Seasonal Affective Disorder Vitamin D

Seasonal Affective Disorder Vitamin D

Seasonal Affective Disorder

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What is seasonal affective disorder?

Many people go through short periods of time where they feel sad or not like their usual selves. Sometimes, these mood changes begin and end when the seasons change. People may start to feel "down" when the days get shorter in the fall and winter (also called "winter blues") and begin to feel better in the spring, with longer daylight hours.

In some cases, these mood changes are more serious and can affect how a person feels, thinks, and handles daily activities. If you have noticed significant changes in your mood and behavior whenever the seasons change, you may be suffering from seasonal affective disorder (SAD), a type of depression.

In most cases, SAD symptoms start in the late fall or early winter and go away during the spring and summer; this is known as winter-pattern SAD or winter depression. Some people may experience depressive episodes during the spring and summer months; this is called summer-pattern SAD or summer depression and is less common.

What are the signs and symptoms of SAD?

SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms lasting about 4 to 5 months per year. Therefore, the signs and symptoms of SAD include those associated with major depression, and some specific symptoms that differ for winter-pattern and summer-pattern SAD. Not every person with SAD will experience all of the symptoms listed below.

Symptoms of major depression may include:

• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Experiencing changes in appetite or weight
• Having problems with sleep
• Feeling sluggish or agitated
• Having low energy
• Feeling hopeless or worthless
• Having difficulty concentrating
• Having frequent thoughts of death or suicide

For winter-pattern SAD, additional specific symptoms may include:

• Oversleeping (hypersomnia)
• Overeating, particularly with a craving for carbohydrates
• Weight gain
• Social withdrawal (feeling like "hibernating")

Specific symptoms for summer-pattern SAD may include:

• Trouble sleeping (insomnia)
• Poor appetite, leading to weight loss
• Restlessness and agitation
• Anxiety
• Episodes of violent behavior

Get Immediate Help

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

How is SAD diagnosed?

If you think you may be suffering from SAD, talk to your health care provider or a mental health specialist about your concerns. They may have you fill out specific questionnaires to determine if your symptoms meet the criteria for SAD.

To be diagnosed with SAD, a person must meet the following criteria:

• They must have symptoms of major depression or the more specific symptoms listed above.
• The depressive episodes must occur during specific seasons (i.e., only during the winter months or the summer months) for at least 2 consecutive years. However, not all people with SAD do experience symptoms every year.
• The episodes must be much more frequent than other depressive episodes that the person may have had at other times of the year during their lifetime.

Who develops SAD?

Millions of American adults may suffer from SAD, although many may not know they have the condition. SAD occurs much more often in women than in men, and it is more common in those living farther north, where there are shorter daylight hours in the winter. For example, people living in Alaska or New England may be more likely to develop SAD than people living in Florida. In most cases, SAD begins in young adulthood.

SAD is more common in people with major depressive disorder or bipolar disorder, especially bipolar II disorder, which is associated with recurrent depressive and hypomanic episodes (less severe than the full-blown manic episodes typical of bipolar I disorder). Additionally, people with SAD tend to have other mental disorders, such as attention-deficit/hyperactivity disorder, an eating disorder, an anxiety disorder, or panic disorder. Learn more about these disorders by visiting the NIMH Mental Health Information page.

SAD sometimes runs in families. SAD is more common in people who have relatives with other mental illnesses, such as major depression or schizophrenia.

What causes SAD?

Scientists do not fully understand what causes SAD. Research indicates that people with SAD may have reduced activity of the brain chemical (neurotransmitter) serotonin, which helps regulate mood. Research also suggests that sunlight controls the levels of molecules that help maintain normal serotonin levels, but in people with SAD, this regulation does not function properly, resulting in decreased serotonin levels in the winter.

Other findings suggest that people with SAD produce too much melatonin—a hormone that is central for maintaining the normal sleep-wake cycle. Overproduction of melatonin can increase sleepiness.

Both serotonin and melatonin help maintain the body's daily rhythm that is tied to the seasonal night-day cycle. In people with SAD, the changes in serotonin and melatonin levels disrupt the normal daily rhythms. As a result, they can no longer adjust to the seasonal changes in day length, leading to sleep, mood, and behavior changes.

Deficits in vitamin D may exacerbate these problems because vitamin D is believed to promote serotonin activity. In addition to vitamin D consumed with diet, the body produces vitamin D when exposed to sunlight on the skin. With less daylight in the winter, people with SAD may have lower vitamin D levels, which may further hinder serotonin activity.

Negative thoughts and feelings about the winter and its associated limitations and stresses are common among people with SAD (as well as others). It is unclear whether these are "causes" or "effects" of the mood disorder, but they can be a useful focus of treatment.

How is SAD treated?

Treatments are available that can help many people with SAD. They fall into four main categories that may be used alone or in combination:

• Light therapy
• Psychotherapy
• Antidepressant medications
• Vitamin D

Talk to your health care provider about which treatment, or combination of treatments, is best for you. For tips for talking with your health care provider, refer to the NIMH fact sheet, Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider.

Light Therapy

Since the 1980s, light therapy has been a mainstay for the treatment of SAD. It aims to expose people with SAD to a bright light every day to make up for the diminished natural sunshine in the darker months.

For this treatment, the person sits in front of a very bright light box (10,000 lux) every day for about 30 to 45 minutes, usually first thing in the morning, from fall to spring. The light boxes, which are about 20 times brighter than ordinary indoor light, filter out the potentially damaging UV light, making this a safe treatment for most. However, people with certain eye diseases or people taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision.

Psychotherapy or "Talk Therapy"

Cognitive behavioral therapy (CBT) is a type of talk therapy aimed at helping people learn how to cope with difficult situations; CBT also has been adapted for people with SAD (CBT-SAD). It is typically conducted in two weekly group sessions for 6 weeks and focuses on replacing negative thoughts related to the winter season (e.g., about the darkness of winter) with more positive thoughts. CBT-SAD also uses a process called behavioral activation, which helps individuals identify and schedule pleasant, engaging indoor or outdoor activities to combat the loss of interest they typically experience in the winter.

When researchers directly compared CBT with light therapy, both treatments were equally effective in improving SAD symptoms. Some symptoms seemed to get better a little faster with light therapy than with CBT. However, a long-term study that followed SAD patients for two winters found that the positive effects of CBT seemed to last longer over time.

Medications

Because SAD, like other types of depression, is associated with disturbances in serotonin activity, antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are also used to treat SAD when symptoms occur. These agents can significantly enhance patients' moods. Commonly used SSRIs include fluoxetine, citalopram, sertraline, paroxetine, and escitalopram.

The U.S. Food and Drug Administration (FDA) also has approved another type of antidepressant, bupropion, in an extended-release form, that can prevent recurrence of seasonal major depressive episodes when taken daily from the fall until the following early spring.

All medications can have side effects. Talk to your doctor about the possible risk of using these medications for your condition. You may need to try several different antidepressant medications before finding one that improves your symptoms without causing problematic side effects. For basic information about SSRIs, bupropion, and other mental health medications, visit the NIMH Mental Health Medications page. Also, visit the FDA website for the most up-to-date information on medications, side effects, and warnings.

Vitamin D

Because many people with SAD often have vitamin D deficiency, nutritional supplements of vitamin D may help improve their symptoms. However, studies testing whether vitamin D is effective in SAD treatment have produced mixed findings, with some results indicating that it is as effective as light therapy but others detecting no effect.

Can SAD be prevented?

Because the timing of the onset of winter pattern-SAD is so predictable, people with a history of SAD might benefit from starting the treatments mentioned above before the fall to help prevent or reduce the depression. To date, very few studies have investigated this question, and existing studies have found no convincing evidence that starting light therapy or psychotherapy ahead of time could prevent the onset of depression. Only preventive treatment with the antidepressant bupropion prevented SAD in study participants, but it also had a higher risk of side effects. Therefore, people with SAD should discuss with their health care providers if they want to initiate treatment early to prevent depressive episodes.

Are there clinical trials studying SAD?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions—including SAD. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information about clinical research and how to find clinical trials being conducted around the country, visit the NIMH Clinical Trials page.

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For More Information

MedlinePlus (En español)

ClinicalTrials.gov (En español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 20-MH-8138

Seasonal Affective Disorder Vitamin D

Source: https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

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What Happens When Vitamin D Is Low

What Happens When Vitamin D Is Low

• Definition
  • What Is Vitamin D Deficiency?
• Symptoms
  • What Are Symptoms of Vitamin D Deficiency?
• Causes
  • What Causes Vitamin D Deficiency?
• Diagnosis
  • How Is Vitamin D Deficiency Diagnosed?
• Treatment
  • What Is the Treatment for Vitamin D Deficiency?
• Complications
  • What Are Complications of Vitamin D Deficiency?
• Prevention
  • How Do You Prevent Vitamin D Deficiency?
• Guide
  • What Happens When Your Vitamin D Is Low? Topic Guide

What Is Vitamin D Deficiency?

Vitamin D deficiency can cause weakness, bone pain, fatigue and even cancer in some cases. Luckily, vitamin D supplements are cheap and common and can cure the condition in many cases.

Vitamin D is a fat-soluble vitamin that helps the body absorb dietary calcium and phosphorus from the intestines and suppresses the release of parathyroid hormone, a hormone that causes bone resorption. This serves to keep the bones healthy. Vitamin D is also believed to improve muscle and immune function.

Vitamin D is made in the skin when it is exposed to sunlight. Vitamin D is also naturally occurring in certain foods such as fatty fish, cod liver oil, and eggs. It is also found on fortified foods such as cow's milk.

Low levels of vitamin D are referred to as vitamin D deficiency.

What Are Symptoms of Vitamin D Deficiency?

Symptoms of vitamin D deficiency include:

• Bone pain
• Muscle weakness
• Muscle aches or cramps
• Fatigue
• Cognitive impairment in older adults
• Severe asthma in children
• Cancer

What Causes Vitamin D Deficiency?

Vitamin D deficiency may be caused by:

• Low levels of vitamin D in the diet along with inadequate sun exposure
  • Human breast milk contains low levels of vitamin D, and most infant formulas do not contain adequate vitamin D
  • Older adults often do not eat enough vitamin D-rich foods, and when they do, absorption may be limited
  • Exposure to the sun is not recommended as a source of vitamin D for infants and children because of the potential risks of skin cancer
• Certain conditions that result in an inability to absorb vitamin D from the intestines
  • Celiac disease
  • Crohn's disease
  • Cystic fibrosis
• Surgery that removes or bypasses portions of the stomach or intestines such as gastric bypass
• An inability to process vitamin D due to kidney or liver disease
• Certain medications
  • Laxatives
  • Steroids
  • Weight loss medications
  • Cholesterol-lowering drugs
  • Anti-seizure medications
  • Tuberculosis medication

QUESTION

Next to red peppers, you can get the most vitamin C from ________________. See Answer

How Is Vitamin D Deficiency Diagnosed?

Vitamin D deficiency is diagnosed with a blood test called 25-hydroxyvitamin D or 25(OH)D (OH = hydroxy, D = vitamin D).

What Is the Treatment for Vitamin D Deficiency?

Treatment for vitamin D deficiency includes:

• Vitamin D supplements
  • Ergocalciferol (vitamin D2)
  • Cholecalciferol (vitamin D3) - vitamin D3 is usually recommended because it is the naturally occurring form of the vitamin and it may raise vitamin D levels more effectively
• The recommended dose of vitamin D depends upon the nature and severity of the vitamin D deficiency
• Additional supplements
  • Calcium - 1000 mg of calcium per day for premenopausal women and men and 1200 mg per day for postmenopausal women

Foods that are good sources of vitamin D include:

• Seafood
• Trout
• Salmon
• Sardines
• Tuna
• Meat and poultry
• Beef liver
• Chicken breast
• Ground beef
• Vegetables
• Mushrooms – white and portabella
• Dairy products
• Milk, vitamin D fortified
• Cheddar cheese
• Other
• Cod liver oil
• Plant-based milks (e.g. soy, almond, oat), vitamin D fortified
• Eggs
• Ready-to-eat cereals, vitamin D fortified

Exposure to sunlight is also another source for vitamin D but too much sun exposure can lead to sunburns, premature skin aging, eye damage, heat exhaustion or heat stroke, or skin cancer. Talk to your doctor about how much sun exposure you may need and how to get exposure safely.

What Are Complications of Vitamin D Deficiency?

Complications of vitamin D deficiency include:

• Low blood calcium (hypocalcemia)
• Low blood phosphate (hypophosphatemia)
• Rickets (softening of the bones during childhood)
• Osteomalacia (softening of the bones in adults)
• Decreased bone density (osteopenia or osteoporosis)
• Elevated parathyroid hormone (which accelerates bone resorption)
• Increased risk of falls that may result in fractures

How Do You Prevent Vitamin D Deficiency?

Prevention of vitamin D deficiency depends upon a person's skin color, sun exposure (which can be affected by the season and where a person lives), diet, and underlying medical conditions.

• Adults may be advised to take a supplement of 800 IU (20 micrograms) of vitamin D daily. Older people confined indoors may need higher doses.
• Infants and children may be advised to take a vitamin D supplement containing 400 IU (10 micrograms) of vitamin D, which included in most nonprescription infant multivitamin drops.
• Exposure to sunlight is also another source for vitamin D. Talk to your doctor about how much sun exposure you may need and how to get exposure safely.

Reviewed on 8/31/2020

References

Medscape Medical Reference

What Happens When Vitamin D Is Low

Source: https://www.emedicinehealth.com/what_happens_when_your_vitamin_d_is_low/article_em.htm

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Vitamin D Covid 19

Vitamin D Covid 19

Can Vitamin D Help Protect against COVID?

Some studies suggest an impact, particularly for those who are vitamin-deficient. But for now, the jury is out

Credit: Grace Cary Getty Images

From the early days of the COVID-19 pandemic, researchers examining the question of why some people were better protected from the infection than others began to look at a possible role for vitamin D. The nutrient, which is obtained from food and exposure to sunlight, is known to contribute to a well-functioning immune system in a variety of ways, including defending the body from invading viruses and other pathogens. "Vitamin D is cheap, easily available and relatively safe," says genetic epidemiologist Fotios Drenos of Brunel University London. Investigating whether the vitamin could make a difference in COVID patients "was an important question to ask," he says.

Researchers already knew that vitamin D can be helpful in staving off respiratory infections. A 2017 meta-analysis of 25 randomized controlled trials involving about 11,000 people concluded that giving daily or weekly vitamin D supplements reduced the risk of acute respiratory infections—with the strongest impact predictably falling on those who started off with a serious deficiency of the vitamin. That meta-analysis, led by Adrian Martineau of Queen Mary University of London, was updated this year with data from a total of 46 trials and 75,500 participants. Martineau's team confirmed its earlier finding but determined that the impact of the supplements appears to be quite small.

Epidemiological data emerging early in the pandemic also suggested that the vitamin might be useful. People older than age 65 and people of color are more likely to have lower levels of vitamin D. Both groups face a higher risk of poor outcomes from COVID-19, although the reasons for their vulnerability are multifaceted. In addition, studies have shown that countries farther away from the equator—where levels of the vitamin tend to be lower because of less sunlight—have higher COVID death rates than those closer to the equator.

Taken together, such data points are far from conclusive, but they served as a spur to investigate further. Fortunately, several large, potentially relevant studies of vitamin D were already underway when the pandemic struck, and others were swiftly begun.

In Brisbane, Australia, cancer researcher Rachel Neale of the QIMR Berghofer Medical Research Institute has been leading the massive D-Health Trial, a randomized controlled trial of five years of vitamin D supplementation in 21,315 older adults. It has compared monthly high doses of the vitamin (60,000 international units) with a placebo and has looked at a wide range of outcomes, including heart disease, cancer, bone fractures and overall mortality.  Acute respiratory tract infection has also been among the outcomes measured in the study, and with the COVID pandemic raging, Neale and her colleagues decided to examine those data early. Their analysis, published in the Lancet Diabetes & Endocrinology in January, showed that vitamin D did not reduce the risk of acute respiratory tract infection but may have slightly reduced the duration of symptoms. Neale points out, however, that vitamin D levels tend to be high in Australia because of the long hours of sunshine, so supplementation may have a lower impact there than in less sunny places.

Another researcher who started looking at the vitamin early in the pandemic—but in a more northerly latitude—is David Meltzer, a health economist and a professor of medicine at the University of Chicago.

"I got an e-mail in the first week of March [2020] talking about the [2017] Martineau paper, and I was struck by the results, particularly in people who are deficient in vitamin D," he recalls. "We had a lot of people being tested for COVID-19 in our hospital, and we had historical data from these individuals, so we cross-referenced the positive tests and the vitamin D data on record."

The results in a diverse population of 4,638 people were published in JAMA Network Open this past March. Meltzer and his colleagues found that the risk of a positive COVID test was 2.64 times greater for Black individuals with low levels of vitamin D than for those with higher levels. There was no significant correlation in white participants. "Chicago has long winters, and people with darker skin produce less vitamin D. Our northern location and the predominance of Black people attending the hospital allowed us to spot the link," Meltzer observes.

In England, Drenos also took a look at D levels and the risk of COVID infection but used a different methodology. He studied a group of people of European ancestry in the UK Biobank who were genetically predisposed to high or low levels of vitamin D and looked for correlations between their levels of the vitamin and their SARS-CoV-2 infection risk and COVID-19 severity. Like Neale's trial and in contrast with Meltzer's study, Drenos's analysis, published in January, showed no evidence of a preventive effect of higher vitamin levels. Still, he says, "I am keeping an open mind. I believe that large, well-controlled trials will be the gold standard, but this takes time."

The lack of a clear answer from existing studies could reflect limitations in trial design, including populations that are already replete with vitamin D, sample sizes that are too small or inconsistencies in doses or methods of measurement. Some forthcoming trials may help fill in the gaps.

The U.K.'s CORONAVIT trial, with 6,200 participants, is looking at whether correcting vitamin D deficiency during the winter with a standard or high dose of the vitamin will reduce the risk or severity of COVID-19 and other acute respiratory infections. In France, the smaller CoVitTrial is assessing the impact of a single high dose or routine dose of vitamin D on high-risk older adults with COVID-19. Results of both trials should be available later this year.

Meanwhile Meltzer is leading three studies of vitamin D supplementation in populations with mixed ethnicity: one investigation in medically complex patients, a second in health care workers and a third that is community-based. They will assess the impact of various dosages of the vitamin on COVID-19 symptoms and antibodies, as well as on symptoms of other respiratory diseases.

Given the results of Neale's large-scale study and the modest benefits found in Martineau's latest meta-analysis, it seems unlikely that vitamin D will prove to be a critical ingredient in fending off COVID-19 or modulating its severity. But these and other new trials may find it is useful in certain doses for certain populations. As Neale points out, "there is data that is suggestive" and enough smoke to indicate that you don't want to be vitamin-D-deficient in a pandemic.

This article is part of an editorially independent Springer Nature collection that was produced with financial support from Lonza .

Suzanne Elvidge is a freelance medical writer specialising in the pharmaceutical and biotechnology industries. She lives in the Peak District in the UK.

Vitamin D Covid 19

Source: https://www.scientificamerican.com/article/can-vitamin-d-help-protect-against-covid/

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