In part 1 we reviewed the two types of melatonin and how they function in regard to circadian rhythm sleep/wake patterns and antioxidant properties.

In part 2 we will discuss:

• Difference between seasonal affective disorder and winter blues, along with statistics
• How melatonin and cortisol work to maintain sleep/wake cycles
• Tips to overcome and deal with winter blues and help those affected by seasonal affective disorder

The difference between SAD and winter blues:

According to the NIMH:
SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms lasting about 4 to 5 months per year. Therefore, the signs and symptoms of SAD include those associated with major depression, and some specific symptoms that differ for winter-pattern and summer-pattern SAD. Not every person with SAD will experience all of the symptoms listed below.

SAD statistics

• 10 million people in the US are affected
• 90 percent diagnosed in winter
• 10 percent diagnosed in summer
• Incidence increases as you go further north in latitude
• Symptoms are present for about 40 percent of the year
• Does not necessarily occur every year, about 50 percent skip years

Symptoms of major depression may include: (SAD)

• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Experiencing changes in appetite or weight
• Having problems with sleep
• Feeling sluggish or agitated
• Having low energy
• Feeling hopeless or worthless
• Having difficulty concentrating
• Having frequent thoughts of death or suicide

 NOTE THERE IS A NATIONAL SUICIDE CRISIS HOTLINE 24/7- JUST DIAL 988

For winter-pattern SAD, additional specific symptoms may include:

• Oversleeping (hypersomnia)
• Overeating, particularly with a craving for carbohydrates
• Weight gain
• Social withdrawal (feeling like “hibernating”)

Specific symptoms for summer-pattern SAD may include:

• Trouble sleeping (insomnia)
• Poor appetite, leading to weight loss
• Restlessness and agitation
• Anxiety
• Episodes of violent behavior

Winter blues statistics

• Up to 14 percent of the general population experience some form of winter blues
• As latitudes go up incidence also goes up-

Winter blues symptoms (not a clinical diagnosis)

• Lack the motivation to complete some tasks but be able to handle major tasks
• Still able to go to work and take care of home
• Have trouble sleeping
• Spend more time in bed than usual
• Limited to winter months
• Managed with lifestyle changes

Risk factors for both winter blues and SAD

• Age-Younger people are more susceptible to winter blues than older population
• Sex-Females are four times more likely be affected
• Geography- Higher latitudes increase incidence
• Family or personal history of depression

The role of melatonin cortisol in both SAD and winter blues

As stated in part 1, melatonin is produced in 2 places in the body- the pineal gland and mitochondria of cells. The pineal gland synthesizes melatonin during periods of darkness. This is tied to  the circadian rhythm, a roughly 24-hour biological wake/sleep cycle and accompanying physiological activities that occur during the cycle. Blue light, such as daylight and indoor bright LED lights, computer monitors, TVs phones and other devices that transmit blue light signal the pineal gland to shut down production of melatonin.

Cortisol- the awake hormone

Cortisol is a steroid hormone  synthesized by the adrenal glands, Adrenal glands are small triangular glands that sit on top of both kidneys. Cortisol has many functions in the body, from regulating  blood pressure, suppressing inflammation, a role in sugar metabolism and sleep/wake cycle.

Cortisol levels start to increase in the morning as melatonin levels decrease. This increase in cortisol and decrease in melatonin initiates awakening under normal circumstances.  Cortisol is also known as the “stress” hormone. It activates the fight or flight mechanism and triggers the release of glucose during times of stress, danger, or perceived danger.

Blue light, such as daylight and indoor bright LED lights, computer monitors, TVs phones and other devices that transmit blue light are one of the ways cortisol levels are triggered to increase. This is  results in more alert and wakefulness during daytime hours.

Tips to combat winter blues and help SAD patients

• “Anchor” your day by either going outside in the early morning around sunrise for up to 30 minutes or using a light box specifically designed for light therapy. Caution must be exercised if bipolar diagnosis or other psychiatric history that may be exacerbated by light therapy. It is estimated that from 60 to 80 percent of winter blues and seasonal affective disorder sufferers could benefit from timed light therapy.

Light boxes should be at least 10,000 lux at 15-18 inches for 20-30 minutes first thing in the morning. That will shut down melatonin and start cortisol production. Don’t stare directly into the box. Instead, read or do other activities as long as you are within the recommended distance from the light. Light boxes have really come down in price. As of this writing one highly rated 10,000 lux light box is under 20 dollars after coupon.

• If able, get out for a one hour walk during the day. This will also help set your circadian rhythm.
• Avoid computer, LED and phone screens after dark if possible. Limit your exposure by using a blue light blocking filter on the screens. This will help keep cortisol levels down and stabilize melatonin levels. Read by incandescent light if possible.
• Avoid alcohol. Alcohol is a depressant. It also affects circadian rhythm if consumed late in the day.
• Avoid sugar. Sugar consumption creates a sugar high followed by a sugar crash- leading to depression and moodiness
• Eat a healthy, well-balanced diet. Make sure you are getting a good balance of fats, protein, and carbs.
• Maintain a healthy vitamin D level. Consult your care provider for information. Vitamin D
• Focus on or start a new hobby.
• Keep warm. Staying warm and being properly dressed for the elements can lessen the burden on your body. Make a drink such as golden milk, made with turmeric, coconut milk, and a sprinkle of pepper for healthy, warm immune boosting drink. Recipe can be found here: Golden milk
• Talk therapy- either reach out to friends, family or trusted neighbors and connect with others. If you are experiencing debilitating depression, suicidal ideation or unable to shake the slump, reach out to your primary care provider for evaluation. Don’t do this alone.
• Remember, spring is only a few weeks away!

What is melatonin?

You may have heard that melatonin is a hormone that regulates sleep. You may have even heard that melatonin is a powerful antioxidant. Melatonin is both and a lot more.

There are two places melatonin is synthesized and both work in vastly different capacities.

One is subcellular melatonin and the other is circulating melatonin.

Subcellular melatonin is known as the “hormone of daylight” It is synthesized in the mitochondria of  cells throughout the body– skin, epithelial, liver, thyroid, kidney, gastrointestinal tract, bone marrow, leukocytes, immune cells and many others. Once manufactured the melatonin stays near the cells and does its work. Stimulated by the UV spectrum of sunlight, or viruses, free radicals are neutralized by the antioxidant response of melatonin. Melatonin also stimulates other antioxidant enzymes to help fight free radicals.

There is some evidence that subcellular melatonin is synthesized by exposure of near infrared light (NIR).

Circulating melatonin is known as the “hormone of darkness”. It is produced in the pineal gland and regulated by the suprachiasmatic nucleus (SCN) Melatonin secretion is stimulated by darkness and inhibited by light, and in coordination with the (SCN), it is involved in maintaining circadian rhythmicity and regulating sleep. The SCN regulates the timing of melatonin release in a feedback loop, whereby melatonin levels determine the SCN regulation.

 Circadian rhythm disruption is proven to be one of the contributing factors in cancer progression and development.  Blue light, such as LED and computer monitors suppress melatonin production, leading to altered circadian rhythm.

 Circadian rhythm disruption is proven to be one of the contributing factors in cancer progression and development.  Blue light, such as LED and computer monitors suppress melatonin production, leading to altered circadian rhythm.

How to benefit from subcellular and circulating melatonin

Before bedtime:

1. Avoid stimulating lights- blue light from computer and phone screens, LED lights- these will shut down circulating melatonin and disrupt circadian rhythm. Incandescent light to read by are a good choice. Reading on a pad even with blue blocker can disrupt melatonin levels. The blue blockers installed on many devices are not adequate to block the light.
2. Campfires, candles, and red lights help keep melatonin levels intact and may even stimulate the subcellular melatonin to go after free radicals.
3. Practice sleep hygiene- Go to bed at set time, have a routine. This helps signal your body that its time to go to bed. In addition, avoid stimulating conversations, snacking before bed and exercise a few hours before bedtime.
4. Have your vitamin D level checked. Vitamin D plays an important part of melatonin regulation.
5. Even though there isn’t clear cut evidence that blue light blocking glasses work, a small study revealed sleep duration and nighttime melatonin levels increased after use of blue light blocking glasses.

Our lives have become increasingly distant from natural light. Our sleep wake cycles are constantly disrupted by our modern way of living.

Chronobiology, the study of circadian rhythms and our health is becoming an increasingly important field of study.  How light affects melatonin levels is one area that chronobiology focuses on.