Seasonal affective disorder, commonly known as SAD, is a type of depression that happens during certain parts of the year, fall and winter being the most common. It has been suggested that the shortening of days and less daylight trigger a chemical change in the brain. This change may lead to depression. Symptoms may include depression, increased sleep, loss of interest in activities that were formerly enjoyed, social withdrawal, fatigue, anxiety, decreased libido, inability to concentrate, weight gain, and more. 

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CC: Seasonal Affective Disorder, Joint Pain, Hair Loss, Neuropathy 

Lisa was a 50-year-old woman who had come in for wellness and wanted to take a deep dive into her health with functional blood work. During her appointment, SAD, joint pain, hair loss, and neuropathy were all topics that were discussed. Lisa felt really good for most of the year, but as soon as late fall/winter hit, she felt that she had turned into a different person even though nothing really changed. She felt that she had no motivation. She easily gained weight and found herself to be depressed. 

Neuropathy and joint pain had been concerns for years, as she did have a history of Lyme disease. She had treated the Lyme at that time and wasn't sure if it was still causing her any residual issues. Hair loss was something new that started earlier that year. She started to notice diffuse hair loss and large clumps in the shower that started to come out. She admitted that the past year had been more stressful than others with work and balancing work-life balance. She had previously worked with an herbalist, so she had tried many anti-inflammatory herbs for joint pain and neuropathy, but nothing seemed to help. 

Initial Lab Work

NMR LipoProfile Test

Other Lab Work

CBC- Normal
CMP- Normal
Salivary Cortisol x4- All values within normal range
Medical Diagnostic Laboratory (MDL) test- Negative for Lyme+ pathogens

Lab Analysis 

Labs showed nutrient deficiencies that included low omega fatty acids and vitamin D and functionally low b12 with elevated homocysteine. This could be attributed to a lack of dietary intake or decreased absorption. Vitamin D is a common marker that is assessed for SAD. Low B vitamins can be associated with hair loss, fatigue, and SAD as well. 

Lisa did not test positive for autoimmune markers, ruling out rheumatoid arthritis, but did show markers for inflammation. Both GlycA and Ferritin can be measurements of systemic inflammation. Lisa did not have any signs/symptoms indicating hemochromatosis and her Lyme panel was also clear. 

*MDL does not test all Lyme markers, only the most common. Normally, if symptoms do not improve, more specialty testing is discussed. MDL may be submitted through insurance, which is why some prefer to start with MDL rather than other labs that test many more markers.*

Lisa's hormones, for the most part, were normal. No concerns with cortisol, thyroid, insulin, or testosterone. Pregnenolone was low, which can be normal post-menopause. Her cholesterol was elevated, which, although it is not likely the cause of SAD, does show that she could make modifications to her diet/lifestyle as well as address inflammation. 

Interventions

Lisa's treatment plan started with the basics, taking out inflammatory foods, healing her gut, and adding in nutritional support. Her initial intake was done in September, and her follow-up appointment was in early October. Starting in October, she eliminated gluten and dairy from her diet. This was done since her labs were negative for Lyme, RA, and other autoimmune markers, but she was experiencing joint pain, brain fog, and hair loss. She was given gut support to support a leaky gut which included probiotics and GI core (glutamine, zinc, vitamin A, and various demulcent herbs). Lisa was very reluctant to cut out foods but was willing to try.

In addition, she started nutritional support. She started taking a B complex to increase B vitamin levels and decrease homocysteine which can be linked to hair loss and low energy. She started taking vitamin D3/K2 (10,000 IU for two weeks, then 5,000 IU daily) to increase levels and omega fatty acids (2g daily) to support inflammation, joints, and brain health. 

Lisa followed up two months later. Joint pain was 75% better, hair loss was no longer a concern, brain fog was 100% gone, and the neuropathy was gone. Most importantly, it was December, and she had no signs of depression. She had no "winter blues." She reported that she even volunteered at her child's sporting event concession stand and actually had fun— which was completely out of the ordinary for her. 

Lisa was offered additional supplements to support her joints which included Whole Body Collagen (Designs for Health), 1 scoop daily, and The Extinguisher, which contained a mixture of perilla, Curcuma longa, quercetin, and resveratrol. She discontinued the gut support and focused on nutritional support, and continued to cut out gluten and dairy. 

Follow-Up 4 Months Later (6 Months Since Initial Visit)

NMR LipoProfile Test Follow Up

Other Lab Work Follow-Up

CBC- Normal
CMP- Normal
Salivary Cortisol x4- Did not rerun
Medical Diagnostic Laboratory (MDL) test- Did not rerun

RA panel- Did not rerun

Lisa reported back in 6 months (April). Labs were all improved, and she stated that this was the best that she had felt in a long time. She had no issues with SAD and really attributed it to her dietary changes and supplements. 

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Summary

With millions of Americans suffering from SAD, many may not even realize it. Although there are many treatments that may include light therapy, antidepressant medications, and psychotherapy, things as simple as changing up the diet lifestyle and supporting the body with basic nutrients such as B vitamins, vitamin D, and omegas can be very useful.