The pandemic’s impact on mental health or SAD?

In 2021 the world will be different. It’s a year for hope and optimism so navigating the next 8 weeks is the final stage of a tumultuous 12 months. As recently as the 9th October the WHO’s suggested that we may face “severe mental health challenges as we toll with the COVID-19 pandemic, especially during winter season” [1] so is this compounding the normal bout of winter blues?

In the UK 69% of adults reported feeling worried about the impact of Covid-19 on their mental health with 56% feeling stressed and anxious [2]. This is a natural reaction to uncertainty, shielding, and job security but thanks to successful vaccination trials there is light at the end of the tunnel.

SAD (Seasonal Affective Disorder) affects 10+ million people in the U.S [3] and brain imaging studies show that low levels of serotonin, were significantly associated with the condition in the winter [4]. Low serotonin also typifies mood conditions.

The symptoms are the same. What are the options?

The good news is that symptoms of SAD are usually alleviated with the arrival of spring [5] so here are 7, natural, evidence-based options to get you through to March.

1. Make sure you're getting enough tryptophan

Tryptophan is the building block of serotonin. In 2015, a study found young healthy adults that consumed a tryptophan-rich diet experienced fewer depressive symptoms and decreased anxiety [6] and 100g of turkey offers 404 mg of tryptophan [7]. To enter the brain, tryptophan competes poorly with other amino acids in your diet for transporter molecules to cross the blood-brain barrier, resulting in  relatively small amounts being converted into serotonin.

2. 5-HTP - a more effective serotonin enhancer?  

Tryptophan is converted into another amino acid called 5-htp before becoming serotonin (5-HT) which can be taken as a food supplement. The isolated form can be extracted from the Griffonia seed and its primary benefit is its ability to freely enter the brain without the need to change shape or structure. In 2013, a study on the administration of 5-HTP supplements showed that 73% of patients with depression showed improvements in mood [8]. The authors also deemed it to be fast-acting and fewer side effects compared to fluoxetine (pharmaceutical antidepressant).

 3. The evidence for vitamin D

Vitamin D levels fluctuate in the body in response to sunlight [9]. When outdoors, pigments in your skin absorb rays from direct sunlight to create vitamin D. Patient groups with SAD seem to have a higher incidence of vitamin D deficiency compared to the general population [10]. A direct correlation between vitamin D deficiency and depression has yet to be proven. [11].

SAD lights aim to  mimic natural light [12]. The NHS suggests that there is mixed evidence on SAD lights and mood [13] Although one study showed its benefits on depressive symptoms after 3 weeks of continuous light therapy [14].

4. Get exercising! 

Exercise stimulates a surge of endorphins, serotonin, and dopamine [15]. Dopamine is your reward and pleasure chemical and is associated with alertness and motivation. A simple exercise regime may help you re-find your va va voom.  Something as simple as a 30-minute bike riding session once weekly  reduces depressed mood after 10 to 30 minutes post-exercise. The great news is that this effect is not influenced by exercise intensity [16].

5. Practice mindfulness

Mindfulness can take many different forms so it’s up to you to find what works best. Practising deep breathing techniques twice daily for 10 minutes for 2 weeks has shown effective in reducing depressive symptoms [17]. If meditating is your thing then 15 -20 minutes, twice a day can reduce psychological distress [18]. You may want to try out yoga as a 8-week yoga intervention showed significant benefits on symptoms of depression and anxiety [19].

6. Generosity - The gift that keeps on giving

The British Psychological Society state that random acts of kindness provide a feel-good factor [20], and brain imaging scans indicate elevated activity in two areas of the brain occurs during generous decision making [21].

7. Talking therapy

Verbalising your feelings and emotions can be a powerful form of therapy so speaking to friends or family can be a great starting point. The NHS can offer you access to a professional guidance Councellor to help you contextualise your thoughts and feelings or Cognitive Behavioural Therapy (CBT). This involves modifying attitudes, beliefs, and behaviours to improve positive outcomes. One study showed 8 weeks of CBT significantly reduces insomnia and depression severity in adults [22].

[1] World Health Organisation (2020) COVID-19 disrupting mental health services in most countries, WHO survey.  [2] Office for National Statistics (2020) Coronavirus and the social impacts on Great Britain.[3] Neuroscience News (2019) Seasonal l Affective Disorder Impacts 10 Million Americans. Are You One of Them?[4] Mc Mahon et al.(2016) Seasonal difference in brain serotonin transporter binding predicts symptom severity in patients with seasonal affective disorder. Brain: A Journal of Neurology. [5] Healthline (2020) Why More People May Experience Seasonal Affective Disorder This Year.[6] Lindseth et al. (2015) The Effects of Dietary Tryptophan on Affective Disorders. Archives of Psychiatric Nursing.  [7] Myfooddata (2020) Top 10 Foods Highest in Tryptophan.   [8] Jenkins et al. (2016) Influence of Tryptophan and Sero-tonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients.[9] Berumen et al. (2012) Serotonin Receptors in Hippo-campus. The Scientific World Journal.[10] Jangid et al.(2013) Comparative study of efficacy of l-5-hydroxytryptophan and fluoxetine in patients presenting with first depressive episode. Asian Journal of Psychiatry. [11]  Scientific Advisory Committee on Nutrition (2016) Vitamin D and Health. [12] Naeem, Z. (2015) Vitamin D deficiency-An epidemic ignored unfortunately. British Medical Journal.  [13]  Anglin et al. (2013) Vitamin D deficiency and depression in adults: systematic review and meta-analysis. The British Journal of Psychiatry.   [14] Virk et al. (2009) Short exposure to light treat-ment improves depression scores in patients with seasonal affective disorder: A brief report. Interna-tional Journal on Disability and Human Development. [15] Bais et al. (2020) Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial. British Medical Journal. [16] Salguero et al. (2011) Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults. Archives of Gerontology and Geriatrics. [17] Chung et al. (2010) Home-based deep breathing for depression in patients with coronary heart disease: A randomised controlled trial. International Journal of  [18]  Travis et al. (2018) Effect of meditation on psychological distress and brain functioning: A randomized controlled study. Brain and Cognition.[19] Davis et al. (2015) A randomized controlled trial of yoga for pregnant women with symptoms of de-pression and anxiety.  [20] The British Psychological Society (2020) How being kind benefits us psychologically.  [21] Park et al. (2017). A neural link between gen-erosity and happiness. Nature Communications.  [22] Sadler et al. (2018) Cognitive behavior therapy for older adults with insomnia and depression: a randomized controlled trial in community mental health services. Sleep.  

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