As we become more receptive to alternative forms of health and wellness, saunas have become a topic of discussion at many firehouse kitchen tables. Time-limited exposure to high heat for well-being has been used for hundreds of years, dating back to the use of sweat lodges in the Bronze Age. Over time, we've come to theorize that saunas impact not only physical health, but also certain components of mental health.
Suicide is a high ranking killer of both firefighters and law enforcement officers, so any and all pathways to improve mental health and prevent suicides need to be explored. That 2016 study, Whole Body Hyperthermia for the Treatment of Major Depressive Disorder published in the JAMA Psychiatry Journal, revealed findings that were both surprising and encouraging.
By now many of us know the broad benefits of regular sauna use for overall physical health and longevity. For example, a 2018 JAMA Internal Medicine Journal article showed that regular sauna use is associated with reduced cardiovascular mortality and improves risk prediction in both men and women.
Using a sauna two or three times weekly was associated with a 22% decrease in cardiovascular disease and sudden cardiac death, while using a sauna more frequently (four to seven times weekly) was associated with a 63% reduction.
Apart from suicides, sudden cardiac death is consistently the leading cause of on-duty firefighter fatalities. In addition to the cardiovascular benefits, data indicates benefits with both injury recovery as well as heavy metal detox.
Psychiatrists have known since the 1980s that people suffering from depression either do not sweat or have difficulty doing so. When all factors are accounted for (age, gender, etc.), people who are diagnosed with depression have elevated body temperatures when compared to general population. This suggested to the studies’ evaluators that depression may be a hyperthermic state.
Interestingly, the pathways in our brain that control our bodies’ ability to cool down overlap exactly with neural pathways that regulate our mood. Mood and temperature run down the same brain rails. The question the studies’ organizers wanted to answer was: if they stimulated the temperature pathways through the use of a sauna, would they also stimulate the mood pathways?
A six-week, randomized, double-blind study was conducted at a university-based medical center comparing whole body hyperthermia with a sham condition. The sham condition in this study was a machine, used by half the participants, that had a bright light and a mild warming pad to give the illusion they were receiving whole body hyperthermia. The other group actually received whole body hyperthermia.
Sauna use is not the be-all and end-all for addressing mental health issues of first responders, but it is a step in the right direction.
The participants were between 18 and 65 years old, met the criteria for major depressive disorder, were not taking antidepressant medications, and had a Hamilton Depression Rating score of 16 or greater. (The Hamilton Depression Score is the most widely used clinician-administered depression assessment scale.)
The results of this study were striking.
Subjects receiving one single whole body hyperthermia treatment showed a rapid drop in depression scores after three days, which remained significant up to six weeks. If you are depressed and you are hot, it’s because the pathways that should be working to cool you off aren’t working very well.
Dr. Charles Raison, who conducted the study, said in an interview with the British Sauna Society, “The more ‘undepressed’ they got after the treatment, the hotter they were before the treatment. So the people who did the best or had the most significant changes in their depression scores were the hottest (i.e. had an elevated body temperature) prior to whole body hyperthermia exposure.”
Raison went on to say that heating up depressed patients allows for a paradoxical effect. Sensitizing thermoregulatory pathways allows people to better shed and regulate heat moving forward.
While additional studies are required to evaluate whether different levels of heat exposure, or repeated treatments, might increase the intervention’s antidepressant signal, this is great news for the general population and firefighters.
As more and more fire departments adopt sauna use protocols into their wellness and decontamination procedures, they can, by default, assist with addressing some of the mental health issues of their membership with whole body hyperthermia.
Sauna use is not the be-all and end-all for addressing mental health issues of first responders, but it is a step in the right direction.
There has been a dramatic change in the International Association of Firefighters’ position on benefits of saunas for firefighters.
In 2017, IAFF wrote, “There is insufficient medical evidence to support a recommendation for use of saunas to remove toxicants from the body after fire fighting, and the potential adverse health effects outweigh potential benefits.”
Fast forward to 2024, IAFF had this to say regarding firefighter best practices to prevent exposure to harmful chemicals. “Saunas were found to be beneficial. They decrease inflammation and oxidative stress. Studies showed a non-significant decrease in PAHs (polycyclic aromatic hydrocarbons) concentrations after use of saunas.”
Saunas appear to address a multitude of concerns for overall firefighter health and wellness. Promoting responsible use along with proper hydration and rest will help our brothers and sisters in the fire service have a long, happy, healthy career and retirement.
