Ian Spohn, ND, is a staff naturopathic doctor for Energique who enjoys challenging the dogmas of both conventional and alternative medicine. He is a passionate supporter of the paleo diet and classical homeopathy.
The seasonal transition to autumn brings with it cooler days and darker nights, but while some relish this change it can also wreak havoc on patients with certain mood disorders. The remarkable association between winter darkness and depression has been termed seasonal affective disorder, but the onset of autumn can affect other mood disorders as well. Less well-known is the autumn spike in manic episodes for patients with bipolar disorder, a condition increasingly recognized to follow complex seasonal patterns. While different individuals seem to identify their own unique seasonal patterns, a peak in manic symptoms during autumn is among the most frequently reported[i]. A range of other seasonal associations with mood have been reported in the scientific literature, some of which are dramatic and seemingly inexplicable, like a peak in violent crime during the summer[ii] or suicide attempts during the spring[iii]. This all goes to show how interrelated our physiology remains with the earth’s seasonal patterns, and how concerning it is that so many modern cultures insist on maintaining the same year-round lifestyle oblivious to seasonal trends. It is disheartening, for instance, to consider that there is an increase in heart attacks the day after daylight savings time begins[iv]. But given how powerfully such things as light, temperature, or the time we wake up in the morning can affect our physiology, it is also encouraging to think that many complex disorders may benefit from very simple lifestyle recommendations, or other supportive measures to offset the subtle effects of the season.
Seasonal transitions in particular seem to affect patients with bipolar disorder, a condition that remains poorly understood and blurs the line between mental health and physiological functioning. The fact that symptoms are commonly brought on by major life events – whether positive or negative – would seem to argue for a psychological basis, but there are some distinctly non-psychological triggers that suggest bipolar disorder may have a purely physiological basis, the alternating mood symptoms being merely downstream effects of altered brain chemistry. Two common triggers for mood episodes that are widely reported both by patients and in the scientific literature are seasonal changes and travel across time zones. As such, it has become widely theorized that bipolar disorder is in fact the result of altered or misaligned circadian rhythms. How else could a patient who experienced a bout of mania after her grandmother’s death experience a similar bout of mania after returning from travel overseas, a phenomenon not uncommonly reported by people with bipolar disorder? It might be argued that changing time zones may result in psychological stress, but there is a basis for the opposite relationship, that of psychological stress disrupting circadian rhythms, even independent of sleep. The primary stress hormone, cortisol, is normally released along an exquisite circadian rhythm. It has been shown that some tissues actually rely on cortisol to set their own cellular clocks[v], meaning the cortisol rhythm may actually be the means by which the circadian rhythm established in the suprachiasmatic nucleus by sunlight is imparted to the rest of the body. Anything that alters cortisol levels, like stress, could then alter circadian rhythms.
Because circadian rhythm disturbances can aggravate bipolar symptoms, it has been suggested that one way to stabilize moods may be to simply establish consistent daily routines. Known as Social Rhythm Therapy, research shows that this shockingly simple lifestyle intervention can be of significant benefit to patients with bipolar disorder[vi], and likely to anyone with mood problems linked to seasonal light availability. While sunlight is the primary stimulus by which the body’s circadian clock is set, circadian rhythms can also be entrained to a number of other stimuli, collectively known as zeitgebers. These include feeding times, patterns of physical activity, and even the timing of social interactions, which can be kept stable to help offset the effects of changes in daylight. A simple approach to managing mood symptoms during seasonal transitions is to establish a regular routine for such things as eating, exercising, and even social interaction, if cooperation can be obtained from friends and family. Exercise may be especially underrated in this regard. It seems strange that the body would entrain its neuroendocrine functioning at the cellular level based on what time you go to the gym, but anyone who keeps a pet hamster may observe the regularity with which it decides to run on its wheel at the same time each night, even without a clock.
Besides changes in day length, changes in temperature may also contribute to pathological changes in mood. One little-known adaptation to heat stress is a semi-permanent expansion of the extracellular fluid volume. People who exercise in the heat may note that after a couple of weeks or so, they’ve actually gained weight and are suddenly looking puffy and bloated, despite they may be exercising harder than ever. It seems that to cope with the stress of potential dehydration, the body adapts to heat stress by increasing the size of its extracellular fluid compartment, effectively allowing someone to carry more water around with them, as a guard against dehydration. This extra quantity of water can be significant: it has been shown that acclimation to exercise in the heat can increase the amount of fluid in the body by about 50 mL/kg. For an average-sized person, this could equate to over three additional liters of water, or about seven pounds of body weight. One possible contributing factor to manic symptoms peaking in autumn could be the sudden loss of such adaptation as the weather begins to cool. A sudden decrease in extracellular fluid volume through a loss of this adaptation has the potential to increased intracellular sodium levels more rapidly than the kidneys can adjust. It is known that mania can be precipitated by hypernatremia, and it is believed that lithium’s mood-stabilizing effects may involve its interaction with sodium ions in the body, as they are both monovalent cations[vii]. Basically, large shifts in fluid volume precipitated by cool autumn weather can wreak havoc with the body’s electrolyte levels, possibly to the point of triggering psychotic symptoms in some vulnerable individuals. Although disturbed electrolyte levels are rarely considered when approaching mood disorders, it is well known that altered levels of sodium, potassium, calcium, and magnesium can all cause severe psychiatric symptoms[viii]. Patients who experience mood symptoms in the fall, or in accordance with temperature changes, may therefore benefit from simple, supportive approaches to balance electrolyte levels.
There is yet another way that the dwindling of days can potentially affect mood, which involves the effect of increased dark periods on melatonin synthesis. It is well known that light inhibits the synthesis of melatonin while darkness promotes it, synchronizing sleep to the dark period of night. A predictable effect of shorter days and longer nights is therefore an overall increase in daily synthesis of melatonin. On first glance, this might seem inconsequential or perhaps even beneficial to the body, since melatonin is a powerful antioxidant and seems in general to support nervous system function. But an increase in melatonin may alter mood beyond simply making one feel more drowsy, or slightly depressing activity levels ala the winter blues. There is speculation that increased melatonin synthesis during dark months may actually be depleting serotonin in some individuals, by a mechanism similar to the pregnenolone steal.
The pregnenolone steal is a theorized mechanism by which chronic stress can lead to hormonal dysfunction. According to this theory, chronic stress increases the adrenal output of cortisol, a hormone which must be synthesized from the same precursor molecule as estrogen, testosterone, and DHEA. Under periods of increased stress, a greater share of the precursor pregnenolone is shunted towards the production of cortisol, at the expense of adrenal sex hormone production. The relationship between melatonin and serotonin is similar, wherein melatonin must be synthesized directly from serotonin. Because serotonin is the precursor for melatonin synthesis, anything that increases the production of melatonin may decrease levels of serotonin, possibly accounting for the depressed mood symptoms experienced during seasonal dark periods. A simple way to offset this would be to increase tryptophan intake during the winter, either through diet or supplementation. Since tryptophan availability can be a limiting factor in serotonin synthesis, and since longer nights increase the demand for serotonin through an increased production of melatonin, it may well be the case that tryptophan needs are higher during the winter. There is research showing that tryptophan supplementation can benefit seasonal affective disorder[ix], lending credence to serotonin steal hypothesis. Magnesium and supplemental B vitamins, particularly B6, B12, and folate, are equally important to support this pathway, as these are all essential cofactors in the synthesis of serotonin from L-tryptophan.
[i] Akhter A, Fiedorowicz JG, Zhang T, et al. Seasonal variation of manic and depressive symptoms in bipolar disorder. Bipolar Disord. 2013;15(4):377-384. doi:10.1111/bdi.12072
[ii] Michel SJ, Wang H, Selvarajah S, Canner JK, Murrill M, Chi A, Efron DT, Schneider EB. Investigating the relationship between weather and violence in Baltimore, Maryland, USA. Injury. 2016 Jan;47(1):272-6. doi: 10.1016/j.injury.2015.07.006. Epub 2015 Jul 13. PMID: 26233631.
[iii] Cho CH, Lee HJ. Why Do Mania and Suicide Occur Most Often in the Spring? Psychiatry Investig. 2018 Mar;15(3):232-234. doi: 10.30773/pi.2017.12.20. Epub 2018 Mar 16. PMID: 29566464; PMCID: PMC5900367.
[iv] Sandhu A, Seth M, Gurm HS. Daylight savings time and myocardial infarction. Open Heart 2014;1:e000019. doi: 10.1136/openhrt-2013-000019
[v] Balsalobre A, Brown SA, Marcacci L, Tronche F, Kellendonk C, Reichardt HM, Schütz G, Schibler U. Resetting of circadian time in peripheral tissues by glucocorticoid signaling. Science. 2000 Sep 29;289(5488):2344-7. doi: 10.1126/science.289.5488.2344. PMID: 11009419.
[vi] Haynes PL, Gengler D, Kelly M. Social Rhythm Therapies for Mood Disorders: an Update. Curr Psychiatry Rep. 2016;18(8):75. doi:10.1007/s11920-016-0712-3
[vii] Coppen A. The biochemistry of affective disorders. Br J Psychiatry. 1967 Nov;113(504):1237-64. doi: 10.1192/bjp.113.504.1237. PMID: 4169954.
[viii] William L. Webb, Mohan Gehi. Electrolyte and fluid imbalance: Neuropsychiatric manifestations.Psychosomatics. 1981; 22(3):199-203. https://doi.org/10.1016/S0033-3182(81)73532-1.
[ix] McGrath RE, Buckwald B, Resnick EV. The effect of L-tryptophan on seasonal affective disorder. J Clin Psychiatry. 1990 Apr;51(4):162-3. PMID: 2182615.
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