Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. If you live in East Tennessee, as I do, you know that it has been raining a lot lately. As I am writing this Note, we haven’t seen the sun in about a week which was the prompt for today’s topic: Seasonal Affective Disorder (SAD), better known as the holiday/winter blues. 


Seasonal Affective Disorder (SAD) 


To some degree, all of us have experienced Seasonal Affective Disorder (SAD). As the weather turns from warm and sunny to cold and murky, so does your mood! But for some people this can be more severe, especially over the holidays. 

Seasonal Affective Disorder (SAD) is a type of depression related to changes in seasons, usually occurring in late fall and winter. This could be for several reasons, but the most common one has to do with our circadian rhythms, the “24 hour clock” that regulates our energy levels. It’s very important.    

Circadian rhythms are regulated by hormones (like cortisol, melatonin, serotonin). When these get off balance, people get emotionally depressed and sometimes anxious. On top of that, if you’re older, you might not have the correct hormone balance of estrogen, progesterone, testosterone, and DHEA in the first place. This can make it even worse. Note: A lot people going through menopause or andropause have sadness in their lives when the holidays come. I work with hormones all day and see this a lot! 

It’s been even more difficult over the last few years. People are accustomed to being isolated (out of fear), and our immune systems are suffering as a result. As humans, we are social creatures. We need each other! Depression and suicide (especially among younger people) is way higher than it was a few years ago. Young people need social contact even more than older people, like myself. So, it’s been particularly difficult for the younger generation.


Signs Of Depression


When looking for signs of depression, either for yourself or others, listen to family and friends. They’re usually right. They’re going to notice something about you, even before you notice it.

There’s no accurate test to diagnose depression. It’s really a combination of symptoms. The main one, in my opinion, is that you don’t enjoy things like you used to.  

Other symptoms: 

  • Irritability 
  • Decreased libido 
  • Difficulty sleeping (early morning awakening is a hallmark of depression)
  • Feeling sad or hopeless 

I think we all recognize some of these symptoms. If you start to notice that you have some of these (or if your family starts noticing it), then you need to talk to somebody because it can lead to serious medical problems. 

I strongly believe that a lot of autoimmune illnesses are kicked off by depression. Depression affects the gut, and the gut is where the majority of your immune system is located. Depression and anxiety creates real diseases. Remember, there’s always a trigger. 

Twenty percent of Americans have what we call the “winter blues”, which is really seasonal affective disorder. And that’s probably underestimated. Now, with everyone’s immune system already low, it’s even worse. With the flu and everything else going around right now, it may be a difficult and long winter for a lot of people. Why am I talking about this now? It’s mid December, and I want you to be prepared for it. 


What Can You Do?  


The number one thing is to recognize SAD and prepare. If you’re prone to depression, anxiety, or bipolar illnesses, you need to get ready. 

  • Engage with other people. Tell people about your problem. Go to the doctor if you think it’s a serious problem. Note: if you think it is, it usually is. At Performance Medicine we have a psychologist, Dr. Robyn Branca, who deals with a lot of this. 
  • Do things that are new for you. For example, join a bowling league or take up pickleball. Be a volunteer for somewhere that matters. Since it’s winter, think of good winter activities. I’m playing more guitar this winter. I’m learning how to make sourdough bread (the only bread I eat anymore) and having fun with it! I’m the type that can’t really even cook an egg, but under the direction of Steve Nice, I’m learning how to bake sourdough bread! It’s been good for me!
  • Look at your diet. This is another thing you can do to prevent depression and seasonal affective disorder. People that are depressed crave comfort foods, especially around the holidays. Note: sugar is the number one toxin we deal with. Depressed people crave carbohydrates, so be aware! We’re all prone to eating worse over the holidays! In fact, the average American gains 8 pounds between Thanksgiving and New Year’s. I’m not saying that you need to totally avoid holiday treats. You’re not going to do that. What I am saying is be aware of this, and eat less of the bad stuff. This also applies to drinking excessive alcohol. Alcohol is a depressant. It’s also a weight gainer. 
  • Get outside and walk. There’s no excuse for not getting outside. You can bundle up. You need to exercise. Exercise is the best health tool that you will ever find, mentally and physically. Note: It’s not a great weight loss tool, but it is so good for you! 

If I don’t get my exercise in…

  • I don’t have energy
  • I don’t sleep well
  • I don’t feel good
  • I’m irritable 
  • I lose muscle

So, put exercise into your routine and get a good night’s sleep. Yoga is great, especially in the winter. In the summer I like biking and hiking. I always have resistance training in my exercise routine. That’s important, especially as you get older. Muscle strength equals bone strength and brain strength. 

  • Since there’s less sun out, I recommend LIGHT BOXES. I have a couple of these in my office. They’re inexpensive. They need to have 10,000 lux. Start with about 20 minutes. The best time to do this is probably first thing in the morning, but you can use them at any time. They’re not just light bulbs, they’re special lights. If you are really suffering, this is a good non pharmaceutical way to reverse depression.
  • There’s also something called a dawn simulator. I’ve recently purchased this myself. It’s like an alarm clock. It just uses light. It gets brighter as the sun naturally comes up. This slowly wakes you up instead of the jarring buzz of an alarm clock. This is a great holiday gift by the way. Note: I also love an Oura Ring as a healthy gift idea. 


Antidepressants and Supplements 


I don’t prescribe antidepressants nearly as much as I used to, but I still use them when needed. I will usually try other things first, unless it’s really severe. If a patient is having panic attacks and extreme anxiety, sometimes I will prescribe an SSRI (Serotonin drug). Rarely, I will use pure anti anxiety medicine. As for supplements….

  • I use a lot of Saffron. This is an over the counter supplement that’s actually a spice. This is very safe. I love it and take it myself. I’ve prescribed it a lot for anxiety and depression, but it’s also a good weight loss supplement as well. That’s what I first used it for years ago. Check out the literature on this. It works as well as Prozac, probably better and without the side effects. Note: A lot of the SSRIs can cause side effects, and pure anti anxiety drugs can be very habit forming
  • I also like CBD. I have my own formulas in my offices. 
  • I like Melatonin for sleep. You need to work with the correct dose. Some people have to take more than you would think. It’s safe and it kind of mimics your natural circadian rhythms. 
  • Take Vitamin D. Please! You don’t know your vitamin D level unless you do a cheap blood test for it. It always comes on the Cleveland Heart Panel. It’s the most important supplement you will ever take. I like Vitamin D with Vitamin K. 

Note: Vitamin D is actually a hormone. We’ve talked about this many times. Taking Vitamin D helps you in so many ways. It can help prevent cancer and diabetes. It can also protect your heart. It boosts your immune system. Please get your levels checked, especially in the winter (your levels will be lower in the winter).

  • I like Aromatherapy with diffusers. I think essential oils are great. 


Healthy Winter Routines


Get a routine! One thing about successful, healthy people is that they all have routines. Go to bed at the same time each day and wake up at the same time. Exercise at the same time (which you need to do in some form daily). If you can, take a week off in the winter time. I like to take a vacation in the middle of winter to warmer weather. I do this every year and it really seems to rejuvenate me. 

The winter time is such a good time to reboot yourself. It’s a good time to go to your doctor for routine checkups and routine tests if you’ve been putting anything off (i.e., mammograms, colonoscopies, minor surgeries, etc.).  

Get your skin looked at. I always use 5FU on my skin every year starting around Christmas. It gets rid of actinic keratosis, which ages your skin and can turn into skin cancer. If we live long enough, all of us will probably have some sort of skin cancer (hopefully, not a melanoma). I’m a really big believer in using 5FU during the winter. Note: Winter is a great time to see one of our aestheticians for other great facial treatments.   

It’s a great time to learn how to cook different things. Our Nutrition Coach, Lucas Schmidt, offers winter cooking classes that teach you how to create healthy meals that taste great, without the sugar! 


Closing Thoughts


Embrace the winter. Don’t just tolerate it. Winter is a good time to reinvent yourself. Do a lot of reading and studying. People who have a positive attitude and outlook are much more healthy than those with a negative attitude. 

If you think you may have Seasonal Affective Disorder (or any kind of anxiety or depression), TALK TO SOMEONE. This is the time to take corrective measures and reboot yourself. Get the Cleveland Heart Panel to see where you stand. Note: You can’t be a family doctor for 36 years and not see some form of depression every day in your office. 

Enjoy the holidays. Enjoy the winter. It can be wonderful!

Till next week.