Wrestling winter blues: bright lights rescue SAD sufferers

American Fitness, Nov-Dec, 2003 by Carol Jean Finlayson

In late fall, the last leaves swirled to the ground and frost shimmered on the windowpane. While some women might be buoyed by the prospect of Yuletide cheer, my friend Rena, a hard-driving attorney, turned into a couch potato. She munched chips in a trance, certain the twin triggers of cold and dark activated her descent into seasonal depression. "What better way to pass the dreary winter months," she mused out loud, "than to stuff your face, curl up and take a long nap? Perhaps the bears are right."

Definition and Symptoms

In a sense, Rena was right. Seasonal Affective Disorder (SAD) is a form of depression linked to decreased sunlight in autumn and winter months (i.e., November through March). Since we have adapted to the light-dark cycle over time, day and night boundaries affect us. Prehistoric man slept when he couldn't see well and woke at dawn recharged for the day's hunting and gathering. As biological beings, the amount of" light our eyes register synchronizes our internal clocks. It makes sense that seasonal light changes can disrupt the cluster of brain cells that control our living patterns (e.g., eating, sleeping, sexual desire).

Ten million Americans, mostly women who live in the northern latitudes, experience mood disorders during winter. Their internal coping clocks run behind during dark, cold days, especially in January and February. Rena described it as a "kind of Billie Holiday effect--the way you feel on rainy days and Mondays, multiplied by 10,000."

Symptoms include:

* feeling sad or depressed

* extreme fatigue and lack of energy

* increased need for sleep

* carbohydrate or sugar cravings (with accompanying weight gain)

* social withdrawal

* difficulty concentrating

* decreased interest in sex

* irritability.

Contributing Factors

According to renowned authority Norman E. Rosenthal, M.D., where you live is a significant factor--1.4 percent of SAD sufferers reside in Florida, while 9.7 percent live in New Hampshire. Fourteen percent of the American population is affected by the milder subset of SAD known as "winter blues," which some researchers think tops the common cold as the most frequently occurring winter illness.

While the medical community is not in total agreement about what causes the disorder, heredity, stress and chemical make-up play a part. In some people, a chemical tide deviation occurs during winter. The pineal gland in the brain secretes melatonin (i.e., a sleep-related hormone), which has been linked to depression. Melatonin is produced at increased levels in the dark, which explains why gloomy moods often follow darker, shorter days. At the same time, serotonin, a mood-boosting neurotransmitter triggered by sunlight, wanes to its lowest levels. This results in mood deflation in some people.

Bright Light Treatment

In a 1986 study, phototherapy (i.e., light therapy) effectively reversed the winter depressive cycle in 80 percent of 112 patients. Extensive research by the National Institute of Mental Health solidified phototherapy's credibility. The American Medical Association and American Psychiatric Association endorse it as the preferred treatment for patients with severe SAD symptoms. Phototherapy reverses the SAD cycle by fooling the brain into thinking it's summer. The end result is suppression of melatonin emission and elevation of serotonin levels.

Sun boxes use full-spectrum (as opposed to ordinary) fluorescent lights with a reflector behind the rows of lights and a plastic diffusing screen in front. The typical "dose" of light is 5,000 to 10,000 lux (i.e., the intensity of light on a sparkling spring day). Jeri Walker, M.D., a psychiatrist at Newton Wellesley Hospital in Massachusetts, says the best thing about light boxes is they are a natural treatment with few side effects. Sun boxes are most effective when used for an hour early in the morning. "I recommend people place the box one to three feet from where they're going to be doing normal activities--reading the newspaper, doing paperwork or cooking," she says. "The patient shouldn't look directly at the light because that could be damaging to the eyes. In addition, wearing glasses, especially sunglasses should be avoided, as the whole point of the treatment is to have light penetrate the retina."

Sun boxes' downside is their cost, $165 to $180, which many insurers are reluctant to pay due to their ever-changing clientele. Fortunately, used equipment is offered at varying discounts. Walker asserts the clinically designed lights are fairly expensive because they guarantee a certain number of lux, provided they are used at the prescribed range. "Now that full-spectrum lights are so readily available, however, it's possible for people to assemble their own therapeutic arsenals," she says. "Another option is installing dawn simulators set on a timer, so your bedside light comes on earlier."

Alternate Treatments

Because mood disorders can disrupt relationships, home and work life or even prove fatal, research suggests it is important for those who suffer from depression to consult a mental health professional. A combination of psychotherapy and medication has helped some people by reducing stress as well as eliminating negative thoughts and behaviors. Anti-depressants that reversed SAD symptoms in some individuals include paroxetine (Paxil[R]), sertraline (Zoloft[R]), fluoxetine (Prozac[R] or Sarafem[R]) and venlafaxine (Effexor[R]).