fatigue

Could Vitamin D boost your Mood and Energy?

By R. Ryan Patel DO, FAPA OSU-CCS Psychiatrist
Many students may be aware of Vitamin D and with decreasing sunlight, many might not be getting enough vitamin D.
• Initially thought of as a vitamin, it is now believed that it works more like a hormone and has many functions throughout the body.
• Inadequate vitamin D has been implicated in fibromyalgia (1), sleep (2,3), athletic performance (4), energy levels (5) as well as bone disease (7).
• A recent study had discussed findings regarding vitamin d and depression.

What did this study involve?
• 40 patients between 18 and 65 y of age with Major Depressive disorder.
• Randomly assigned to get either a single capsule of 50 kIU vitamin D per week (n = 20) or placebo (n = 20) for 8 weeks.
• This was a randomized, double-blind, placebo-controlled clinical trial.

What did the authors analyze?
• Fasting blood samples before and after.
• The primary [Beck Depression Inventory (BDI), which examines depressive symptoms].
• Secondary outcomes such as glucose homeostasis variables, lipid profiles, hs-CRP, and biomarkers of oxidative stress.
What did the study show?
• After 8 weeks of treatment with vitamin D, depression scores improved in the patients receiving vitamin D supplementation.
• The improvement was also related to improvement in vitamin d levels.
How can I get vitamin D tested?
• There is a blood test for vitamin D, which can be ordered by your prescriber.

Can I get vitamin D from food?
According to the National Institute of Health (NIH) (7),
• “Very few foods naturally have vitamin D. Fortified foods provide most of the vitamin D in American diets.
• Fatty fish such as salmon, tuna, and mackerel are among the best sources.
• Beef liver, cheese, and egg yolks provide small amounts.
• Mushrooms provide some vitamin D. In some mushrooms that are newly available in stores, the vitamin D content is being boosted by exposing these mushrooms to ultraviolet light.
• Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods made from milk, like cheese and ice cream, are usually not fortified.
• Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt, margarine, and soy beverages; check the labels.”

Is too much Vitamin D harmful?
Too much vitamin D can be harmful.

According to the NIH (7):
“Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. And by raising blood levels of calcium, too much vitamin D can cause confusion, disorientation, and problems with heart rhythm. Excess vitamin D can also damage the kidneys.”

What is the main cause of too much Vitamin D?

• Vitamin D toxicity almost always occurs from overuse of supplements (7).
• Excessive sun exposure doesn’t cause vitamin D poisoning because the body limits the amount of this vitamin it produces (7).

What are some caveats?

• To avoid the risk of harm, taking Vitamin D supplements should be done under the supervision of your prescriber/doctor.
• This is the 1st study showing benefits on depression with high dose weekly Vitamin D supplementation.
• Further studies are needed.
• Some previous studies showed mixed results though under-dosing and other factors may have been involved (6).
• Vitamin D has shown benefits in some studies and in clinical experience in psychiatry for select patients.
• Benefits on vitamin D may extend beyond mood.
• Treatment with vitamin D with supplement or prescription may NOT be suitable for everyone, but it may be worth discussing with your prescriber.

Is your mood, energy level, etc impacted by low vitamin D? Could replacement benefit you? Check with your health care provider if treatment is appropriate for you.
What are some resources regarding Vitamin D?

• https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
• Counseling and Consultation Service
• Wilce Student health center

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.
References

1. Jesus CA, Feder D, Peres MF. The role of Vitamin D in pathophysiology and treatment of fibromyalgia. Curr Pain Headache Rep. 2013 Aug;17(8):355.
2. Bertisch SM, et al. 25-Hydroxyvitamin D Concentration and Sleep Duration and Continuity: Multi-Ethnic Study of Atherosclerosis. Sleep. 2015 Aug 1;38(8):1305-11
3. McCarty DE, et al. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014 Aug;18(4):311-9. Epub 2013 Sep 26.
4. B Hamilton. Vitamin D and Human Skeletal Muscle. Scand J Med Sci Sports. 2010 Apr; 20(2): 182–190.
5. Al–Dujaili E, Revuelta Iniesta R. http://www.eurekalert.org/pub_releases/2015-11/sfe-vdp102915.php Preliminary study presented Fall 2015 at the Society for Endocrinology Annual Conference in Edinburgh.
6. Sepehrmanesh Z, et al. Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial. J Nutr. 2015 Nov 25. pii: jn218883. [Epub ahead of print].
7. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

Smartphone use before bedtime might impact sleep, and daytime tiredness

Smartphone or cellphones are a useful tool and when used properly can have many benefits.
Many students frequently use cell-phones and often very close to bedtime. Students may not know that cellphone use might impact their ability to sleep at night and this might impact their daytime energy levels.
This study explored the relationship between cellphone use at bedtime and sleep.

Who was studied?
532 students aged 18–39 were recruited from lectures or via e-mail (1).
Mean time of media use per night was 46.6 minutes.

What were the study results?
Mobile phone usage for playing/surfing/texting was positively associated with insomnia.
Computer usage for playing/surfing/reading was positively associated with insomnia.

What do the results mean?
Computer or cellphone use in bed before bedtime may worsen your sleep.

How does screen time impact sleep?
There are various potential causes:
Media use might make it take longer to fall asleep (2).
Media use might mean less time spent sleeping, thus reducing sleep (3).
Bright light emitted by electronic devices might impact sleep quality (4).

Light exposure might be temporarily activating you (5-6).

Are you sleeping poorly? Are you tired during the day? Is screen time before bed impacting your sleep? Will cutting down on screen time improve your sleep? How do you know?

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatrist
Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References
1. Fossum IN, et al. The Association Between Use of Electronic Media in Bed Before Going to Sleep and Insomnia Symptoms, Daytime Sleepiness, Morningness, and Chronotype. Behavioral Sleep Medicine. Volume 12, Issue 5, 2014, pages 343- 357. Published online: 14 Jul 2014. DOI: 10.1080/15402002.2013.819468.

2. Higuchi, S., Motohashi, Y., Liu, Y., & Maeda, A. (2005). Effects of playing a computer game using a bright display on presleep physiological variables, sleep latency, slow wave sleep and REM sleep. Journal of Sleep Research, 14, 267–273.
3. Van den Bulck, J. (2004). Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep, 27, 101–104.
4. Cain, N., & Gradisar, M. (2010). Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Medicine, 11, 735–742.
5. Cajochen, C., et al. (2011). Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. Journal of Applied Physiology, 110, 1432–1438.
6. Campbell, S. S., et al. (1995). Light treatment for sleep disorders: Consensus report. III. Alerting and activating effects. Journal of Biological Rhythms, 10, 129–132.

Bothered by Winter? Could you have Seasonal Affective Disorder?

By R. Ryan Patel DO, FAPA OSU-CCS Psychiatrist

Job # 071125 Snow DEC-05-2007 Photo by Jo McCulty The Ohio State UniversityWinter can be a difficult time of year. For some students, it could be seasonal affective disorder (SAD).

What is SAD?
SAD is depressive symptoms that come and go during a particular time of year. SAD is now considered a subtype of either depression or bipolar illness (1).
Two seasonal patterns of SAD are fall-onset SAD and the summer-onset SAD. The fall-onset type, also known as “winter depression,” is more common; with depressive symptoms starting in the fall and improving by spring or summer. A spring-onset, fall-offset pattern is quite rare (2).

How common is SAD?
•SAD can occur in up to roughly 10% of the population across 20 retrospective studies (5) and a milder form among 10% to 20 % of the population (7).
• It is more common at higher northern latitudes (further away from the equator) (6), possibly because of less sunlight.
• People who relocate to higher latitudes from lower latitudes can be more vulnerable (5).

What are the symptoms of SAD?
Fall-onset tends to have what I call, “hypoactive type” symptoms depression (1,3), with symptoms of:
• Depressed mood AND
• Increased sleep, increased appetite with carbohydrate craving
• Increased weight
• Irritability
• Interpersonal difficulties (including sensitivity to rejection)
• Heavy, leaden feelings in arms or legs

Spring-onset SAD can have “hyperactive type” symptoms of depression such as insomnia, poor appetite, and weight loss.

What can students do to prevent or lessen SAD symptoms?
• Get active by exercising (check with your doctor first)
• Eat a healthy balanced diet of protein/veggies/fruit/whole grains, Omega 3’s
• Don’t isolate from family, friends, or colleagues and get involved on campus
• Take advantage of sunny days (open blinds, study near windows, time outside if possible, etc)
• Counseling
• Talk to your doctor about light therapy, medication options.

What are some of OSU’s campus resources for SAD?
• Student Wellness center (Wellness coaching, nutrition)
• Exercise at the RPAC
•  Counseling and Consultation Service
• Wilce Student health center

Are there any other helpful resources?

• Medline plus (4)
• NAMI (National Alliance for Mental Illness)

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013
2. Wehr TA, Sack DA, Rosenthal NE. Seasonal affective disorder with summer depression and winter hypomania. Am J Psychiatry 1987; 144:1602.
3. Tam EM, Lam RW, Robertson HA, et al. Atypical depressive symptoms in seasonal and non-seasonal mood disorders. J Affect Disord 1997; 44:39.
4. http://www.nlm.nih.gov/medlineplus/seasonalaffectivedisorder.html
5. Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand 2000; 101:176.
6. Mersch PP, Middendorp HM, Bouhuys AL, et al. Seasonal affective disorder and latitude: a review of the literature. J Affect Disord 1999; 53:35.
7. Kasper S, Wehr TA, Bartko JJ, et al. Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Arch Gen Psychiatry 1989; 46:823.
8. Uptodate.com Seasonal Affective disorder. Accessed 2/3/2015.