day. A soft, plushy blanket draped over yourself while reading a book surrounded by candlelight. Sipping lemon ginger honey tea with thick multicolored socks warming your feet contemplating the trail of smoke and heavenly scents released by a lit incense stick. A bottle of red wine shared over rich, unctuous Swiss fondue with the person (or people) you love most in the world on a cold, snowy night. The possibilities of coziness are as limitless as your imagination.

Norway’s cultural emphasis on life’s creature comforts may, at least partially, explain why two of their darkest places, Tromsø and the Svalbard Islands, have unusually low rates of depression in spite of months without a visible sun in the sky [27,28].

One study in particular noted a stark contrast in self-reported depression exceeding two weeks during the dark season between Norwegians (6%) and Russians (29.4%) both living in the Svalbard archipelago. Roughly four years after those results came out, two Swiss doctors from the Clinical Psychopharmacology Unit at University of Geneva commented on the equally stark contrast between the Norwegian and Russian settlements after having visited them as tourists [29]:

”Indeed, having gone as tourists to Svalbard, we were impressed by the hotels, the small university, the gastronomic restaurant, the supermarkets, as well as the comfort and the nice colors of the houses that are characteristic of Longyearbyen, the Norwegian setting. In Barentsburg, the Russian setting, workers enjoy a covered swimming pool and a huge library, but their comfort of living is nowhere near that of the Norwegians. We propose that the conjunction of economic status, the social organization as well as free time and access to varied forms of leisure during free time are very important in the well being of people who live in extreme climates.

Incorporating more color and varied forms of leisure into daily life —TV probably doesn’t count— stand out as especially doable.

A New Jersey graduate student who studied Norwegian attitudes towards winter at the northernmost university in the world in Tromsø, also noticed a correlation between having a positive attitude towards winter and expressing an overall higher level of satisfaction with life in general [30]. Those who liked winter also tended to exhibit more of a growth mindset. People with growth mindsets in a nutshell, the belief that they can improve themselves with effortappear to experience more success in life in general than people with fixed mindsets who, on the whole, believe they are how they are and have no control over their abilities.

Oddly enough, people living in the south of Norway seemed to hate a more negative view of winter than those living in the harsher conditions of the north like in Tromsø.

Said student, Kari Leibowitz, noticed a change in her own attitude towards winter while living in Norway:

“Instead of frequenting bars and restaurants as I had in the U.S., I enjoyed hikes, cabin trips, and yoga with my new friends. I joined several Norwegian meditation groups, which gave me friends outside the student community… in New Jersey, where I grew up, almost no one looked forward to winter, myself included (I even chose to attend college in Atlanta to escape the cold). In my experience, people simply got through the wintertime darkness on the way to a brighter, happier season. But in Tromsø, the Polar Night seemed to hold its own unique opportunities for mental and emotional flourishing.” [30]

Could a shift in perception change how we see winter? Instead of a bleak, cold, cabin-fevered snow-shoveling exercise in torture, what if it were a colorful, comforting time filled with fun, activity, coziness, and personal growth?

Suddenly loving winter when you enjoy the season as much as contracting a contagious disease is, how can I say it, a challenge? I get it. You’re talking to a recovering pessimist. So focus on this instead. Which foods bring you comfort? What colors soothe your soul? Which simple sights and activities lift your spirit? Pepper your every day with them. Light candles. And get cozy.

(And maybe buy that bright light).

References

  1. Avoid the winter blues: A tap into mental awareness. Grazia South Africa, 19 July 2016, www.graziadaily.co.za/health-self/avoid-the-winter-blues-a-tap-into-mental-awareness/.
  2. Unschuld PU, Tessenow H. Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di’s Inner Classic – Basic Questions: 2 volumes. Berkeley: University of California Press, 2011. Print.
  3. Hippocrates, Adams F. On airs, waters, and places. Adelaide: University of Adelaide, 2014.
  4. How prevalent is seasonal affective disorder? Mood Disorders Association of Ontario, https://www.mooddisorders.ca/faq/seasonal-affective-disorder-sad#t10n533.
  5. Rox P. Does too little sunlight give us all the winter blues? BBC News, BBC, 13 Nov. 2011, www.bbc.com/news/health-15692180.
  6. Nilssen O, Brenn T, Høyer G, Lipton R, Boiko J, Tkatchev A. Self-reported seasonal variation in depression at 78 degree north: The Svalbard Study. Int J Circumpolar Health 1999; 58(1): 14-23.
  7. Traffanstedt MK, Mehta S, LoBello SG. Major Depression With Seasonal Variation: Is It a Valid Construct? Clinical Psychological Science 2016; 4(5): 825-834.
  8. World Happiness Report 2017, United Nations, worldhappiness.report/ed/2017/.
  9. Nilssen O, Lipton R, Brenn T, Höyer G, Boiko E, Tkatchev A. Sleeping problems at 78 degrees north: the Svalbard Study. Acta Psychiatr Scand. 1997; 95(1): 44-8.
  10. Johnsen MT, Wynn R, Bratlid T. Is there a negative impact of winter on mental distress and sleeping problems in the subarctic: The Tromsø study. BMC Psychiatry 2012; 12: 225.
  11. Su K-P, Matsuoka Y, Pae C-U. Omega-3 polyunsaturated fatty acids in prevention of mood and anxiety disorders. Clinical Psychopharmacology and Neuroscience 2015; 13(2): 129–137.
  12. Hansen AL, Dahl L, Olson G, Thornton D, Graff IE, Frøyland L, et al. Fish consumption, sleep, daily functioning, and heart rate variability. Journal of Clinical Sleep Medicine 2014; 10(5): 567–75.
  13. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? The Journal of Steroid Biochemistry and Molecular Biology 2014; 144PA: 138-145.
  14. The Nutrition Source. Vitamin D and Health. Harvard School of Public Health 2017, https://www.hsph.harvard.edu/nutritionsource/vitamin-d/.
  15. Anglin RES, Samaan Z, Walter SD, McDonald. Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The British Journal of Psychiatry 2013; 202(2); 100-107.
  16. DeRubeis RJ, Strunk DR. The Oxford handbook of mood disorders. Oxford: Oxford University Press, 2017. Print.
  17. Lambert GW, Reid C, Kaye DM, Jennings GL, Esler MD. Effect of sunlight and season on serotonin turnover in the brain. The Lancet 2002; 360(9348): 1840-1842.
  18. Carlsson A, Svennerholm L, Winblad B. Seasonal and circadian monoamine variations in human brains examined post mortem. Acta Psychiatr Scand Suppl. 1980; 280:75-85.
  19. Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41(1): 72-80.
  20. Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: Efficacy, protocol, safety and side effects. CNS Spectr 2005; 10; 647-63.
  21. Geddes L. Will Norway ever beat the winter blues? The Atlantic, 14 March 2017, https://www.theatlantic.com/health/archive/2017/03/seasonal-affective-disorder-mosaic/519495/.
  22. Lansskog T. Giant mirrors bring the winter sun to the town of Rjukan. ThorNews, 1 November 2014, https://thornews.com/2014/11/01/giant-mirrors-brings-the-winter-sun-to-the-town-of-rjukan/.
  23. Perera S, Eisen R, Bhatt M, Bhatnagar N, de Souza R, Thabane L, Samaan Z. Light therapy for non-seasonal depression: Systematic review and meta-analysis. BJPsych Open. 2016; 2(2): 116–126.
  24. Reid E. Seven ways to feel better now using neuroscience. Where’s Your Head?, 20 September 2017, https://www.yourhead.space/2017/09/20/7-ways-to-feel-better-right-now-using-neuroscience/.
  25. Anderson E, Shivakumar G. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry 2013; 4: 27.
  26. Reid E. Want a better memory? Do this exercise. Where’s Your Head?, 26 August 2017, https://www.yourhead.space/2017/08/26/want-better-memory-exercise/.
  27. Johnsen MT, Wynn R, Bratlid T. Is there a negative impact of winter on mental distress and sleeping problems in the subarctic: The Tromsø Study. BMC Psychiatry 2012; 12: 225.
  28. Nilssen O, Brenn T, Hoyer G et al. Self-reported seasonal variation in depression at 78 degree North. The Svalbard study. Int J Circumpolar Health 1999; 58: 14-23.
  29. Schulz F, Curtin F. Confounding factors and seasonal depression. International Journal of Circumpolar Health 2003; 62: 3.
  30. Leibowitz K. The Norwegian town where the sun doesn’t rise. The Atlantic, 1 July 2015, https://www.theatlantic.com/health/archive/2015/07/the-norwegian-town-where-the-sun-doesnt-rise/396746/.

Seasonal Affective Disorder: Beat Winter Blues the Scandinavian Way

Nov 19, 2017 | The Rewire

Anecdotes abound that seasonal affective disorder (SAD) is an oppressive plague in the North. Just look at memes posted on your average Canadian Facebook friend profile by late February. Social media laments might include “when will the misery end,” “why winter, why,” or perhaps a gratuitous “I hate my life” caption crowning photos of a snow bank blanketing an unrecognizable car.

Even southern latitude dwellers in countries like South Africa [1], which barely see snowfall outside of mountainous terrains, reportedly experience a mood dip, albeit in June, July and August when winter hits the southern hemisphere as northern countries, in glaring contrast, soak up their sunniest days.

What people who hate winter see.

(Photo courtesy of Pixabay)

None of this is new insight, though. Traditional Chinese medicine, for example, has been saying for millennia that the seasons affect all living things [2], as did Hippocrates over 2,000 years ago: “whoever wishes to investigate medicine properly, should proceed thus: in the first place consider the seasons of the year, and what effects each of them produces for they are not at all alike.” [3]

According to the Mood Disorders Association of Ontario [4], roughly one in 20 Canadians experiences SAD, which is essentially a full-blown depression, in their lifetime. Another 1+ Canadian out of 7 faces the winter blues, a milder form of SAD. Across the pond in the UK [5], as many as 1 person in 5 gets the winter blues. A similar story unfolds in northern states in the U.S. and across assorted north European nations, notably Russia [6].

Meanwhile, researchers who argue that SAD might not even exist suggest bad weather and perhaps the dip in sunlight hours is simply worsening pre-existing psychological conditions [7]. Either way you spin it, the forecast seems dreary.

Depressing, ennit.

But what if it doesn’t have to be?

What people who love winter see.

(Photo courtesy of Pixabay)

The Winter Happiness Paradox

According to the World Happiness Report produced annually by the United Nations since 2012, the three happiest countries in 2017 are Norway, Denmark, and Iceland [8]. All Scandinavian nations. All northern countries which happen to experience the shortest days on Earth courtesy of their distance from the Equator and proximity to the Arctic Circle.

Considering that SAD research commonly associates winter blues with the drop in sun exposure typical of winter’s shorter days and longer nights, the World Happiness Report presents a paradox. How could Earth’s most sun-deprived citizens also be its most content?

Above: aurora borealis (i.e., northern lights) spotted in Norway.

(Photo courtesy of Pixabay)

Take the Svalbard Islands and its dark season. The sun disappears completely from view mid-November through late January, with its Norwegian residents seeing at most the colors of dawn and dusk as the sun stays below the horizon anywhere from two to six hours a day. By late December, day and night are indistinguishable. And yet in spite of this “Polar Night,” studies discovered that the people of Svalbard are remarkably resilient, resistant to the alleged effects of sun deprivation [9,10]. Mental distress, in particular, wasn’t any more prevalent during the dark season than in the summer when the islands are flooded with 24 hours of sun days on end.

What could be happening here?

Above: salmon, an oily fish and excellent source of omega-3 fatty acids and Vitamin D.

(Photo courtesy of Pixabay)

Oily Fish

A quick look at Scandinavian culture reveals a dietary staple especially pertinent to mood regulation: oily fish [11]. Pickled and smoked herring, salmon gravlax, trout, sardines, and mackerel are a common sight at the Nordic dinnerand lunch, and even breakfast—table.

And perhaps the most important sleep hygiene recommendation put forth in Sleep Aids That Work published here on Where’s Your Head is the fishy one. Consuming fatty fish on a consistent basis, at least 3 times a week, isn’t just about absorbing the brain-boosting treasure trove of omega-3 fatty acids they provide, but for their rich vitamin D content.

As detailed in the sleep aids piece, men located in Wisconsin who ate farmed Atlantic salmon three times a week for six months (September through February) slept better at night and functioned better during the day than men fed meat instead [12]. It was as if the fish protected them from experiencing the winter blues. Incidentally, their Vitamin D levels were near optimal while their meat-eating counterparts showed significant Vitamin D deficiencies by the end of the study.

This is as bright as Svalbard gets in the winter months. By late December, it’s 24 hours a day of pitch black.

(Photo courtesy of Pixabay)

The Vitamin D Connection

Vitamin D deficiency is a global health problem, even in countries near the Equator with sun-filled days year round [13]. Differences in skin absorption efficiency and sun avoidance lifestyles aside, the possibility that even regions with abundant sunshine hours still feature prevalent Vitamin D deficiencies only adds to the winter sun problem. Yet getting enough of the “sunshine” vitamin could drastically improve health. Promising research on the subject points to cancer, heart disease, stroke, bone loss, autoimmune disease, the flu, common colds, infection, and mood disorders being mitigated and possibly prevented altogether with sufficient vitamin D intake [14].

And in relation to SAD and the winter blues, a 2013 meta-analysis confirmed the significance of 14 studies revealing a clear association between low levels of Vitamin D and depression [15]. One popular theory is that Vitamin D is involved in optimal serotonin production and release. Furthermore, evidence suggests that Vitamin D is involved in an array of critical brain processes, from the production of new neurons in adulthood to protecting the brain from neurodegenerative disease, standing to reason that optimal Vitamin D levels are crucial to psychological well-being.

Supplementation is often recommended since vitamin D food sources are limited. Apart from fatty fish, good to excellent sources of Vitamin D include cod liver oil, beef liver, shrimp, oysters, and eggs from chickens fed with vitamin D (check the nutrition label when in doubt).

Natural vegetarian and vegan options are even more limited. Mushrooms treated with UV rays contain Vitamin D, but otherwise, look for fortified soy products, orange juice, and non-dairy substitutes and eat them copiously. Compared to fish and seafood, Vitamin D content per vegan serving is significantly lower.

(Photo courtesy of Pixabay)

Bright Light Therapy

In spite of oodles of studies emerging on the subject of SAD and winter blues over the last 30 years, researchers still aren’t clear on what causes the mood dip, if winter depression, or SAD, is indeed a thing.

The leading theory in the running is the phase-shift hypothesis [16], the idea that a drop in sunlight hours throws off circadian rhythms, the human sleep-wake cycle. See, sunlight doesn’t just stimulate Vitamin D production. Sunlight’s absence (and presence) signals the body to increase (or decrease) melatonin release, the so-called sleep hormone which regulates the body’s 24-hour clock. Wake up at 6 a.m. on a January morning to pitch black darkness? The body still thinks it’s nighttime since it looks like it. So melatonin is still being released when, if it was summer, it would have slowed down to a trickle or stopped altogether at the sight of the sun, making way for hormones like serotonin that promote wakefulness.

While most people feel the downer effect of morning darkness, it’s especially pronounced in those diagnosed with SAD.

Then, when winter darkness descends in the afternoon, the body is compelled to release melatonin hours before it does in the summer, hours before actual bedtime. Lethargy and weariness aren’t far behind.

Getting serotonin levels to rise is believed to be critical in mitigating this arguably maladaptive phase shift. As hinted earlier with relation to Vitamin D, researchers believe that the rate of production of serotonin, the neurotransmitter coined as a major mood-regulating hormone in the body, is “directly related to the prevailing duration of bright sunlight” [17], conclusions that echoed postmortem brain analyses conducted decades earlier, in 1980, showing higher levels of serotonin in humans who died in the summer than in humans who died in the winter [18].

Low serotonin levels are commonly associated with anxiety, depression, and SAD. And since the body needs serotonin in order to produce melatonin, the sleep hormone, sleep disruption isn’t far behind if the body is releasing too little.

Now what’s emerged from dozens of clinical trials and subsequent meta-analyses is the idea of mimicking the effects of sunlight in the comfort of home. Or at work. Evidence has been piling up since 1984 [19] that sitting in front of a bright light for up to a 60-minute stretch per day relieves SAD patients and people with milder winter blues [20].

And if anyone was an early adopter, it was winter sun-deprived countries like Sweden, among the first to integrate bright light therapy into the fabric of local communities, installing specialized light systems in schools and medical clinics [21]. It even occurred to book-keeper Oscar Kittilsen in 1913, decades before seasonal affective disorder became a subject of study in science journals, that giant mirrors placed in just the right spot overlooking the Norwegian town of Rjukan could reflect the sun just enough to lift spirits [22].

But does bright light therapy work? Ask anyone who counts the days to summer.

But to get back to the research, skeptics point out that the problem with bright light research is the difficulty in blinding participants no pun to whether they’re in the experimental group or the control group. It’s firmly embedded in public consciousness that bright light therapy is a first-line defense against SAD. So how do you control for the placebo effect and prove once and for all that the bright lights really are working and not the result of patients wishfully thinking they’re working?

Think about it. Clinical trials typically involve duping half of the participants into taking sugar pills that look identical to the real treatment pills. That way, any possibility of subjects willing themselves better is eliminated. The whole point is they’re not supposed to know what they’re taking. But with bright therapy studies, you’re either being treated with a bright light. Or you’re not. The best a researcher can do is have control subjects stare at a less bright light. But even then, they’re still staring at a light, confounding results.

In spite of the difficulty in removing that bias, mounting evidence points to bright light therapy not only alleviating SAD, but helping depressive disorders unrelated to winter. A 2016 meta-analysis compared 20 bright light studies addressing non-seasonal depression and found that, notwithstanding the bias problem which was painstakingly emphasized, light therapy appears to be doing something to alleviate depressive symptoms. Authors went as far as to say that bright light therapy may actually “be most effective when applied as a stand-alone treatment” rather than in conjunction with medication, at least when looking at out-patients with less severe symptoms than hospitalized in-patients [23].

So what kind of bright light is best? Aim for one that illuminates 10,000 lux. Use it preferably in the morning. A minority might find symptoms alleviated more if used later in the day, but try it out in the morning first, the closer to when you wake up, the better. For how long? Start with 20 minutes and gradually increase it to 30 minutes, and then 60 minutes if possible. Set up it up on the breakfast table, or on your desk at work and go on with your day. Start in the fall if possible and make it a daily habit until spring.

Neuroscience Hacks

So you’re eating the fish (or vegan alternatives). And you’ve got your bright light. But it can take a couple of weeks or longer to feel the cumulative effects of the serotonin boost those lifestyle changes are supposed to engender. What if you need some kind of relief right now? Try these 7 neuroscience hacks for feeling better [24]. Some of these tricks make a difference in a matter of seconds.

(Photo courtesy of Pixabay)

Work It

I can almost hear the moans and groans, echoes of tell-me-something-I-don’t-know as the next sentence is read out. But you can’t deny it: exercise is good for you. Really, really good for you. A formidable mood regulator to boot.

Research on the subject is especially praiseworthy of aerobic exercise‘s role in producing and releasing more of that glorious depression-rectifying serotonin into the brain [25]. Cardiovascular activity is also brilliant for memory and cognition [26]. And who knows? You might end up with a six-pack.

Incidentally, winter activities popular in Scandinavian nations and assorted cold-weather countries like my native Canada are aerobic boons. Ice skating, hockey, cross-country skiing, alpine skiing, snowshoeing, and snowboarding are all aerobic activities. And they’re fun. They’re a big part of the reason I get excited about winter. They also offer the added benefit of warming you up when it’s cold outside. I’ve been known to break a sweat cross-country skiing or snowshoeing, having to keep my down-filled parka open in -20°C (-4°F) weather to cool down.

For optimal results, gradually work up to 3 hours of aerobic exercise a week. Every little bit makes a difference. Even brisk walks and quick 10-minute bouts of anything that gets the heart pumping count, activities like, say, shoveling snow.

Suddenly loving winter when you enjoy the season as much as contracting a contagious disease is, how can I say it, a challenge? I get it. You’re talking to a recovering pessimist. So focus on this instead.

Hygge Your Mind The Danish dub it hygge, the Norwegians call it koselig, and considering both nations the two happiest in the world, remember?swear by the concept in darker, colder months, one can’t help but wonder if they’re onto something. Both words refer to coziness and the pleasures of little things.

Cocooning in a blankie with a book. Pure hygge.

(Photo courtesy of Pexels)

A comforting bowl of homemade soup on a freezing day. Marshmallows drowning in a café au lait cup of hot chocolate with a side of pistachio biscotti, decadent evening rewards after a tough workoutor leisurely ice skate?earlier in the day. A soft, plushy blanket draped over yourself while reading a book surrounded by candlelight. Sipping lemon ginger honey tea with thick multicolored socks warming your feet contemplating the trail of smoke and heavenly scents released by a lit incense stick. A bottle of red wine shared over rich, unctuous Swiss fondue with the person (or people) you love most in the world on a cold, snowy night. The possibilities of coziness are as limitless as your imagination.

Norway’s cultural emphasis on life’s creature comforts may, at least partially, explain why two of their darkest places, Tromsø and the Svalbard Islands, have unusually low rates of depression in spite of months without a visible sun in the sky [27,28].

Something as simple as lighting a candle can soothe on cold, winter nights.

(Photo courtesy of Pexels)

One study in particular noted a stark contrast in self-reported depression exceeding two weeks during the dark season between Norwegians (6%) and Russians (29.4%) both living in the Svalbard archipelago. Roughly four years after those results came out, two Swiss doctors from the Clinical Psychopharmacology Unit at University of Geneva commented on the equally stark contrast between the Norwegian and Russian settlements after having visited them as tourists [29]:

”Indeed, having gone as tourists to Svalbard, we were impressed by the hotels, the small university, the gastronomic restaurant, the supermarkets, as well as the comfort and the nice colors of the houses that are characteristic of Longyearbyen, the Norwegian setting. In Barentsburg, the Russian setting, workers enjoy a covered swimming pool and a huge library, but their comfort of living is nowhere near that of the Norwegians. We propose that the conjunction of economic status, the social organization as well as free time and access to varied forms of leisure during free time are very important in the well being of people who live in extreme climates.

Incorporating more color and varied forms of leisure into daily life —TV probably doesn’t count— stand out as especially doable.

A New Jersey graduate student who studied Norwegian attitudes towards winter at the northernmost university in the world in Tromsø, also noticed a correlation between having a positive attitude towards winter and expressing an overall higher level of satisfaction with life in general [30]. Those who liked winter also tended to exhibit more of a growth mindset. People with growth mindsets in a nutshell, the belief that they can improve themselves with effortappear to experience more success in life in general than people with fixed mindsets who, on the whole, believe they are how they are and have no control over their abilities.

Oddly enough, people living in the south of Norway seemed to hate a more negative view of winter than those living in the harsher conditions of the north like in Tromsø.

Said student, Kari Leibowitz, noticed a change in her own attitude towards winter while living in Norway:

“Instead of frequenting bars and restaurants as I had in the U.S., I enjoyed hikes, cabin trips, and yoga with my new friends. I joined several Norwegian meditation groups, which gave me friends outside the student community… in New Jersey, where I grew up, almost no one looked forward to winter, myself included (I even chose to attend college in Atlanta to escape the cold). In my experience, people simply got through the wintertime darkness on the way to a brighter, happier season. But in Tromsø, the Polar Night seemed to hold its own unique opportunities for mental and emotional flourishing.” [30]

Could a shift in perception change how we see winter? Instead of a bleak, cold, cabin-fevered snow-shoveling exercise in torture, what if it were a colorful, comforting time filled with fun, activity, coziness, and personal growth?

Suddenly loving winter when you enjoy the season as much as contracting a contagious disease is, how can I say it, a challenge? I get it. You’re talking to a recovering pessimist. So focus on this instead. Which foods bring you comfort? What colors soothe your soul? Which simple sights and activities lift your spirit? Pepper your every day with them. Light candles. And get cozy.

(And maybe buy that bright light).

References

  1. Avoid the winter blues: A tap into mental awareness. Grazia South Africa, 19 July 2016, www.graziadaily.co.za/health-self/avoid-the-winter-blues-a-tap-into-mental-awareness/.
  2. Unschuld PU, Tessenow H. Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di’s Inner Classic – Basic Questions: 2 volumes. Berkeley: University of California Press, 2011. Print.
  3. Hippocrates, Adams F. On airs, waters, and places. Adelaide: University of Adelaide, 2014.
  4. How prevalent is seasonal affective disorder? Mood Disorders Association of Ontario, https://www.mooddisorders.ca/faq/seasonal-affective-disorder-sad#t10n533.
  5. Rox P. Does too little sunlight give us all the winter blues? BBC News, BBC, 13 Nov. 2011, www.bbc.com/news/health-15692180.
  6. Nilssen O, Brenn T, Høyer G, Lipton R, Boiko J, Tkatchev A. Self-reported seasonal variation in depression at 78 degree north: The Svalbard Study. Int J Circumpolar Health 1999; 58(1): 14-23.
  7. Traffanstedt MK, Mehta S, LoBello SG. Major Depression With Seasonal Variation: Is It a Valid Construct? Clinical Psychological Science 2016; 4(5): 825-834.
  8. World Happiness Report 2017, United Nations, worldhappiness.report/ed/2017/.
  9. Nilssen O, Lipton R, Brenn T, Höyer G, Boiko E, Tkatchev A. Sleeping problems at 78 degrees north: the Svalbard Study. Acta Psychiatr Scand. 1997; 95(1): 44-8.
  10. Johnsen MT, Wynn R, Bratlid T. Is there a negative impact of winter on mental distress and sleeping problems in the subarctic: The Tromsø study. BMC Psychiatry 2012; 12: 225.
  11. Su K-P, Matsuoka Y, Pae C-U. Omega-3 polyunsaturated fatty acids in prevention of mood and anxiety disorders. Clinical Psychopharmacology and Neuroscience 2015; 13(2): 129–137.
  12. Hansen AL, Dahl L, Olson G, Thornton D, Graff IE, Frøyland L, et al. Fish consumption, sleep, daily functioning, and heart rate variability. Journal of Clinical Sleep Medicine 2014; 10(5): 567–75.
  13. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? The Journal of Steroid Biochemistry and Molecular Biology 2014; 144PA: 138-145.
  14. The Nutrition Source. Vitamin D and Health. Harvard School of Public Health 2017, https://www.hsph.harvard.edu/nutritionsource/vitamin-d/.
  15. Anglin RES, Samaan Z, Walter SD, McDonald. Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The British Journal of Psychiatry 2013; 202(2); 100-107.
  16. DeRubeis RJ, Strunk DR. The Oxford handbook of mood disorders. Oxford: Oxford University Press, 2017. Print.
  17. Lambert GW, Reid C, Kaye DM, Jennings GL, Esler MD. Effect of sunlight and season on serotonin turnover in the brain. The Lancet 2002; 360(9348): 1840-1842.
  18. Carlsson A, Svennerholm L, Winblad B. Seasonal and circadian monoamine variations in human brains examined post mortem. Acta Psychiatr Scand Suppl. 1980; 280:75-85.
  19. Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41(1): 72-80.
  20. Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: Efficacy, protocol, safety and side effects. CNS Spectr 2005; 10; 647-63.
  21. Geddes L. Will Norway ever beat the winter blues? The Atlantic, 14 March 2017, https://www.theatlantic.com/health/archive/2017/03/seasonal-affective-disorder-mosaic/519495/.
  22. Lansskog T. Giant mirrors bring the winter sun to the town of Rjukan. ThorNews, 1 November 2014, https://thornews.com/2014/11/01/giant-mirrors-brings-the-winter-sun-to-the-town-of-rjukan/.
  23. Perera S, Eisen R, Bhatt M, Bhatnagar N, de Souza R, Thabane L, Samaan Z. Light therapy for non-seasonal depression: Systematic review and meta-analysis. BJPsych Open. 2016; 2(2): 116–126.
  24. Reid E. Seven ways to feel better now using neuroscience. Where’s Your Head?, 20 September 2017, https://www.yourhead.space/2017/09/20/7-ways-to-feel-better-right-now-using-neuroscience/.
  25. Anderson E, Shivakumar G. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry 2013; 4: 27.
  26. Reid E. Want a better memory? Do this exercise. Where’s Your Head?, 26 August 2017, https://www.yourhead.space/2017/08/26/want-better-memory-exercise/.
  27. Johnsen MT, Wynn R, Bratlid T. Is there a negative impact of winter on mental distress and sleeping problems in the subarctic: The Tromsø Study. BMC Psychiatry 2012; 12: 225.
  28. Nilssen O, Brenn T, Hoyer G et al. Self-reported seasonal variation in depression at 78 degree North. The Svalbard study. Int J Circumpolar Health 1999; 58: 14-23.
  29. Schulz F, Curtin F. Confounding factors and seasonal depression. International Journal of Circumpolar Health 2003; 62: 3.
  30. Leibowitz K. The Norwegian town where the sun doesn’t rise. The Atlantic, 1 July 2015, https://www.theatlantic.com/health/archive/2015/07/the-norwegian-town-where-the-sun-doesnt-rise/396746/.

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