Seasonal Affective Disorder (SAD)
Everyone recognizes "spring fever," the giddiness that lifts the spirits as the short, dark days of winter become the longer, sunnier days of spring. Doctors first noticed its opposite number, annual winter depression, 150 years ago, but the condition remained a medical footnote until about 15 years ago. In the early 1980s, researchers began linking the darkening of winter moods to, well, the dark--lack of sunlight from November through March.
The Top Salesman Who Couldn't Sell in Winter
Back in the late 1970s, Neal Owens of Rockville, Maryland, was a petroleum salesman with an odd problem. "Every spring and summer," he recalls, "I was my company's top salesman. But come fall and winter, my sales fell to last place." Owens' boss accused him of goofing off around the holidays each year, but Owens insisted he wasn't. "I just seemed to loose my get up and go in winter." Maybe you're sick, his boss said, get a checkup. Owens saw his doctor, who ran a battery of tests, but all the results were normal. Owens wound up seeing a psychiatrist, who diagnosed depression, and prescribed various stimulants and antidepressants. "They helped, but I still felt out of it."
Then by accident one weekend during the fall of 1982, Owens happened to catch a television show about depression. It mentioned that researchers at the National Institute of Mental Health (NIMH) in nearby Bethesda had begun studying an odd, newly identified type of depression that struck some people like clockwork every winter, and caused other symptoms, including winter weight gain. They called it "seasonal blues."
Hey, that's me, Owens thought. As his mood darkened each winter, his weight climbed by 20 pounds, and as his depression lifted each spring, he lost the weight. Owens contacted the NIMH researchers and volunteered for their study, which involved a therapy that struck him as bizarre--sitting in front of bright lights for several hours a day. "I was skeptical," Owens recalls. "The best antidepressants hadn't cured me. How could I possibly get relief from something as ordinary as light? But I was desperate, so I signed on." Owens credits what is now known as light therapy with saving his sanity, and possibly his life.
The Spectrum of Winter Depression
Winter blues varies in severity from mild "winter blahs," to moderate "winter doldrums," to severe winter depression, medically known as "seasonal affective disorder," or, aptly enough, SAD.
Winter Blahs. People with the mildest winter blues function normally throughout winter, but by February they feel vaguely out of sorts, according to San Francisco psychiatrist Michael Freeman, M.D. "They typically develop the late-winter irritability popularly known as 'cabin fever,' followed by a welcome surge of spring-fever energy as the days lengthen."
Winter Doldrums. Those with moderate winter blues can function throughout winter, but not normally. "They feel down," Dr. Freeman explains, "and suffer more noticeable cabin fever. They often feel an increased need for sleep, gain a few pounds, and may have difficulty getting out of bed in the morning."
Seasonal Affective Disorder. Like Neal Owens, people with severe winter blues become seriously depressed each autumn, and can't function normally until spring. SAD shares several symptoms with other forms of depression: lethargy, joylessness, hopelessness, anxiety, and social withdrawal. In addition, SAD sufferers crave additional sleep, experience daytime drowsiness despite it, and gain a good deal of weight, often feeling irresistible cravings for sweets.
The Farther North You Live...
SAD afflicts about 5 percent of U.S. adults--some 10 million Americans--but an estimated 25 percent of the population experiences some form of winter blues. The farther north you live, the greater your risk. Studies show that about 1 percent of Floridians suffer SAD. Among Alaskans, the figure is 10 percent. About 3 percent of Floridians experience winter doldrums. In New Hampshire, the figure is 11 percent. Draw a line across the United States from San Francisco through Kansas City to Richmond, Virginia, and north of it, winter blues is fairly prevalent.
Until recently, SAD was considered an adult illness that typically appeared in the early 20s. But the latest studies have shown that it can strike children as well. Experts now believe that about 4 percent of American 10 year olds have SAD. But childhood winter blahs and doldrums are much more common. In a recent survey of 1,700 children's mood changes, Mary Carsakdon, Ph.D., a professor of biomedicine in psychiatry at Brown University in Providence, Rhode Island, discovered that almost 50 percent showed at least one symptom of depression in winter, compared with only 10 percent in the spring and fall.
Other types of depression afflict many more women than men, and SAD is no exception. The NIMH estimates that women with SAD outnumber men four to one. The condition also seems to run in families.
Human Hibernation?
Many animals show profound seasonal behavior changes--bears hibernate, birds migrate, salmon return to where they were born. Seasonal behavior changes in animals involve the light-sensitive pineal gland in the brain. As the days grow shorter, the eyes transmit less light energy along the optic nerve, and the pineal gland releases more of the hormone melatonin, which helps regulate behavior. In some animals, the rise in melatonin suppresses reproduction, which has a significant survival advantage. It means that females and offspring are spared the hardship of delivering young or being born during the coldest, most physically stressful time of year.
Humans also have light-sensitive pineal glands, but until recently, scientists didn't think people had seasonal rhythms. Now they know differently, and not just because of winter blues. Like other animals, human conceptions increase in late summer and fall, meaning that babies are more likely to be born in spring and summer than in winter.
Increasingly, winter depression looks like an echo of our evolutionary past. "The sleep need and weight gain you see with SAD look hauntingly similar to hibernation," Dr. Freeman says. "Some authorities even call SAD a 'hibernation response.'"
Let There Be Bright Light
A decade ago, researchers noticed that some SAD sufferers regularly went south for winter vacations. After a few days of Caribbean sun, they invariably felt better, and continued to feel fine for a few weeks after their return. "The extra day length and greater light intensity temporarily relieved their depressions," says SAD expert William Sonis, a professor of psychiatry at the University of Pennsylvania in Philadelphia.
This observation led to another treatment that proved equally effective--daily exposure to high-intensity, artificial sunlight (full-spectrum minus the ultraviolet, which causes sunburn and increases risk of skin cancer). Among the scientists who proved the effectiveness of light therapy were the NIMH researchers contacted by Neal Owens. They loaned him a 70-pound box resembling a TV with four fluorescent lights instead of a screen, and instructed him to sit in front of it for four hours a day, two hours before breakfast and two after work. "The time investment was a major hassle," Owens recalls, "but after a week, I felt much better." Still, Owens remained skeptical. The lights might possibly be helping, he thought, or perhaps his improvement was a delayed benefit of the new antidepressant he'd been taking. Then the NIMH researchers asked him to return the light box. "Within a few days, I felt awful again," Owens recalls. "I realized that the lights really helped."
By the mid-1980s, bright-light therapy (phototherapy) had become the treatment of choice for SAD, says Michael Terman, Ph.D., director of the Light Therapy Unit at Columbia Presbyterian Medical Center in New York City, "but at four hours a day, it took so long that for most people, it just wasn't feasible." Then studies by Dr. Terman showed that the evening session was unnecessary. Morning-only bright-light therapy cut treatment time in half. A few years later, Dr. Terman cut it further by brightening the lights.
Light intensity is measured in "lux" units. The typical home is illuminated at a twilight level of about 250 lux. Early light boxes emitted 2500 lux, which sounds like a lot, but really isn't. "That's the brightness of outdoor light shortly after dawn," Dr. Terman explains. "At noon on a summer day, you can have 120,000 lux." Dr. Terman constructed a 10,000-lux light, and found that SAD sufferers obtained effective relief with daily exposure of just 30 minutes. "You put the unit on your kitchen table," he explains, "and by the time you've finished your morning coffee, you're protected for the day."
SAD symptoms typically begin to lift about a week after the start of phototherapy. But as Neal Owens learned the hard way, they return shortly after discontinuing treatment. As a result, authorities urge SAD sufferers to sit under bright light daily from October through April.
Can prolonged daily exposure to 10,000 lux hurt? No, says Dr. Terman. Ten thousand lux is no brighter than early morning sunlight. On the other hand, individual bright-light tolerance varies, and after a while, some people may start to feel uncomfortable. Overdose symptoms include queasiness and agitation, but they disappear within a few hours of turning the lights off. "When people learn their limits and stay within them, they don't have any problems," Terman says. Several effective bright-light appliances are currently available (see below).
Dawn's Earlier Light
Within just the last few years, scientists have discovered that for some people with winter blues, ultrabright light might not be necessary. Dr. Terman was one of several researchers who confirmed that the light of simulated dawns also elevates depressed mood. Dr. Terman fashioned a simulated-dawn device using a nightstand light fitted with a timer and dimmer. At 4 a.m. the timer turns the light on, bathing the sleeping winter-blues sufferer in the faint glow of an artificial dawn. The light brightens over two or three hours until the person awakens. In one early study, six of eight SAD sufferers experienced substantial relief after two weeks of awakening to simulated sunrises. Since then, other studies have confirmed the effect.
Once Neal Owens felt convinced of phototherapy's value, he asked two friends, an electrical engineer and a lighting fixture salesman, to help him build his own bright-light box. The NIMH researchers liked Owens' design better than theirs, and bought 20. Then other researchers began calling, and as word spread, Owens had SAD sufferers from around the country calling at all hours pleading for one of his light boxes. For about a year, Owens made the boxes in his spare time. Eventually, he quit his job, and founded The SunBox Company, a leading producer of bright-light appliances.
When dawn simulators were first developed, Owens tried one. "It helped me get out of bed in the morning. For people with mild SAD or winter doldrums, a dawn simulator may be all they need. But by itself, a dawn simulator doesn't work for me. I wake up to one, but I still sit in front of a 10,000 lux SunBox SunRay at breakfast."
Light Therapy for Nonseasonal Depression
Winter blues is just the tip of the depression iceberg. Some 10 to 15 million Americans are seriously depressed, and the condition's most tragic consequence, suicide, claims 30,000 lives a year. Light therapy's success in treating SAD has led to studies of its effectiveness for nonseasonal depression--with promising preliminary results. At the University of California at San Diego, psychiatry professor Daniel F. Kripke, M.D., divided 50 men with severe nonseasonal depression into two groups. Half spent seven consecutive evenings in a room illuminated with 1,600 watts of bright light. The other half spent the time in a room with the lights turns low. Compared with the dim-light group, symptoms in the bright-light group improved 18 percent.
How To Brighten Your Mood
Bright-light boxes and dawn simulators may be necessary for some seasonal blues sufferers, but experts in phototherapy offer other suggestions as well:
Get more natural sunlight. Trim the bushes around your windows and keep your curtains and blinds open. Use bright colors on walls and upholstery.
Sit near windows whenever possible--at school, at work, on public transportation, and when dining out. If you exercise indoors, work out near a window.
Take a walk. People with SAD often spend unusually little time outdoors in winter. A Swiss study showed that a one-hour walk in midday winter sunlight can significantly lift the spirits. For winter blahs and winter doldrums, a daily outdoor winter walk may be all that's necessary.
Take all or part of your vacation time in winter instead of summer. Head for a sunny destination. "With a diagnosis of SAD," Dr. Freeman says, "it might even be tax-deductible."
Try a dawn simulator. These devices can be set like alarm clocks to produce an artificial dawn from one minute to three hours before the user awakens. Neal Owens' pocket-size SunUp costs about $200. Write The SunBox Company, 19127 Orbit Dr., Gaithersburg, MD 20879.
Try bright-light therapy. The light must enter the eyes, but don't look directly at bright-light appliances. Simply sit near them. Several companies now make bright-light boxes, among them: the SunBox Company, address and phone above; and Apollo Light Systems, 352 West 1060 South, Orem, UT 84058. 1-800-545-9667.
Check out full-spectrum lighting and other lighting products online at Ott BioLightSystems: http://www.ottbiolight.com/
Try a support group. Neal Owens and other SAD sufferers founded a nationwide support group, NOSAD, to help people with winter blues--and their families--cope with the condition. Write for free information: P.O. Box 40133, Washington, D.C. 20016.
Woman's World Source:
Depression.com