A Season of Depression
Less Light Dims Lives Of Many Americans |
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By Mark Azzara
copyright 1997 Republican American
This time of year, a lot of people know what Honi Mitchel meant when she sang "You don't know what you got 'till it's gone."
The sun isn't gone, but it's not around as much in January and February as it was (and will be) in June and July. And that's a problem if you are one of the estimated 35 million Americans who mope around from November to April unable to get their engines started, oversleep, suck up carbohydrates and gain weight. The National Institute of Mental Health says that 25 million Americans have the "winter blues," more formally known as sub-syndromal seasonal affective disorder. Another 10 million have full-blown season affective disorder (SAD).
Somehow, no matter what kind of weather Punxsatawney Phill finds, the groundhog in the hills of western Pennsylvania won't be much help to people with a bad case of the "winter blues."
According to William J. Shoemaker, a neurobiologist in the department of psychiatry at the University of Connecticut Medical Center, everybody has the winter blues to some extent.
"We all are mammals. We all go through a hibernating response. When the nights get long and temperature drop, it leads to changes in the metabolic rate and mood, " Shoemaker said. "But we still have to go to work. We all feel it somehow. You get lots of people complaining about the short days in the winter."
Seasonal affective disorder is not an imaginary illness created by lazy people, say the experts. It's a form of depression.
Dr. Charles Atkeins, a psychiatrist at Waterbury Hospital's Tribury Behavioral Health Center in Middlebury, has treated several patients with seasonal affective disorder.
In general, SAD patients oversleep, overeat, crave carbohydrates and gain weight as they "veg out" during the winter, unable to cope easily, if at all, with life's chores. As the days get shorter, the condition gets worse. Atkins said the laundry list of depression symptoms can also include sadness, insomnia, feelings of guilt, diminished concentration and even thought of suicide. |
Atkins said some SAD patients show signs of manic depression (being very "up" in the warm-weather months and very down when days are short). Whatever it is, Atkins said, it needs to be treated.
The only way to find out what's causing the depression is to see a psychiatrist, although some people, the idea of visiting one is even scarier than the thought of enduring SAD.
But Shoemaker said there is no other choice. "You just can't go to your neighborhood practitioner. They won't have much sympathy for you. The person who needs to see one is one who can't get to work in the morning, can't get out of bed. If you're just in a grouchy mood but still do everything you have to do, I don't know if that would require seeing a physician."
If SAD is the problem, the answer can be pretty simple: more light. For thousands of years, sunlight has been recommended as cure for what ails you. The solarium has always been regarded as a key place of healing.
Researchers have found that when full-spectrum bright light enters the eye, it slows the pineal gland's production of melatonin, which makes people drowsy and regulates the body's sleep rhythms. The less bright light, the more melatonin and thus the greater the desire to sleep or just mope around.
When Dr. Norman Rosenthal and his team of researchers at the National Institute of Mental Health identified SAD in 1984, they theorized that exposure to bright light would alleviate the problem. The research proved successful.
Now, many SAD patients get their dose from a fluorescent light fixture that simulates the brightness of sunlight. "you sit in front of this light for a period of time daily and it seems to help people get out of their depression," Aktins said. "It's quite effective for those who clearly have seasonal affective disorder."
You don't have to necessarily stare at the light but your light has to be open, "Shoemaker said. "The light has to go into the eye." Rosenthal's research indicates that people can read or work during the exposure time, only glancing up occasionally into the light. |
Aktins said this king of therapy may be covered by some health insurance plans.
Unlike tanning booths, the light to which SAD patients are exposed is filtered to block out harmful ultraviolet rays. Patients need the brightness, not the UV rays. They also don't lay inside a light box but sit upright among a bank of lights around their heads. "Phototherapy" is getting to be big business.
Atkins said light therapy can have a related benefit. Doctors can eliminated SAD as the cause for a patient's depression if the light does not work. In those cases, patients are forced to consider other forms of treatment, including medication..
Although some people erroneously believe they can get a sunlight fix using tanning booths, you won't here Grant-Keys endorsing them. "There are no benefits, " she said bluntly. "Any dermatologist would tell you they are not in favor of suntan parlors and are dangerous."
"Skin cancer can be dangerous, mutilating and potentially deadly. It amazes me how unaware people are of that fact. They think, 'Well the cancer's just on the skin so it can't hurt me. Some skin cancers can cause death in patients."
When using Phototherapy to treat certain skin conditions "there 's a risk-to-benefit ratio when you're using the suntan parlors just to get a tan."
Grant-Kels can understand why people use the parlors. "I think the tan is indicative of people looking healthy, feeling good, it's indicative of wealth and the good life." Grant-Kels said some of her patients literally begin to cry out "when I do my little spiel about suntan blocks and protective clothing. "There is no questions that abuse of these parlors and regular use of them will ultimately cause cancer.
... People who are cavalier about it are people who haven't had cancer. |
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Rosenthal, N. E.
Light Therapy
Treatments of Psychiatric Disorders, Vol. 3 APA Press, 1989. p 1890-96
Rosenthal lists the criteria and gives a history of the syndrome. He then discusses the efficacy, practical considerations, side effects and mechanisms of phototherapy.
Lewy, A. J.
Treating Chonobiologic Sleep and Mood Disorders with Bright Light.
Psychiatric Annals 17:10 October 1897. p 664-669.
One of the most promising nonpharmacological treatment of psychiatric disorder is bright light. The article discusses how bright light and other factors affect human circadian rhythms. It supports the hypothesis that winter depression is the result of delayed circadian rhythms with respect to sleep. The article is followed by "Treatment Guidelines for Patients with Seasonal Affective Disorder."
Jacobsen, F. M. Wehr, T.A. Sack, D.A. James, S.P. Rosenthal, N.E.
Seasonal Affective Disorder: A Review of the Syndrome and it's Public Health Implications.
American Journal of Public Health, January 1987. 77 (1) p57-60.
Seasonal Affective Disorder (SAD) is a disturbance of mood and behavior which resembles some seasonal changes seen in lower mammals. Like these animals seasonal changes, SAD is thought to be related to decreased sunlight during winter months. [SAD has been successfully treated with exposure to bright artificial light of higher intensity than is usually found in the home or in the work place. Many people not suffering from SAD may nonetheless have seasonal changes which could be helped by environmental light supplementation. Lighting standards in the home should be re-evaluated on the basis of new knowledge of the psychobiological effects of light.] We review the literature on SAD and discuss it's public health implications in the context of a typical case presentation. Author Abstract.
Rosenthal, N.E. Carpenter C.J. James, S.P. Parry, B.L. Rogers, S.L. Wehr, T.A.
Seasonal Affective Disorder in Children and Adolescents.
American Journal of Psychiatry, March 1986. 143(3) p. 356-8.
The authors studied seven children with symptoms of Seasonal Affective Disorder. During the winter months, the children regularly experienced irritability, fatigue, school difficulties, sadness, and sleep change as well as other symptoms of Seasonal Affective Disorder found in adults. An open trial of bright environmental light reversed many of these symptoms and improved mood and social functioning in the winter months. School counselors and therapists should consider Seasonal Affective Disorder in the differential diagnosis of children with school difficulties that are most prominent in the fall - winter semester. Author Abstract.
Rosenthal, N.E. Blehar, M.C.
Seasonal Affective Disorders and Phototherapy.
The Guilford Press, New York, 1989.
"'Seasonal Affective Disorder and Phototherapy' is an impressive compilation or research that illustrates a profoundly important trend in modern psychiatry: the rapid application of knowledge about the pathophysiology of a disorder to the rational design of safe and effective treatments. Rosenthal and Blehar, who convened the NIMH workshop from which the papers are drawn, are both thorough and balanced in their selection and presentation of the research. Essential reading for those involved in the study and treatment of seasonal affective disorders, it also will prove highly informative to readers with a more general interest in the process and outcome of research."
Whybrow, P. Bahr, R.
The Hibernation Response
Arbor House, William Morrow, New York, 1988.
This work examines phase-delayed/advanced sleep disorder. It draws similarities between these disorders and hibernation in animals. It suggests changes in life-style to combat mild symptoms and phototherapy to battle the overwhelming struggle of SAD patients.
Terman, M. Link, M.
Fighting the Winter Blues with Bright Light.
Psychology Today, January/February 1989. p18-21.
Terman and Link review the major studies, symptoms and treatment of SAD. They highlight the convenience and effectiveness of artificial light therapy.
Wurtman, R.J. Wurtman, J.J.
Carbohydrates and Depression.
Scientific American 233(1), January 1989. p 68-75.
Dr. Wurtman discusses the similarities of SAD, PMS, and carbohydrate-craving obesity. He explains how each are influenced by photoperiodism. Included in the discussion are citations of remission from depression and carbohydrates craving through exposure to intense artificial light.
Hellekson, C.J. Kline, J.A. Rosenthal, N.E.
Phototherapy for Seasonal Affective Disorder in Alaska.
American Journal of Psychiatry, August 1986. 143(8) p 1035-7.
Six patients with Seasonal Affective Disorder showed marked improvements in depressive symptoms after following three different two-hour schedules of bright artificial light, and they relapsed when the light was withdrawn. Author Abstract.
Cyeisler, C.A. Johnson, M.P. Duffy, J.F. Brown, E.N. Ronda, J.M. Kronauer, R.E.
Exposure to Bright Light and Darkness to Treat Physiologic Maladaptation to Night Work
The New England Journal of Medicine 1990; 322:1253-9.
Working at night results in a misalignment between the sleep-wake cycle and the output of the hypothalamic pacemaker that regulates the circadian rhythms of certain physiologic and Behavioral variables. We evaluated whether such physiologic maladaptation to nighttime work could be prevented effectively by a treatment regimen of exposure to bright light during the night and darkness during the day. We assessed the functioning of the circadian pacemaker in five control and five treatment studies in order to asses the extent of adaptation in eight normal young men to a week of night work......We conclude that maladaptation of the human circadian system to night work, with its associated decline in alertness, performance, and quality of daytime sleep, can be treated effectively with scheduled exposure to bright light at night and darkness during the day. Author Abstract.
Lewy, A.J. Sack, R.L. Miller, S. Hoban, T.
Antidepressant and Circadian Phase-shifting Effects of Light.
Reprint Series, 16 January 1987, Volume 235, p 352-4.
Bright Light can suppress nighttime melatonin production in humans, but ordinary indoor light does not have this effect. This finding suggested that bright light may have other chronobologic effects on humans as well. Eight patients who regularly became depressed in the winter (as day length shortens) significantly improved after 1 week of exposure to bright light in the morning (but not after 1 week of bright light in the evening). The antidepressant response to morning light was accompanied by an advance (shift to an earlier time) in the onset of nighttime melatonin production. These results suggest that timing may be critical for the antidepressant effects of bright light. Author abstract.
Group authorship
Those SAD Winter Days.
Newsweek, May 4, 1987. p 54.
This article describes symptoms of SAD and tells of research at the NIMH involving the use of artificial bright light to treat patients with SAD.
Long, Michael E.
What is this Thing Called Sleep?
National Geographic, December 1987. p 787-821.
Michael Long reviews the use of bright artificial light in treating sleep disorders of the elderly, jet lag, and seasonal depressions. He cites actual experiments where the use of bright light altered the body's circadian rhythms.
Moor, L.J.
Lightening Up the Winter Blues.
U.S. News and World Report, December 5, 1988. p 92.
Moore gives a brief overview of seasonal depression, carbohydrate craving and light therapy. Included in the article is a list of approved light systems which may be covered by insurance.
Toufexis, A.
Dark Days, Darker Spirits.
Time, January 11, 1988. p 66.
Millions of people suffer from SAD. Phototherapy can make people's lives bright again. Dalene Barry said, "It's like a gift someone has given me ... I get four months a year back that I never had."
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