Greg Alexander

Winter can be a SAD time

Baltimore Sun, February 26, 2006

With winter winding down and spring just around the corner, most Americans – especially those who live in areas with harsh winters – are anxiously awaiting the onset of warmer temperatures. While most in the mid-Atlantic are simply a little stir crazy, tired of shoveling snow and ready for spring’s more pleasant weather and the arrival of baseball; for others, winter’s shorter days result in more than just the “winter blues.” Instead, these individual suffer from seasonal affective disorder (SAD), a type of depression that can cause irritability, disinterest, loss of energy, weight gain and possibly even suicidal thoughts.

Those who suffer from SAD are affected typically in the fall and winter when the days become shorter and the amount of natural light available decreases, especially for those who live in northern climates. More than just the “winter blues,” a milder form of depression, SAD typically affects adults more than children, says Carol E. Watkins, M.D., of Northern County Psychiatric Associates. “SAD is a recognized condition in the DSM [The American Psychiatric Association’s diagnostic manual], and more women are affected than men,” says Dr. Watkins, who is board certified in child, adolescent and adult psychiatry. “The further away you get from the Equator, the more likely you are to be affected by SAD. Also, if you were raised in Maryland and then moved to Ontario or you lived in Miami and then moved the Maryland, you may be affected.” Dr. Watkins says that those who suffer from SAD begin experiencing symptoms in late fall, and the peak is the winter solstice in December, the shortest day of the year in the northern hemisphere. “It’s unfortunate because this is also right before the holidays, which can be a depressing time for people.”

Those affected by SAD have difficulty concentrating, low energy, reduced interest in daily activities, increased need for sleep and increased appetite, especially for carbohydrates. According to the National Mental Health Association (NMHA), SAD was first noted in 1845 but was not officially named until the early 1980s. The link between sunlight and the seasonal activities of animals, such as hibernation, has been well documented for years, and SAD may be an effect of this seasonal light variation in humans, the NMHA says. Many experts believe that the shorter days in winter also cause the increased production of Melatonin, a sleep-related hormone in the brain, since this hormone is produced at increased levels in the dark.

In order to diagnose a patient with SAD, Dr. Watkins says that she gathers information from relatives, collects a family history and asks a series of questions related to when the patient tends to feel better. “You have to determine how severely the changing of the seasons affects the individual and whether it is a mild or major depression. You especially have to be careful with children to determine whether you are dealing with SAD or bipolar disorder,” says Dr. Watkins.

Once a patient is diagnosed with SAD, the most common treatment method is light therapy. There are two types of light therapy. Bright light treatment involves sitting in front of a light box for a certain amount of time, while dawn simulation utilizes a low-intensity light that is timed to go on in the morning and gradually gets brighter to help the patient wake up. While not a cure for SAD, the use of a light box can help relieve symptoms.

The use of light boxes can be traced back to studies done in the 1980s by the National Institute of Mental Health (NIMH), and for many who suffer from SAD, the device is a lifesaver. “I’ve been using light therapy for 21 years, and I can’t live without it,” says Neal Owens, who was diagnosed in the early 1980s with SAD. “I was definitely a pioneer; there wasn’t talk about SAD back then. I was working for a petroleum company in the Washington, D.C., area, and I noticed that in the spring and summer, everything at work was great – I was productive and alert. However, in the fall and winter, I felt like I was going at half speed. I was tired, run down, unproductive and would gain weight.”

Owens says he first went to his family doctor, who tested for thyroid disorders, vitamin deficiencies and mononucleosis. “All the tests came back normal, so he referred me to a colleague, and when I arrived for my appointment and saw that the colleague was a psychiatrist, I thought I was at the wrong place,” he laughs. “I thought, ‘Great, my family doctor thinks I’m crazy,’ but the psychiatrist assured me that this was not the case.” Owens says that his boss was really leaning on him to improve his performance in the winter, so he felt the need to figure out what was going on.

“I had over 300 accounts, and during the summer, I would call on 15-20 clients a day; however, in the winter, I would only call on four a day because I was no tired. Then, one day, I was ‘channel surfing’ on the TV – I am an expert at that – and I came across a PBS special on SAD. I then heard about these studies done at NIHM. They did studies in Washington, D.C., New York, New England and Florida and found that those in the northern climates experienced marked seasonal changes. Some were mild “winter blues,” but others were seriously affected and needed treatment.”

Owens contacted the NIHM about the bright light therapy experiments; however, he did not qualify for the program as was taking antidepressant medications at the time. However, the researchers allowed him to borrow a light box to try. Convinced by the effectiveness of the light box, Owens asked where he could purchase one and found that they were not commercially available. Seeing a market need, Owens developed his own light box in accordance with the brightness and safety specifications provided to him by the researchers, and The SunBox Co. was born.

“Light boxes are great because they work fast – most people feel positive effects with three to five days,” says Owens who founded The SunBox Co. in 1985. Owens says that the 10,000 lux light boxes are 15 to 20 times brighter than the typical home or office lighting. “Sitting by a light box is the equivalent of sitting in front of a clear window for 40 minutes an hour and a half after sunrise,” says Owens, who stresses that his clients typically come to him via a physician referral. “It’s important not to self-treat depression, and if they get a prescription from a doctor, many times insurance companies will cover all or part of the cost.” Most light boxes retail from $200 to $500, and Owens sells six different light boxes. “The all have the same light brightness, but come in different sizes. We have some that look just like normal office lamps so that you can take one to work without having to explain to your co-workers or boss,” he says. For those unsure of whether a light box will work for them, Owens also rents light boxes to customers.

Owens also touts dawn simulators as many people who suffer from SAD have difficulty getting out of bed in the morning. “They also are great for parents who have difficulty getting kids up in the morning for school.”

Dr. Watkins says that it’s important for individuals to have a complete psychiatric evaluation before embarking on a course of light treatment, as sometimes a medical illness or another psychiatric condition can masquerade as depression. “I personally prefer that patients use light boxes when possible versus medication. However, for some patients using a light box every day is a hassle, and they’d rather take medication,” says Dr. Watkins, who says that for those who suffer from serious depression, light box use may be combined with medication and counseling. “Patient preference and the severity of the depression are considered,” says Dr. Watkins, who adds that patients should also check with their eye doctor before using a light box. Regular exercise and exposure to natural outdoor light should also be practiced, she says.

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