may lose interest in sex, become irritable and bad tempered, and have trouble thinking clearly and quickly, which may lead to mistakes.
and go to sleep. Winter wreaks havoc with some people’s physiology, and unlike the rest of us, individuals with SAD aren’t able to suppress the production of melatonin in their system caused by the dim winter light.
SAD is a major depressive syndrome with clinical manifestations. Thanks to the pioneering work of doctors like Norman Rosenthal, it is now listed in the American Psychiatric Association’s standard text, the Diagnostic and Statistical Manual of Mental Disorders. In the past, SAD has been treated using strong antidepressant drugs and even electric shock therapy. However, by far the most effective treatment for SAD is sunlight, or artificial bright light that replicates the effect of sunshine in the summer. In Norman Rosenthal’s study, he told a large group of patients that he was going to expose them to bright light, which might or might not help their condition. He exposed half the patients to the kind of high-intensity light that simulates midday summer sunshine (between 5,000 and 10,000 lux) and the rest to the equivalent to bright indoor household light (bright office lighting emits between 500 and 700 lux, which is equal only to the light at dusk or dawn). The patients did not know which type of light therapy they were getting. Almost all the SAD patients who were exposed to the high-intensity lights experienced a dramatic reduction in symptoms, whereas those in the yellow-light group saw no improvement. Numerous studies have duplicated these results. Bright-light treatment administered by a light box is now the treatment of choice if you have SAD. 80 percent of people with SAD benefit from it. Remember, it’s important to have a qualified doctor provide you with guidelines for using your light box, although you will find through trial and error what works best for you.
Therapists usually have their SAD patients start with a single ten-to fifteen- minute session every day, gradually increasing their exposure to thirty to forty-five minutes. If symptoms persist or worsen as the days shorten, two sessions a day may be the protocol—one in the morning, upon waking, and another in the evening. As with any bright-light treatment, however, figuring out the ideal timing to treat a specific condition should be done under the care of a doctor or therapist trained in this arena. Total daily exposure is usually limited to between ninety minutes and two hours. Keep in mind that the light boxes used to treat SAD are not sunlamps, so you will not get a tan from them—nor any vitamin D benefits. Studies have shown that morning bright-light sessions work better to treat the symptoms of SAD.
The Clinical Practice Guidelines issued by the U.S. Department of Health and Human Services recognize bright light as a generally accepted treatment for
SAD. However, on the rare occasion that bright-light treatments don’t work, antidepressant medications may be prescribed for use in conjunction with this kind of therapy.
SAD symptoms usually improve after just a few days of bright-light therapy.
The best results are seen in people who stick to a consistent schedule beginning in the fall or winter and continuing until the spring. A common mistake is to discontinue treatments as soon as you feel better. In such cases, the symptoms return. This reinforces the need to keep up treatments throughout the winter months.
Guidelines for Minimizing the “Winter Blahs”
If your spirits inevitably sink a little during the winter months, you may have not seasonal affective disorder but a less serious, or subclinical, version of this condition colloquially referred to as the winter blahs. Be attuned to your moods and energy levels. If you start feeling “low” toward the end of summer, take preventive action, including some of the following measures:
• Get as much natural sunlight as possible. When it’s sunny, spend as much time as you can outdoors. Early-morning sunlight is ideal, as this can help calibrate a circadian rhythm gone haywire.
• If you are at home during the day, keep the curtains open as much as possible.
• If you work in an office, try to get a workspace that’s near a window.
• Be physically active, and begin your physical activity before the symptoms start. Physical activity outside in the bright morning light is a win-win.
• Try to establish a mind-set that will enable you to enjoy the wintertime.
Plan active events for yourself in advance of the fall. Schedule things to look forward to.
If you feel yourself succumbing, don’t feel ashamed or try to hide it. You are by no means alone. Seek competent professional help. What you learn this winter you can apply in winters to come.
Nonseasonal Depression
There are different degrees of nonseasonal depression.
Mild depression, or the “blues,” may be brought on by an unhappy event, such as a divorce or the death of a relative, and is characterized by feelings of sadness, gloominess, or emptiness, which may be accompanied by lethargy.
Chronic low-grade depression, also known as dysthymia, exists when a person feels depressed most of the time for a period of two years. These feelings are accompanied by changes in energy, appetite, or sleep, as well as low self-esteem and feelings of hopelessness.
Major depression involves severe, persistent mood depression and loss of interest and pleasure in daily activities, accompanied by decreased energy, changes in sleep and appetite, and feelings of guilt or hopelessness. These symptoms must be present for at least two weeks, cause significant distress, and be severe enough to interfere with functioning. If the depression is very severe, it may be accompanied by psychotic symptoms or by suicidal thoughts or behaviors.
Until recently, few studies had measured the effect of bright light on nonseasonal depression. The success of bright-light treatment on seasonal affective disorder, however, has prompted numerous researchers to study whether this therapy would be effective for the treatment of nonseasonal depression. The results have been extremely encouraging.
Several studies have shown that bright-light therapy alone is as effective as antidepressant medications in reducing the symptoms of nonseasonal depression.
One study showed that just a single hour of bright-light treatment was as effective as several weeks on a standard medication for depression. Some of the most significant work in this area is being done at the University of California at San Diego and at the University of Vienna. Researchers at these institutions have found that combining bright-light therapy and antidepressant medications is an extremely successful way to alleviate the symptoms of depression.
Bright-light therapy is a fundamental component of the latest and most successful treatment for nonseasonal depression. This form of therapy involves a three-pronged approach: bright-light exposure, antidepressant medication, and
“wake therapy.” In wake therapy, patients wake themselves halfway through the night on the first night their program begins and stay awake until they have their bright-light treatment at around breakfast time (these patients had already begun antidepressant medications, so the effects of the drug had begun). Wake therapy seems to intensify the effectiveness of the bright-light therapy, perhaps because it jump-starts the suppression of melatonin production and increases serotonin
production. Patients who have undergone this “triple-whammy” depression therapy have experienced a 27 percent decrease in symptoms in one week.
The success of bright light in treating depressive disorders has inspired doctors to use this therapy to treat conditions such as bulimia, chronic fatigue syndrome, post-and antepartum depression, alcohol withdrawal syndrome, adolescent depression, jet lag, and certain forms of mental illness.