Lighten Up!

The leaves have fallen and turned brown. The days are shorter, colder, and darker. You wake up to a morning that`s dark and dreary, something like your mood, and you want to hide in the covers and ignore the world. You have no interest in anything anymore. The approaching winter seems like a cold, dark hole of despair and it`s pulling you in. You begin to feel this way every November and you just want to hibernate through it all and emerge when it`s sunny and warm again. Bears have it all figure

Nov 1st, 1999

Light therapy cheers up patients who suffer from seasonal affective disorders.

Joanne Iannone Sheehan, RDH

The leaves have fallen and turned brown. The days are shorter, colder, and darker. You wake up to a morning that`s dark and dreary, something like your mood, and you want to hide in the covers and ignore the world. You have no interest in anything anymore. The approaching winter seems like a cold, dark hole of despair and it`s pulling you in. You begin to feel this way every November and you just want to hibernate through it all and emerge when it`s sunny and warm again. Bears have it all figured out.

This is a typical profile of a person with seasonal affective disorder (SAD). It took the American Psychiatric Association only six years after the first SAD patients were treated to recognize it as an important clinical condition. One of the pioneers in treating this condition was Dr. Norman E. Rosenthal, a prominent SAD researcher. Dr. Rosenthal found that SAD, a more severe form of the "winter blues," was four times more common in women than men. Although anyone could have it, it was mostly found in people ages 20-40. Six percent of the population (10 million people) fit the profile for SAD and 14 percent (25 million) seemed to have a milder version.

The worst months of the year for people with SAD are December, January, and February. March marks beginning of spring and more sunlight. Dr. Rosenthal found this correlation between depression and lack of light to be the key in treating this incapacitating condition. Some people just need more light.

In the early 1980s, the first studies on light therapy were conducted at the National Institute of Mental Health (NIMH) in Bethesda, Md. The researchers concluded that bright light, preferably full spectrum light, changes one`s mood for the better. In 1982, NIMH researchers published a paper in the American Journal of Psychiatry, "Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle." The article described how patients exposed to light 10 times the brightness of ordinary lamplight experienced a decrease in symptoms of depression. Every subsequent clinical study has replicated these findings, a consistency almost unheard of in clinical research.

Many studies were done on severely depressed people, all with amazing results. One such patient had tried to commit suicide as a teenager after a week of gray days in the winter. She noticed that the day after her failed attempt, the sun had finally come out and her depression lifted. She could cope with life again. As she grew into adulthood, though, she found that every year she would become a different person in the winter. She would overeat (especially sweets and snacks) and oversleep. She was less able to function at work and her problem-solving skills were impaired. Christmas cards were a real chore, and she basically just wanted to be left alone.

The patient enrolled in the seasonal studies program at NIMH. After just a few light treatments, she was greatly improved. She was able to be her old self again and learned to take vacations in sunny places in the winter. She now lives in a house with large, sunny windows and continues the light therapy every winter. She also started a support group for people with SAD, called NOSAD, the National Organization for Seasonal Affective Disorder.

Can light therapy really make such a difference in people`s lives? I spoke to one woman who had been diagnosed with SAD 20 years ago. She was so severely affected that she could only get out of bed long enough to get her kids on the bus, then she went back to bed until dinner time. She couldn`t get it together, couldn`t work, couldn`t cope, but she could cry for hours. She saw what her depression was doing to her family. She finally saw a doctor who diagnosed her with SAD and recommended a new treatment -bright light therapy. It was just a theory he had read about in his journals and still experimental, but it made sense to him. Her husband built her a light box with full spectrum light bulbs and, after a few treatments, her condition improved. She now wears a light visor for an hour or so every morning. This is worn like a regular visor and shines towards her eyes, but also allows her mobility to get things done around the house. She`s been using it every day for 20 years now and has been able to hold down a job and function normally. Today, she attributes bright light therapy with saving her marriage and restoring normal family life.

How does light therapy work? The duration of darkness affects the length of time the pineal body, a gland buried deep inside the brain, produces melatonin, a depressant - the more darkness, the more melatonin, the more depression. When bright light is used, it suppresses the production of melatonin, thus alleviating the depression. Further studies suggest that serotonin, a chemical messenger and stimulant, are at their lowest levels during the winter months due to lack of bright light.

Why do most people use full spectrum light for bright light therapy? Studies have shown that full spectrum lights for people with SAD are a little easier on the eyes than ordinary fluorescent lights. The light used must be at least five to 10 times as bright as ordinary room light - about the same amount of light as one sees looking out a window on a sunny spring day. Dr. Rosenthal used five 10,000 lux light bulbs in his studies. This may sound like a lot of light, but your eyes take in 100,000 lux during a sunny day at the beach. The rays from full spectrum light are most like the sun, only without the ultraviolet rays.

You don`t have to be a manic-depressive to benefit from the photo therapy of light boxes. Mary Batterson, a high school English teacher in Jackson, Mich., uses her light box daily.

"I have not been diagnosed by a doctor, but I always get grumpy and blue in the winter months. I gain weight, sit around, and do nothing. I have been using my light box since last October for about 20 minutes in the morning while I have my coffee and answer e-mail. I feel the effects of the light within 15 minutes of turning it on. It gives me an extra boost without making me jittery, like an extra cup of coffee would do. Now I feel less like Eeyore and more like Tigger!"

One business reported that using full spectrum lighting in their workplace increased productivity. A writer using full spectrum light when writing claimed an increase in creativity and production. Putting fingers to the keyboard became an adventure instead of an assignment. Most of this article was written by the light of a light box.

Light boxes also can help those suffering from the winter blues, SAD, or depression of another kind. People who can`t get outside to benefit from the sun can easily use a light box or light visor. Maybe they`re in a hospital room, a wheelchair, or "sunny windows" are not available. I spoke to Margaret Lancaster, whose son, Mert, is a quadrapelegic and gets depressed in the winter months. It`s too cold for him to sit outside, and there is no easy access to windows.

"Mert has a really rough time in the winter," she told me. "He misses his daily fix of sunlight. In his case, a light visor would be better. I know I felt a lot better after my vacation last winter in the Florida sun. Light therapy is a substitute for the real thing, but let`s face it, we all can`t go to the Florida Keys every winter to be happy."

I did my own impromptu experiment with my light box last January. My 17-year-old daughter was having a bad day. Nothing she did came out right and everybody wanted something from her, she sobbed. She messed up an English test, missed the deadline for merit scholarships and was PMSing to the point of tears. I set my light box on the desk where she was working on the computer. After about an hour of light therapy, the child was actually laughing. A mood lifter! And it`s legal for minors!

Light therapy can not only be a tool in treating the winter blues and SAD, but it has already been used in treating people with the year-round symptoms of overeating, sleep disorders, alcoholism, drug abuse, PMS, night shift maladaption, and jet lag. Hospital patients suffering from depression are being treated with bright light therapy as well.

In purchasing your own light box or light visor, you should shop around. If you are online, type in light therapy and search the net for the type that would best suit your needs. They come in all sizes. Some have stands, some sit on your desk. Some can be custom built with your choice of wood trim. Some slant, some don`t. Mine has a dimmer switch which is a must for my blue-eyed son. Some companies sell light visors that run on batteries. You wear them like a golf visor. Most light boxes start at around $300.

If you plan on making your own box, research it thoroughly before you start. It can be a dangerous venture if the wiring is not done correctly or the wrong fixtures are used. One do-it-yourselfer saved money on building his own light box, then burned his retina from the lack of proper filtering. Commercially made boxes have a good safety record.

One word of caution: once you start light treatment and you`re feeling fine, don`t abruptly discontinue it. You`ll find yourself back in depression. When the spring comes and as sunlight becomes more accessible, you can gradually decrease light box therapy.

If you have been diagnosed with SAD, it`s good to know there are support groups for you. You can write the National Organization for Seasonal Affective Disorder at P.O. Box 40133, Washington, D.C. 20016. Or you can e-mail the Northern Organization for Seasonal Affective Disorder at nosads@go2net.org. For more information on SAD and the winter blues, I suggest reading Winter Blues, Seasonal Affective Disorder, What it is and How to Overcome it, by Norman E. Rosenthal, M.D.

Statistics tell us depression during the winter is more common than we think. It`s good to know that medicine has recognized it for what it is and is providing a "light" solution that is the first line of defense and, in some cases, the only one needed.

Joanne Iannone Sheehan, RDH, is a frequent contributor to RDH. She is based in Huntsville, Alabama.

References

- Rosenthal, M.D., Norman E. (1998) Winter Blues, Seasonal Affective Disorder New York, Guilford Press.

- Mondimore, M.D., Francis (1993) Depression, The Mood Disease Baltimore and London Johns Hopkins Univ. Press.

The blues ... or worse?

If you think you may have the "winter blues," ask yourself the following questions:

- Do you feel yourself getting depressed towards late fall?

- Do you notice a lack of energy in the winter months?

- Do you notice a change in your eating and sleeping habits, as well as sex drive, during winter months?

- Do you have trouble with concentration and information processing in the winter?

- Do you feel moody, worthless, or a burden on others during the winter?

- Are you constantly craving junk food or complex carbohydrates in the winter?

- Would you just like to be left alone to hibernate until spring?

If you experience any of the following, you may be suffering from SAD. It`s best to seek medical advice in these cases.

- It`s almost impossible to get to work on time regularly, and you require more sleep.

- You`re having serious problems thinking and concentrating.

- You`re having big problems finishing a job that used to be easy for you.

- You are totally withdrawn from everyone and have frequent crying spells.

- You feel life isn`t worth the hassle, have a bad self image, and are contemplating suicide.

- You feel you have no control over eating and weight gain.

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