Melatonin improves SAD patients
In a report to appear online this week in the Proceedings of the National Academy of Science, researchers at Oregon Health & Science University (OHSU) show that the hormone melatonin effectively treats seasonal affective disorder (SAD), a form of depression that occurs during winter months when sunlight is reduced. The disorder is currently treated with bright light exposure.
Alfred Lewy, MD, PhD, who is OHSU School of Medicine’s Richard H. Phillips Professor of Biological Psychiatry, senior vice chairman of psychiatry, and director of the Sleep and Mood Disorders Lab, and who has pioneered research in circadian rhythm disturbances, led the current study. Dr Lewy’s team sought to determine whether depression results from a misalignment of circadian rhythms with the sleep/wake cycle that occurs during winter. Circadian rhythms can be tracked to the later dawn or earlier dusk of the winter months.
Dr Lewy’s team compared melatonin’s effect when taken during the morning than melatonin taken in the afternoon. Sixty-eight patients with seasonal effective disorder received low-dose melatonin or a placebo during morning or afternoon for three weeks.
After several years of research, the team concluded that, similar to jet lag, circadian misalignment is a major factor in seasonal affective disorder. Melatonin worked best if taken in the afternoon or evening in the majority of patients who were phase-delayed “night-owl” types, while another group of “morning lark” phase-advanced patients responded better to melatonin if it was taken in the morning. The dose of melatonin taken was low enough not to cause day-time drowsiness.
Although low-dose, sustained-release melatonin may be effective for SAD, “People in the phase-advanced subgroup should use these treatments at different times of the day than the typically phase-delayed type of patient," explained Dr. Lewy.
Many people may feel sad or down during the winter months, when the days are shorter and temperatures drop. For some people, this condition goes beyond the winter “blahs” and develops into a subtype of clinical depression that lasts throughout the late fall and winter months. This condition is known as seasonal affective disorder, or SAD. The term SAD was introduced in 1984 and has since been included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
SAD is characterized by recurring, cyclic bouts of depression, increased appetite, and an increased need for sleep (Ford K 1992; Magnusson A et al 2003). It contrasts with most depressive disorders, which are characterized by sleep disturbances and diminished appetite (Magnusson A et al 2005). Besides mild depression, typical symptoms of SAD include anxiety, decreased activity, social withdrawal, increased sleep duration, increased appetite, weight gain, and carbohydrate craving (Rosenthal NE et al 1984; Sher L 2001).
If bright light therapy is recommended, and your insurance covers it, it is an effective method of relieving the depression and lethargy associated with SAD. Tryptophan has been shown to enhance the effectiveness of light therapy. In addition, a number of nutrients may help relieve SAD. These include:
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