A Holistic Approach to Shaking the Winter Blues

Here’s another installment in our Healthbooks series discussing the late winter energy and how it affects many of us. You can read the inaugural article here, dig into nutritional approaches to late winter health, hear more perspectives on SAD and learn about how movement – especially Qigong – might help during this sometimes challenging time. For now, enjoy the new article.

CrocusI’m in love with springtime in Portland.

Already the Daphne buds are beginning to open and purple crocuses are popping up out of the wet earth. The sweet smells and the long succession of flowers emerging fills me with relief and joy. It always seems like a miracle, this annual return of beauty, after a season of bare branches, dormant gardens, and cold, damp weather!

But this time of year in Portland is confusing too!

As soon as I see and smell these early flowers I think, Spring is here! The ordeal of Winter is over! And then it continues to be grey, wet, and cold for much of the next several months. This late-winter limbo can be hard to endure.

Do you notice that you experience a significant mood change during the winter months? During an extended period of reduced natural sunlight, some people suffer from Seasonal Affective Disorder or, SAD. It is a type of depression that comes on in the winter months and lifts in the spring or summer. Mental/emotional symptoms may include sadness, anxiety, hopelessness or pessimism, feelings of guilt and worthlessness, helplessness, irritability and restlessness, and/or a loss of interest in pleasurable activities you used to enjoy. One may also experience difficulty concentrating, remembering details or making decisions and even have thoughts of death or suicide. Physical symptoms may include fatigue and decreased energy, difficulty sleeping or oversleeping, changes in appetite and changes in weight.

Clearly, with symptoms like these that have such a huge impact on a person’s quality of life and well-being, it’s important to treat SAD.

There’s a lot you can do to shake off the winter blues!

naturewalkFirst of all, take yourself by the hand and get outside to take a walk through the neighborhood or in nature, or putter in a garden. Make sure that there is movement in your life (preferably something you love to do!).

Seek more sunlight, set up a light box, and take your vitamin D. Do your best to eat and sleep well, and to reach out to others. Consider massage or acupuncture. Talk to a doctor to rule out other causes of your symptoms and to customize a treatment for you. Get to know a new herb or two.

Here, I’ll outline how I work with patients to assess cases and give an idea of what a treatment plan might include.

First, I take the time to really get to know each patient. Of course, I‘ll ask about a person’s present symptoms, their medical history and family history and what medications and supplements they are taking or have taken in the past. I’ll also want to know about a person’s diet, physical activity, sleep, relationships, life-stressors, use of alcohol or recreational drugs and the ways they practice self-care.

I’ll usually order lab tests. When a person suffers with symptoms of depression, it’s wise to rule out physiologic causes like anemia, hypothyroid, blood sugar imbalances, or vitamin D or B vitamin deficiencies. In some cases I will also rule out other hormonal imbalances. All of this information helps me to evaluate and reach an accurate diagnosis and then tailor a treatment to a specific patient. 

A comprehensive treatment plan to treat SAD would begin with dietary recommendations to optimize nutrition and keep blood sugar balanced, along with a customized exercise plan. I would also address sleep problems and provide counseling pertaining to self-care and stress reduction.

I would prescribe dietary supplements that have been proven to be supportive, including a methylated B complex, vitamin D3, omega 3 fatty acids, and probiotics. I would also do acupuncture.

Acupuncture has also been shown to be very effective in treating depression.

Results have proven as effective as Prozac and appeared weeks earlier, without the side effects of the medication.

I would discuss light therapy. Research has shown light therapy can also perform as well as Prozac for SAD. I educate patients on what kind of light box they should get, as well as advise them on the positioning of the light and timing of treatments. Also, I would offer referral to counselors or psychiatrists as needed.

Herbal medicine is one of my favorite treatments. I love to create herbal formulas customized to each patient. I have found that herbs alone can keep some people from dipping into seasonal depression, and treat SAD and depression in cases that are mild.  There are two herbs that deserve special mention in treating SAD: St. John’s Wort and Lemon Balm.

The Latin name for St. John’s Wort is Hypericum perforatum. Hypericum comes from the Greek word hyperikon which combines the two words, hyper, meaning ‘over’ and eikon, meaning ‘image or apparition’, a reference to the belief that the herb could ward off evil spirits. Interesting, isn’t it, that today it’s used to ward off our inner demons of depression and dispel the darkness of seasonal affective disorder?

St. John’s Wort has a sunny yellow flower whose common name refers to the fact that it historically blooms on or near St. John’s Day, or Summer Solstice, also known as Midsummer. It blooms at the time of year when the sun is highest and the days are longest, and it seems that it also imparts the sun’s qualities of brightness and energy to us when we ingest it as well. St. John’s Wort has been studied extensively for the treatment of depression and anxiety, and for treating SAD.

St._John's_Wort_(5976542341)It has been found to be a safe and very effective treatment for these conditions.

It has been found to positively affect the neuroendocrine system in multiple ways, increasing serotonin, norepinephrine and dopamine, as well as influencing levels of glutamate and GABA. For an adult, the recommended dose of St. John’s wort is 300mg, three times per day. As a tincture, 20-30 drops, three times per day, is recommended.

Because St. John’s wort is so effective at increasing serotonin levels in the brain, it is not a safe treatment for people who are already on SSRI (selective serotonin re-uptake inhibiting) antidepressant medications, as together they could increase a person’s serotonin to a dangerous level. This is an herb where care should be taken if a patient is on ANY prescription medication.

St. John’s wort ‘up-regulates’ a couple of liver detoxification pathways, meaning it could cause the body to break down medications too quickly and reduce their effectiveness, including reducing the effectiveness of oral contraceptives. Take extra care with sun exposure while taking St. John’s wort, as it can increase sun sensitivity and sunburn.

St. John’s wort also has anti-inflammatory, antiviral and antibacterial effects. Research has also shown it to be helpful in treating symptoms of PMS, menopause, OCD and social phobia. It also can be used topically to help eczema and minor irritations and injuries to the skin.

Melissa_officinalis_Lemon_balmThe other herb that I love to use to treat SAD is lemon balm, Melissa officinalis. The Latin Melissa means ‘bee’, and indeed, bees are delighted by the unassuming but sweet-smelling Melissa flowers when they bloom. Part of the Laminacea, or mint family, lemon balm gets its common name because of it’s lemony scent and flavor. It’s leaves are full of fragrant essential oils, which rub off on your fingers and make lemon balm tea delicious. Ancient nicknames for lemon balm are ‘heart’s delight’ and ‘the gladdening herb’.

 An old Arabian proverb says that “balm makes the heart merry and joyful”.

It is an herb that is both uplifting and soothing to the spirits, and it was traditionally used to treat ‘melancholy’. Lemon balm is gentle and safe enough for babies and children, as well as adults. Used in combination with other herbs, it’s helpful in treating anxiety and insomnia due to nervousness.

Lemon balm can boast many other health benefits, such as it’s soothing effect on digestion, and it’s antiviral abilities. One caution with taking lemon balm is that it can have a thyroid-suppressing effect if taken in very large amounts. In fact it is used in some cases where the thyroid gland is overactive.

Tea-TimeAs I mentioned before, lemon balm makes a lovely tea. The ritual of preparing a pot of tea for oneself and stopping to sit and sip a fragrant, steaming cup adds to the healing. Pinch or snip off the tops of the fresh plant and add a large handful to a teapot or mason jar, fill with boiled water, and allow to steep, covered for at least 20 minutes. If using dried loose leaf lemon balm tea, add one tablespoon of herb per cup of hot water. Traditional Medicinals also makes an organic lemon balm tea in teabags that I recommend. Drink a cup 2-3 times a day.

St. John’s wort, however, is best taken as a tincture, which is an alcohol and water extraction, or encapsulated.

Whenever you take herbal medicine it’s critical to be aware of the source and quality of the herbs. Unfortunately, the supplement industry is so poorly regulated that herbal products often contain ineffective or dangerous ingredients, and often do not actually include the herb that is listed on the label. I usually recommend Herb Pharm as a source of good quality herbal medicine. With it’s bright orange labels, it’s easy to find in health food stores. I personally know the owner, and trust the expertise and integrity of this company completely. Vitanica, Oregon’s Wild Harvest, Gaia, Mountain Rose and Urban Moonshine are other excellent sources of herbs.

If you find yourself inspired to, you can also learn to make your own medicines. Both St. John’s wort and lemon balm grow happily and like weeds in the Pacific Northwest. You’re likely to spot lemon balm growing along the sidewalk as you walk through Portland’s older neighborhoods. You’re more likely to find St. John’s wort in an abandoned lot or field. They’re both distinctive enough to easily identify once you know their distinguishing features. They’re both abundant and easy to harvest for making into medicines for yourself.

Wishing you well. Hang in there. The days are getting longer, and the flowers are starting to open. This too shall pass.

 

 

Written by Ann Holland


I’m a general practitioner experienced in treating all types people for all types of conditions. I’m trained as a naturopath, an acupuncturist, an herbalist, and a yoga teacher, which gives me a lot of tools in my toolbox! My favorite healing modality is love. I have seen how cultivating a caring and compassionate relationship with patients is the very best medicine.