Seasonal Affective Disorder (SAD): Symptoms, Causes, and Treatment

Seasonal affective disorder is a type of depression that occurs in the winter in countries that are far from the equator.

Also known as SAD, it is sometimes referred to as winter depression. As winter approaches, the mornings start later and the evenings begin earlier, so there is less sunlight each day. Experts say SAD is most likely caused by lack of sunlight alone and not by cold temperatures.

Depressive symptoms usually build up slowly as days start getting shorter, and they gradually subside in early spring, as the amount of sunlight rises each day.

Fast facts on SAD:

  • SAD did not receive a clinical name until the early 1980s.
  • The symptoms of SAD are similar to those of depression.
  • Common symptoms include low mood, lethargy, and social withdrawal.

What is SAD?

SAD (seasonal affective disorder) is a common seasonal issue affecting people who don't get enough natural sunlight.

SAD (seasonal affective disorder) is a subtype of depression.

SAD was first mentioned in scientific literature in 1845 but the condition did not get a clinical name until the early 1980s.

We know that seasonal variations in sunlight have an impact on animal behavior, for example, hibernation, reproduction, and seeking out a mate. Seasonal changes in sunlight affect our circadian rhythms, which are also referred to as our internal biological clocks.

SAD is thought to affect 4-6 percent of people in the United States and is more common among young adults with onset typically between 20-30 years of age. It is often seen in females more than males, although depression is more common, generally, in females.

It also occurs more in areas that are further north. For example, it is seven times more common in Washington State than in Florida.

Interestingly, people can have SAD during the summer, although this is rare.

Symptoms of SAD

The signs and symptoms of SAD are similar to those of depression, but they come on as winter approaches and go away during springtime. In the majority of cases, symptoms come back each year at around the same time.

Symptoms are usually mild as autumn advances, and they worsen as the number of daylight drops. The severity, characteristics, and patterns of SAD can vary considerably from person-to-person.

About four-fifths of people who experience SAD develop unipolar depression, while the rest have bipolar depression. Unipolar means they have persistent depressive symptoms, while bipolar involves swinging from high or manic periods to very low or depressive ones.

The signs and symptoms of SAD include:

  • anxiety
  • feeling guilty and worthless
  • feeling stressed
  • indecision
  • irritability
  • low moods and despair
  • reduced libido
  • crying
  • lethargy, fatigue, hypersomnia
  • increased appetite
  • social withdrawal
  • difficulty concentrating
  • weight gain

Symptoms of spring and summer SAD

Insomnia is a common symptom of spring and summmer SAD.

Insomnia is a common symptom of spring and summer SAD.

Rather than feeling depressed during the winter, some people have symptoms in the spring and summer. This type of SAD is rare, but symptoms can include:

  • insomnia
  • low mood
  • reduced appetite
  • weight loss
  • anxiety
  • agitation

Who has a higher risk of developing SAD?

There are factors that can affect who gets SAD and who is less likely to have the condition.

Sex – females are more likely than males to suffer from SAD, although this may be due to a greater prevalence of depression among women. Males may have more severe symptoms.

Geography – some studies suggest that the further someone lives from the equator, the higher the chances of developing SAD. Put simply, those who live in places where days are considerably shorter in winter are more susceptible.

Genetics – individuals with a close relative who has or had SAD have a greater risk.

Having, or having had depression – people with a history of depression or bipolar depression are more likely to develop SAD than those with no such history.

Causes of SAD

Experts are still unsure of the exact causes of SAD. However, studies have pointed to the following:

  • Circadian rhythm – our body clock. Each of us has an internal body clock that tells us when to be awake and asleep. Less sunlight in the winter is thought to disrupt our circadian rhythm, causing depressive symptoms.
  • Melatonin levels – melatonin is a hormone that influences our sleep patterns and mood. Experts believe that reduced exposure to sunlight through shorter days in winter disrupts our melatonin balance. People with SAD also have decreased serotonin levels during the winter months.
  • The hypothalamus – sunlight is thought to stimulate the hypothalamus, a part of the brain that controls sleep, mood, and appetite, all of which impact on how we feel. Similarly, production of serotonin, a brain chemical (neurotransmitter) that affects mood, may be affected by low sunlight.

Diagnosis of SAD

The doctor may carry out a physical exam and ask questions covering:

  • How long symptoms have been present, how severe they are, and how they affect daily activities.
  • What eating patterns are like.
  • General lifestyle questions.
  • Sleeping patterns and if they have changed.
  • How thoughts and behaviors change with the seasons.
  • Details about family medical history, such as depression, SAD, etc.

As there are several types of depression, diagnosing SAD accurately may take time. There is no medical or laboratory test that can diagnose the condition. The doctor may order some diagnostic tests, including blood tests, to rule out other illnesses or underlying conditions.

The American Psychiatric Association do not class SAD as a separate disorder under the DSM-5 criteria, but a “course specifier.” They refer to it as “depression with a seasonal pattern.”

Treatments for SAD

According to the American Psychiatric Association, people may alleviate SAD symptoms by boosting their exposure to sunlight. For example, going for long walks outdoors when there is still some sunlight could help.

The National Institute for Health and Care Excellence (NICE) in the United Kingdom recommend that SAD treatment should be the same as for other types of depression, involving psychosocial and antidepressant medication.

Bright light therapy

If symptoms are so severe that they affect a person’s daily life, light therapy is sometimes recommended. Bright light therapy, also known as phototherapy, can help restore circadian rhythm.

With this kind of therapy, a person sits in front of a special light for 30-90 minutes each day. It is important to purchase a light box that is designed for treating SAD. UV lamps, full-spectrum lights, and tanning lamps will not do the same job.

In general, light therapy is required from 30 minutes to 2 hours per day, depending on the strength of the light. Doctors say exposure in the mornings tends to give the best results.

A similar treatment is known as dawn simulation when a special light in the bedroom is programmed to get slowly lighter in the mornings, to simulate dawn.

Experts say this type of phototherapy also helps restore brain chemistry balance. Nobody is sure how all this occurs.

Psychotherapy

Although SAD involves a change in a person’s brain chemistry, therapy that focuses on mood and behavior can also help.

Cognitive behavioral therapy (CBT) is based on the premise that it is how a person thinks and reacts to things that cause unhappiness rather than the situation. For example, if the way a person perceives certain situations can be altered, their behavior will change, and their symptoms will be reduced.

CBT usually includes an individual program of self-help, and another for the person and their partner, if appropriate. Sometimes a group program can also be helpful.

Medication

A doctor may prescribe an antidepressant, usually a selective serotonin reuptake inhibitor (SSRI), which raises serotonin levels.

Antidepressants do not work straight away; they can take from 10 days to 1 month to work well. Experts say antidepressants for SAD are more effective if taken at the beginning of the SAD season before symptoms appear. Usually, they are taken daily until springtime.

People should always follow their doctor’s instruction when taking these drugs.

Self-help

Some people have found that making their environment sunnier and brighter helps alleviate symptoms. Examples include opening blinds and curtains, trimming trees around the house, and sitting closer to the window during daytime.

Even in winter, the sun still comes up, and there is more sunlight outdoors than indoors. So, getting out every day for a long spell in the open air may help.

Similarly, exercise is not only good for the health but alleviates symptoms of anxiety and aids proper sleep. Exercises can also help people nurture a better self-image, which tends to lift their mood.

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Oral Allergy Syndrome: Foods, Symptoms, and Treatments

Oral allergy syndrome is an allergic reaction that specifically affects the mouth, lips, tongue, and throat. It is related to allergic rhinitis, otherwise known as hay fever.

In oral allergy syndrome, the body cross-reacts to certain proteins in specific foods. These proteins are similar to the proteins found in the pollens that are associated with hay fever and seasonal allergies.

As these foods are typically available throughout the year, oral allergy syndrome is not seasonal.

Causes

[hand holding birch emitting pollen]
Many food allergies are, in fact, cross-reactions to allergies caused by pollen.

Proteins are found in all organic matter. The immune system identifies specific proteins in order to target bacteria, viruses, and other unwanted germs. However, it sometimes identifies everyday proteins, such as pollens, as harmful as well.

After being eaten or breathed in, these proteins are available in large numbers and the immune system identifies them as abnormal. The body reacts with a significant immune response, which leads to swelling, various other allergy symptoms, and discomfort.

For many, the key signs of oral allergy syndrome are swelling and itchiness of the lips, mouth, tongue, and throat immediately after eating certain fruits and vegetables, especially when raw.

Experts estimate that more than 60 percent of all food allergies are actually cross-reactions to pollen allergies. The most common cause of allergic rhinitis in the United States is birch pollen. However, multiple trees, grasses, and weeds can cause it as well.

Typically, oral allergy syndrome can be traced back to an allergy to the following:

Trees

  • birch
  • alder
  • Japanese cedar
  • plane

Grasses

  • Timothy
  • orchard grass

Weeds

  • wormwood
  • ragweed
  • mugwort
  • Parietaria species

Common foods that cause oral allergy syndrome

As there is a wide range of potential causes of allergic rhinitis, there is also an extremely varied range of fruits and vegetables that cause oral allergy syndrome.

Similarly, different fruits and vegetables may cause a different response depending on the type of pollen the immune system cross-reacts to. According to a paper in the Journal of Allergy, typical foods that may cause a reaction include:

[woman vehemently refusing nuts]
Nuts such as peanuts and walnuts are common allergens and can cause mild to severe symptoms.

Fruits

  • Prunus genus: cherries, nectarines, peaches, plums, apricots
  • apples and pears
  • mangoes
  • bananas
  • figs
  • avocados
  • strawberries
  • raspberries
  • kiwis
  • watermelons
  • melons
  • oranges

Vegetables

  • Apiaceae family: celery, carrots, parsley, parsnips, cilantro, cumin, dill, chervil, and fennel
  • Nightshades: tomatoes, potatoes, and peppers
  • Cucurbitaceae family: pumpkins, butternut squashes, zucchini, cucumbers
  • lettuce
  • corn
  • artichokes
  • peas

Others

  • hazelnuts and walnuts
  • peanuts
  • chickpeas
  • wheat
  • soy
  • almonds
  • lentils
  • sunflower seeds
  • honey

Symptoms

Symptoms of oral allergy syndrome only occur after eating specific foods. The symptoms vary significantly and can peak at different stages of life.

Mild symptoms include:

  • itching of the throat, mouth, lips, or tongue
  • swelling, particularly of the lips and tongue

More severe symptoms include:

  • swelling of the throat
  • nausea and vomiting

Additional symptoms can include hives and asthma. Typically, hives occur when the food is being peeled, chopped, or grated. Asthma occurs when the food is being blended or otherwise vaporized, such as during stir-frying.

Those who experience more severe symptoms should see their doctor.

Diagnosis

Diagnosing oral allergy syndrome often involves several steps. Typically, these include clinical and laboratory methods.

Clinical

Clinical methods are the most common. Diagnosis requires confirmation of allergic rhinitis along with itching and tingling that develops after eating fresh fruit or vegetables. In many cases, an accurate patient history shows a link between eating a specific type of food and the start of tingling or swelling.

In other cases, the doctor may propose an elimination diet. The person avoids specific food groups that may cause oral allergy syndrome for a set amount of time and records whether it makes a difference.

Laboratory

[a doctor does an allergy test on a patient's arm]
A dermatologist can diagnose allergies by using a prick test and measuring the level of reaction.

Laboratory tests typically involve skin testing via a prick test, a scratch test, or a blood test. For skin testing, a dermatologist marks out a grid on the back or the forearm and applies extracts of pollens, fruits, or vegetables. Any marks that develop on the skin are measured after 15 minutes to determine the level of reaction.

If prick tests with the pollen are positive but the food itself fails to provoke a reaction, the person may be asked to eat a certain amount of the suspected food. A reaction immediately after eating this food will confirm the presence of oral allergy syndrome.

In some cases, blood tests might be used to diagnose the condition. First, the doctor performs a test to work out the total level of antibodies in the blood. Another test then checks for specific antibodies. Blood tests are often used when skin tests are not available or practical.

Treatment and lifestyle tips

There are no standard treatments for oral allergy syndrome other than avoiding specific foods that are associated with allergy symptoms. Careful management of diet can ensure that people with the syndrome can lead otherwise normal lives. People with oral allergy syndrome should explain the condition to others to help them understand what foods are off-limits.

In the event of an allergic reaction, initial treatment generally involves rinsing the mouth with water and then resting. Hot drinks can also destroy some proteins, and so inactivate them.

Antihistamines typically take 1-2 hours to work, while the effects of oral allergy syndrome typically start to wear off after about 30 minutes. However, an antihistamine can prevent effects from lingering and should be taken as soon as the reaction occurs.

In some cases, it may be possible to make the immune system less sensitive to the allergen through immunotherapy or allergy shots. This is especially useful when a single allergen is involved. Under-the-skin delivery of immune therapy is currently being studied as a treatment option for oral allergy syndrome.

Does cooking foods help with oral allergy syndrome?

In some cases, cooking foods can destroy the proteins that cause oral allergy syndrome. However, this depends on the foods that trigger the allergies.

In general, nuts and spices are exceptions to the cooking rule. Nuts contain multiple allergens and not all of them are destroyed by heat. The same applies to celery. Allergens in strawberries are also resistant to heat.

Pasteurized fruit juices are generally okay as they have been heat-treated. However, some smoothies may contain raw, unpasteurized juices or purees. These are best avoided if any of the ingredients are triggers.

However, most foods are made sufficiently safe by cooking. Examples include tomatoes, apples, potatoes, pears, and most soft fruits.

Lifestyle tips

In many cases, avoiding the food completely is the only sure way to prevent the symptoms of oral allergy syndrome. However, there are some methods that people may wish to try so they can enjoy their favorite foods.

Lightly microwaving fruits – particularly apples – for about 1 minute and then chilling them immediately may reduce the effects of oral allergy syndrome to a manageable level. This process can remove the main proteins that cause reactions.

In addition, there is usually plenty of these proteins in the skin, so peeling fruits before consuming them may reduce reactions significantly.

Wearing gloves when peeling fruits can reduce the symptoms of hives. Not stir-frying vegetables can also reduce the risk of asthma.

People with oral allergy syndrome often find that their symptoms worsen during pollen season so they may wish to avoid trigger foods at the peak of that season.

In addition, managing seasonal allergic rhinitis correctly is key to coping with oral allergy syndrome symptoms. This is normally done with antihistamines and a steroid nasal spray 2 weeks before the season is due to start, and then regular use throughout.

What Is Leaky Gut? Causes, Symptoms, and Relief

A leaky gut is characterized by perforations in the intestinal wall that allow molecules or microorganisms to pass through into the bloodstream. The phenomenon is a profound failure of the intestines’ duty to act as a protective barrier. Leaky gut syndrome is difficult to diagnose; many physicians do not know to look for it when diagnosing patients who are experiencing a complicated array of symptoms.

What Exactly Is the Gut?

The gut encompasses the intestinal mucosa (lining), the microbial community (and its genes) in the intestines, and the immune system and nerves. In addition to being the most important organ in the digestive system, the intestines are the largest immune organ, with roughly 2,700 square feet (or 250 meters) of surface area. Eating or drinking exposes this tennis court-sized area to the outside world. The digested molecules (micro-, macro-, and phytonutrients) in food are supposed to filter through the intestinal mucosa, which is made up of the epithelial cells on the surface of the small intestine. The contents of the intestines are supposed to remain in the intestinal lumen and continue the journey to the colon. But, with a leaky gut, the contents of the intestine can slip, unregulated, between the epithelial cells of the intestine.

The spaces between the intestinal cells, known as tight junctions, are supposed to form a seal between the inside of the intestinal lumen and the rest of the body. When the tight junctions aren’t tight enough, things slip past the intestinal gatekeepers and into the bloodstream. From here pathogens, toxins, and antigens can circulate throughout the body, wreaking havoc and provoking a systemic inflammatory response. The loose gaps between the cells in the intestinal mucosa are associated with a myriad of conditions and syndromes including:

  • Inflammatory bowel disease (IBD)
  • Irritable bowel syndrome (IBS)
  • Type 1 diabetes
  • Rheumatoid arthritis (RA)
  • Food allergies
  • Celiac disease
  • Asthma
  • Autism
  • Parkinson’s

What Causes Leaky Gut?

The tight junctions are not a perfect barrier. A number of factors can cause them to relax or contract—diet, medication, hormones, inflammation, and more. When the tight junctions relax or contract, their function may be disrupted.

1. Diet

Few things affect health as much as diet. Several primary offenders appear to contribute to the development of leaky gut:

  • Alcohol: When the human body metabolizes alcohol, the metabolic product acetaldehyde can increase intestinal permeability.
  • Sugar: Sugar and artificial sweeteners cause inflammation that compromises gut health. Additionally, a urine analysis that measures glucose in the urine is a useful indicator of the severity of leaky gut.
  • Dairy: Dairy products are linked to gastrointestinal disorders—–particularly among individuals on the autism spectrum.
  • Gluten: Consumption of gluten contributes to increased intestinal permeability in those with gluten sensitivity.
  • Additives: Industrial food additives such as emulsifiers, solvents, microbial transglutaminase, glucose, and salt contribute to leaky gut syndrome.
  • Pesticides: Glyphosate disrupts gut bacteria, which can contribute to the development of intestinal permeability.

    2. Candida

    Several species of candida are known to disrupt the makeup of the gut microbiota. The resulting imbalance in the microbiota is called dysbiosis. These disturbances can lead to the development of digestive disorders including leaky gut.

    3. Chronic Stress

    It’s no secret that stress negatively affects your health but it’s especially taxing on gut health. Psychological stress increases the presence of inflammatory cytokines, a class of signaling proteins created by the immune system that contributes to the development of leaky gut. Animal studies have shown that both psychological and physical stress compromise the integrity of the intestinal barrier.

    4. Environmental Toxins

    The environment is flooded with harmful chemicals and substances, many of which pose a significant risk to your health. Mercury, BPA, fungicides, and insecticides can all negatively affect intestinal permeability.

    5. Medications

    Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen have demonstrated a tendency to increase intestinal permeability and provoke inflammation.

    6. Zinc Deficiency

    Zinc is an essential trace mineral that supports the immune system and plays a significant role in irritable bowel diseases. Zinc deficiency can lead to intestinal permeability, while supplementation with zinc supports the function of the tight junctions.

    Symptoms of Leaky Gut Syndrome

    You might think the symptoms of leaky gut are all digestive disorders but, because leaky gut allows foreign bodies to enter the bloodstream, it can exert a wide range of effects the body as a whole and produce a varied array of symptoms. Some of the more obvious symptoms include allergies, cardiovascular disturbances, and a multitude of metabolic disruptions. Chronic fatigue syndrome and depression are separate and unique conditions, but both are known to result from compromised integrity of the intestinal mucosa.

    Intestinal permeability allows foreign microbes access directly to the bloodstream. In response, the immune system releases antibodies, which mistakenly attach to normal proteins in the blood, tagging them for immune action. Fortunately, there are ways to ease the burden of living with a leaky gut.

    What’s the Best Solution for Leaky Gut?

    Following a healthy diet is one of the most effective measures to help manage leaky gut. Foods that are a source of probiotics are helpful for mitigating the effects of the disorder. Nutrients like glutamine and curcumin support the intestinal environment by balancing the overstimulated immune response and the oxidative stress that weakens the intestinal wall.

    Monitoring what goes into your body is one of the best natural remedies for managing leaky gut. If you suffer from a digestive disorder, whether it’s leaky gut, irritable bowel syndrome, celiac disease, Crohn’s disease, or any of the many disorders associated with hyperpermeability, try keeping a daily food journal to identify the foods that trigger symptoms. If you experience frequent flare-ups, it’s time to make significant lifestyle changes such as incorporating the best foods for leaky gut into your diet to support your health and quality of life.