Does Winter Make You 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.
Symptoms Of SAD (In addition to suffering from depression that can last for months)

• Crave carbohydrates (starchy foods) and sweets and feel better after eating them
• Gain Weight
• Sleep longer hours but wake up feeling tired
• Lose interest in sex.
• Feel overwhelmed by insignificant things
• Avoid family and friends
• Have difficulty thinking and concentrating
• Feel achy and suffer from frequent infections

Studies have shown that during fall and winter about 20% of the population is affected by fatigue, irritability, anxiety, weight gain, social withdrawal, and a lack of alertness. Most affected are those living in northern latitudes and in frequently overcast areas, especially during the shortened fall and winter days. About 75% of those affected are women.


Bright Light Therapy Treats SAD

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 light boxes 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.

The lightbox 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. Photobiologists 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 ones work and lifestyle. Exposure time is determined by the intensity of the light source. Although there are individual differences, a 1/2 hour treatment at 10,000 lux per day (usually during the morning hours) is the average.

Portsmouth, N.H. psychotherapist Stephen Little treated more than 250 of his patients with light boxes. "As opposed to antidepressants, 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.

As reported in (Mood Brighteners: Light Therapy Gets Nod As Depression Buster by Bruce Bower 4/05), A research review commissioned by the American Psychiatric Association in Washington, D.C., concluded that in trials, daily exposure to bright light is about as effective as antidepressant drugs in quelling seasonal affective disorder (SAD), or winter depression, and other forms of depression.

"I now tell my patients that light therapy is a reasonable depression treatment, even if the data base for this approach is relatively small," says psychiatrist Robert N. Golden of the University of North Carolina at Chapel Hill. Golden directed the new statistical review, which appeared in the April American Journal of Psychiatry.

Like many mainstream psychiatrists, Golden had been skeptical of studies reporting that depression diminishes in response to daily bright-light exposure, usually administered early in the morning for 30 minutes to 1 hour.

Can Light Therapy Treat Bi-Polar Disorder?

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.

Symptoms Of BiPolar Disorder

The depressive symptoms are similar to major depression. Mania symptoms may include some of the following:

   • Heightened mood
    • Excited behavior, increased energy or activity
    • Aggressive behavior and/or irritability
    • Lack of desire for sleep
    • Impulsiveness or poor judgment, reckless behavior
    • Racing speech, thoughts, etc.
    • Overly optimistic, egoistic, delusions of grandeur
   • Hallucinations (extreme mania)

Light Therapy

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 vs. Anti-Depressants

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.

Precautions 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.
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