• Madalyn Otto

Winter Is Coming...

That's either an ominous title, or an exciting one, depending on punctuation...


I've been talking a lot with patients lately on identifying and coping with the sympathetic stress response during this uncertain era. Learning how to control the internal dimmer switch from the sympathetic state to the parasympathetic state is a life-changing skill to have during times like these. But, in addition to learning to reduce the stress response, it's also to our benefit to spend some time talking about mood in general and especially the impact of season changes on mood. Seasonal depression (known as seasonal affective disorder or SAD) is a common experience many of us and our loved ones face.


We are entering a season that tends to take a toll on many people's subjective sense of well-being even before factoring in the impact of a pandemic, uncertainty and social distancing. But there are things we can do to help! Leveraging lifestyle strategies and habits along with the use of natural mood boosters can turn a bleak winter into a hopeful one.


Natural anti-depressants: In practice, I prescribe both herbs and key nutrients to combat depression. Vitamin D levels should be checked periodically via a blood test, and subsequent dosing with this key nutrient should be maintained year-round, especially during fall and winter when sunlight exposure is at an all-year low. I also check for methylation defects that can make an individual more susceptible to mood disorders. This is done using a blood test for an MTHFR deficiency. It can be indirectly investigated by measuring homocysteine and B12/MMA levels in the blood. A person who has a deficiency in the MTHFR enzyme is more likely to suffer a mood imbalance and will respond well to methylated B vitamins and SAMe. If you are suffering with anxiety or depression and haven't been screened for this issue, let me know! I also utilize botanical medicines in practice. Herbal anti-depressants are generally considered safe and effective for treating mild and moderate depression. My favorites are Rhodiola rosea and Hypericum perforatum (St. John's Wort), though these need to be checked against any prescription medications you are taking as harmful interactions are possible. Remember that supplement quality is key for safety and efficacy. Last, but certainly not least in this category is classical homeopathy. I will often prescribe a homeopathic medicine for patients suffering with mood imbalances based on their specific, unique symptoms. Your depression symptoms are actually quite unique to you and dissimilar to others with depression. When we take the uniqueness of your symptoms into account, we can often find a homeopathic remedy to help reduce your depression symptoms. Note that homeopathic medicines are only effective if they are prescribed based on your specific & characteristic presentation of depression rather than taking a generic remedy "for depression".


Prescription anti-depressants: There is a time and a place for prescription medications! And a global pandemic is, in my opinion, the time and place for some people. Chronic depression has severe health consequences. If natural agents prescribed by a knowledgeable integrative or functional medicine doctor or naturapathic doctor are not having a significant impact on your depression, or if the depression is severe, prescription medications should be considered. My role with patients already using prescription anti-depressants ranges from using functional medicine to enhance the response to current medications, improving mood to the point where medications can be reduced, or working with a patient to find an alternative to prescriptions due to medication side effects.


Get a "happy light": I recommend "happy lights" to many patients who struggle with seasonal depression, adrenal fatigue or chronic fatigue. Natural light stimulation is the way we signal to our brains to produce our "get-up-and-go" hormone in the morning. The absence of light is what triggers our sleepy hormone (melatonin) to be secreted at night. This dance between cortisol and melatonin is what makes up our circadian rhythm. Since light exposure affects more hormones in the body than just these two, seasonal light deprivation plays a big part of why people have lower energy and lower moods in the darker months. This year, it is likely that we will all be noticing the seasonal darkness more intensely than we usually do. Be ahead of the curve and get your happy light before it gets dark! Morning and midday light exposure may help keep you afloat through the storm.


Get active & get outdoors: Exercise promotes happy-feeling hormones (endorphins) and can actually be as effective as prescription anti-depressants for moderate depression. It also helps reduce anxiety and it promotes healthy sleeping patterns. If you can do it outdoors, all the better. Exposure to nature reduces anxiety and stress and promotes subjective feelings of well-being. Many of my patients tend to reduce their physical activity during fall and winter because of cold weather, fear of falling and the increasing darkness. But we cannot afford to be inactive this year! More than ever, it's important to make a commitment to maintaining daily activity no matter the weather. It's helpful to have your spouse on board with the commitment. Whether it's getting indoor exercise equipment that is simple and accessible, or getting better footwear and outdoor gear so that you can continue to move outdoors no matter the weather, there is a solution. I have been walking to and from work each day for about a year now, and know that this commitment will be an essential part of my mental health plan this winter.


Maintain healthy relationships: All of us benefit tremendously from having strong connections with friends and family. If you are partnered, I think it is essential that we first acknowledge the importance of kindling and tending to this relationship. Your partner or spouse is a major foundation component of your health and well-being. The COVID-era changes might have brought new challenges to your relationships or potentially showed you your relationship strengths. Expressing your gratitude through words as well as action regularly will benefit your experience of your relationship as well as your partner's experience of your relationship. Prioritizing time for relaxation and bonding together each week is also key. In addition to tending to your primary partnership, be sure to connect to friends and other family members as well to enhance subjective well-being and reduce the incidence of depression. Whether your are introverted requiring ample down-time or extroverted requiring ample social stimulation, maintaining the social connections that are important to you is a critical component of having a balanced mood. In the COVID-era, we've all learned that this requires behavioral modifications to achieve, but is nonetheless possible. Using communication platforms like Skype, Zoom & FaceTime and even Facebook allow you the possibility of virtual dinner dates and coffee dates with your buddies at no cost to you. If using your smartphone, consider a camera tripod like this to help you have your meeting anywhere you can get a a wifi/data connection. Since we all need more exercise (especially time outdoors), consider walk-dates or outdoor/winter activity dates to help you keep in touch with your local friends and family. As a strong introvert myself, I have found that having one weekly Skype date per week with a friend or family member works really well for me, bringing me happiness and comfort and allowing me to strengthen relationships with my favorite people.


Having a healthy, balanced mood requires effort in the same way that all aspects of health require effort. Integrating activities that are good for your mood into your daily and weekly schedule will help ensure that you have a strong emotional foundation for weathering changes in both your geographical and political climates. Using natural and prescription medicines to provide further support on top of a lifestyle foundation may be equally important to integrate as part of your treatment plan.


In Health,

Dr. Otto

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