Winter Depression is S.A.D.
It is estimated that 10 million people in the United States alone experience the effects of Seasonal Affective Disorder (SAD), while another 25 million suffer from a milder version sometimes referred to as winter depression.
Dr. Norman E. Rosenthal , of the National Institute Of Mental Health in Bethesda, Maryland, spearheaded research in the disorder in 1980 when he noticed patients became severely depressed in the winter but snapped out of it in the spring. He also noticed that some patients from the North brightened when they visited a southern climate, but experienced a relapse when they returned home. Since then, dozens of research psychiatrists and doctors have analyzed SAD, finding that light can influence moods, possibly because it produces an increase in a hormone called melatonin which can cause depression when present in large amounts. It is believed that production of this hormone decreases when the body is exposed to sunlight.
Dr. Rosenthal describes the symptoms of SAD in his book, Winter Blues. Typically, the symptoms last from early November, when the days become noticeably shorter, until March, when days begin to lengthen. January and February are the worst months for depression. Women are about four times more susceptible to SAD than men. This may be related to hormonal differences.
Like water and air, light is essential to our well-being. Our body has a very distinct 24 hour cycle. This cycle is controlled by bright light (the sun). Shift workers, travelers crossing several time zones, people with certain sleep disorders, often feel "out of sorts" because their daily cycle is "out of sync" with the sun.
Studies have shown that during fall and winter about 20% of the population is affected by specific symptoms related to changes in our sleep/wake pattern that may include sleep problems, change in appetite or weight, lack of energy, diminished sex drive, body aches or pains, memory loss, inability to make decisions, problems concentrating, low self-esteem, lack of interest in or enjoyment of activities, suicidal thoughts.
Seasonal Affective Disorder is a specific type of major depression, which reoccurs at specific times of the year. The most common pattern is the onset of major depression in the fall (September through November) and abating of the symptoms in late winter to early spring (March through May). The frequency of SAD seems to vary with geographic location. It may approach 10% of the general population in northern New England, 5% of the population in the Baltimore/Washington area, and less the 2% of the population of Southern California or Florida.
About 75% of SAD sufferers are women, but Seasonal Affective Disorder affects men and children as well. The most typical age of onset is in the twenties, but other onsets are common such as during puberty, middle age, and old age. After women pass through menopause the numbers in men and women become equal. Most affected are those living in northern latitudes and in frequently overcast areas, especially during the shortened fall and winter days.
As in the case of major depression, the diagnosis of Seasonal Affective Disorder is a clinical one, based on the presence of specific symptoms. To meet the criteria for a seasonal relationship, there should be at least three episodes of mood disturbance in three separate seasons, at least two of which are consecutive. There should be no association between the disturbance and situation stresses, such as being unemployed with each winter.
The primary cause of Seasonal Affective Disorder is change in sunlight exposure. The reduction in daylight hours in the fall and winter can affect sufferers of SAD. The most commonly accepted hypothesis for the underlying cause of SAD is that reduced natural sunlight exposure affects the body's natural daily rhythms, which are not fully precise and rely on the intensity of sunlight to provide adjusting cues. These cues originate in the retina at the back of the eye, creating signals which pass through the optic nerve to the mid-brain, setting in motion a number of chemical changes. These changes include:
Increase in the neurotransmitter serotonin, necessary for a sense of well being.
Seasonal Affective Disorder can be experienced as an isolated disorder or may be experienced in conjunction with an existing mood disorder or chronic illness. The tendency toward SAD or severity of the symptoms can be influenced by many factors, such as living in a northern latitude, recent cloudy weather patterns, family history of SAD, working in a windowless office, recent illness, or general life stresses.
Brighten The Mood
According to Dr. Robert deVito, chairman of the Department of Psychiatry at Loyola University Medical Center in Maywood, Illinois, 60% of the adult population experiences some change in mood and behavior linked to the seasons. But in most cases the problem is easily solved. DeVito reports an 80% recovery rate in his patients when full-spectrum light therapy is used. Light therapy evens out the mood swings, decreases the need for sleep, and lessens the cravings for carbohydrates. "The full-spectrum lights give the body the equivalent of a longer day and lift the mood considerably," deVito explains. " Ordinary interior lights won't do," he adds. "You need light 10 times as bright, light that imitates sunlight, without the intensity of the sun's rays."
One of the most effective methods of treatment is a device known as a "lightbox." Designed to simulate the brightness of the sun as it is in the midmorning hours of springtime, the lightboxes trick the body into believing it is no longer winter. The light from a lightbox may range between 2500 to 10,000 lux, (a lux is a standard unit of measurement for light brightness). This compares with the usual 500 to 700 lux in an ordinary well-lighted room and up to 100,000 lux outdoors on a bright day.
Portsmouth, N.H. psychotherapist Stephen Little has treated more than 250 of his patients with lightboxes. "As opposed to anti-depressants, which can take as long as a month to know if they are working," according to Little," light therapy can take from one to five days and with no side effects." He said if SAD sufferers sit in front of a lightbox for 30 minutes each morning, the light almost instantly makes them feel better.
In many ways the treatment of Seasonal Affective Disorder is similar to that of other major depressive episodes, utilizing antidepressant or mood stabilizing medication and/or psychotherapy. In addition, the exposure to bright light has been found to be an effective means of treating Seasonal Affective Disorder. The individual sits in front of a bright light unit, a specialized, portable box which houses balanced spectrum fluorescent tubes. An individual's needs for light therapy specifies the duration of exposure and the optimal time of day. An individual should meet periodically with their health care professional. The dose of light therapy should be adjusted as needed.
The most successful treatments for SAD involve identifying how the change in daylight shifts the person's daily circadian rhythms, especially in their sleep cycle. Most people with SAD symptoms show changes in their sleep/wake patterns and melatonin levels. Bright light is known to be a powerful regulator of melatonin and the sleep/wake cycle. Seasonal Affective Disorder and "Winter Blues" sufferers tend to show two common patterns in their sleep phase: Delayed or Advanced.
For most patients, light therapy is the most natural and safe treatment for SAD, as well as the most cost-effective.
Bipolar disorder is also known as manic depression because of extreme swings in mood, thought and behavior. Bipolar is different than major depression in that it is marked by episodes of euphoria or mania. These episodes commonly last from hours to days, but can also last for months.
Bipolar Disorder afflicts 2 million adults, and possibly another 1 million plus children. It usually starts in adolescence, with males first experiencing a manic episode and females experiencing a depressive one.
There are two types of bipolar illnesses, bipolar 1 and bipolar 2. Bipolar 1 is more severe than bipolar 2, and is marked by one or more manic swings followed by one or more major depressive episodes. Bipolar 2 generally starts with one or more depressive episodes, followed by a milder (hypomanic) episode.
The medical journal The Lancet reports that the lack of bright light like sunlight may be a cause of depression. Bright light produces serotonin in our brains, and scientists believe that low levels of serotonin contribute to depression. As light produces serotonin, our natural balance returns, and we're productive again. Clinical studies at Yale, UCSD and others, have shown dramatic results using bright environmental light (10,000 lux intensity).
Light does what anti-depressants can't
The discovery that light produces serotonin is significant, because it may be the only way to increase serotonin levels in the brain. Pharmaceutical companies have never been able to replicate this process. Anti-depressant medications are designed to keep serotonin in the system, but they cannot produce it. For those who already have low levels of serotonin, SSRI's are not as effective as they otherwise might be. This is why light may be a beneficial supplement. Recent studies suggest depression may be more effectively treated with light and medication rather than medication alone.
Light Therapy Treatment for Bipolar Disorder
Specialized bright light is known as an effective antidepressant. Because most bipolar patients suffer from depressive episodes during the winter and in overcast conditions, researchers feel that light therapy should be an obvious choice for manic depression. Several studies have demonstrated the success of light therapy in averting depressive episodes in manic depression. In January 2004, the Cochrane Medical Review recommended light therapy for treating Bipolar Disorders.
Light appears to be successful for two reasons: First, bipolar patients suffer from low serotonin levels during depressive lows, and second, they are also supersensitive to melatonin fluctuations. Since light effectively regulates melatonin and serotonin, bipolar patients respond almost immediately.
Light Therapy & Bipolar Children
Because light therapy poses no long-term negative side effects, it is also recommended for children. One of the more accurate works on childhood bipolar disorder, The Bipolar Child, recommends light therapy as a first line treatment.
Cautions With Light Therapy and Bipolar Disorder
Researchers have noted that manic depression sufferers (bipolar 1) should be on an effective mood stabilizer before using light therapy. Because light produces serotonin, it may precipitate a manic reaction. Light has been found to be safe when used for less than an hour at a time, but physician supervision is always recommended.
The most common device used for bright light therapy is a fluorescent light box, which produces a light intensity of 2,500 to 10,000 lux at a comfortable distance (1-2'). Light box intensity ratings are always at a given distance. Fewer headaches and eyestrain are associated with using balanced spectrum light.
The light box is placed in front of the user at the recommended distance for the desired intensity. One should be directly in front of the unit as the light shines into the user's eyes. The eyes need be open, and sunglasses should not be worn. Some may be instructed to look at the light box briefly at regular intervals. The light box intensity of 10,000 lux is much brighter than normal indoor light which is usually 300-500 lux, but not as bright as summer sunlight which can be as bright as 100,000 lux.
The Aurora bright light system provides a measured amount of balanced spectrum light equivalent to standing outdoors on a clear spring day. This has been shown to help regulate the body clock. Photo biologists point out that the light is registered by the eyes through the retina, which then transfers impulses to the hypothalamus in the brain to normalize the body clock function. The light from the box will help synchronize sleep/wake patterns with one's work and lifestyle.
Regular daily usage of the Aurora bright light systems at the same time each day is recommended until symptoms disappear. After that period the patient may be able to cut session time or split a half-hour morning session into 15 minutes each in the morning and afternoon. Once a routine is established, most people can skip a couple of days without ill-effects. However, by the third day without light therapy most Seasonal Affective Disorder sufferers will see symptoms return. Light therapy sessions should begin at the time of the year before symptoms become obvious or distressing. Most patients will discontinue use in the spring when they receive enough natural light. The times when usage is necessary can be greatly affected by the amount of sunlight or cloudy rainy weather.
It is possible to overuse a light box. Overuse can result in irritability and agitation, which is often followed by fatigue. Irritability, agitation and initial eyestrain for 1-3 days appear to be the main side effects. Inducing mania is seen in about 1% of light box users and mild hypomania may occur from persistent overuse. Some drugs make patients photosensitive, as can contact lenses, and those patients may need to be conservative when using staring light therapy. Those on antidepressants can often reduce their dosage, with their doctor's consent, once light therapy becomes effective.
Given the effectiveness of treatments for Seasonal Affective Disorder, it would be a shame for anyone suffering from SAD not to seek help. SAD is often correctly self-diagnosed and anyone can purchase light devices. Nevertheless, other illness factors may be at play, and seeking the guidance of a qualified medical practitioner in both the diagnosis and treatment of SAD is highly recommended. (Usage patterns outlined herein represent those most typically given by current clinical practices. They are not intended to encourage self-prescription or to contradict an individual's prescribed therapy.)
Note: Tan Plus and Lumiram makes no medical claims and it is recommended to consult your physician or therapist on how to use light therapy.
If your doctor has prescribed light treatment to help relieve symptoms of SAD or winter depression contact Essentials Of Life at 1-800-800-6193. In addition to lightboxes, we sell full-spectrum lighting for all your home and office needs
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