Don’t be SAD
Lack of light in winter can lead to depression for many
As much as 10 percent of the population may suffer from winter depression – Seasonal Affective Disorder, or SAD – according to the Academy of Family Practice. And as many as 25 percent feel the “winter blahs,” a condition of less severity, but with many of SAD’s symptoms.
Think of a scale from one to 10. At one to four, a person may feel blue, having lost the joy he or she normally experiences. From five to eight, the person is likely in full-blown SAD. At nine to 10, a crisis may occur; people can become so depressed they consider suicide.
Seasonal Affective Disorder is caused not by the cold, but by diminished light. It’s worse in northern latitudes where days are shorter. For example, in Florida only about 1.5 percent of people have SAD. In Washington state, it’s about 10 percent, beginning around October and ending in May.
In Spokane, the majority of the days from November to March are cloudy, compounding the problem.
“For some people, it seems as if they have two different personalities,” Dr. Norman Rosenthal, clinical professor of psychiatry at Georgetown Medical School, writes in his book “Winter Blues” (The Guilford Press, 2005).
“The summer person is energetic, cheerful and productive. But the winter person has little energy and finds it difficult to cope with everyday tasks. As days grow longer in March and April, the energetic person reappears.”
Why do people get SAD? The answer is not known exactly, but researchers believe lack of sunlight affects the body’s chemistry.
With shorter days, melatonin (the “hormone of darkness”) is secreted in higher levels, resulting in a disturbance of the body’s natural rhythms. Declining light also decreases serotonin (“the happiness hormone”). And it may be that the body’s inability to produce Vitamin D (the “sunshine vitamin”) in the winter causes mood to plummet.
Rosenthal’s 25 years of research has shown that increasing light can help with SAD. Light therapy, or phototherapy, is as effective as taking an anti-depressant medication, he says, and may help more quickly and with fewer side effects.
“It is best to start light therapy as soon as the first symptoms of winter depression appear, before they progress to a full-blown picture of SAD,” Rosenthal writes.
“Although it varies from person to person, most feel the effects of light therapy in two to four days,” he says, adding: “Don’t give up on light until you have used it consistently for several weeks.”
As time passes, 80 to 95 percent of people can continue their journeys to a normal mood state, even on dark, cold days.
But not just any light will do. Most studies have shown that depressive symptoms can be lifted by exposure to a particular type of bulb that provides intense light.
Recommended treatment is to sit next to a special fluorescent light that provides 10,000 lux (a unit of measuring the light’s intensity).
To get a feeling for light intensity, a typical living room might have lighting at 50 lux. A business office might about 320 to 500 lux.
On a December day in Spokane there may be 1,000 lux. In direct sunlight on a summer day, there would be greater than 100,000 lux.
Special SAD lamps have filters to remove damaging UV rays. Rosenthal suggests starting with 15 to 20 minutes a day, and working up to about 30 minutes.
Place the lamp about 12 to 15 inches from the face, with the light shining from above. The light should pass in front of the face; don’t stare into the light.
Most people need the light first thing in the morning. They often use these lights at the breakfast table, to apply makeup, or on the desk next to the computer.
These lamps come in several styles: desk lamps, floor lamps, light boxes, even as bulbs embedded in visors so that a person can move around and take the light with them.
Light therapy can have negative effects. Some people experience headaches, insomnia or dry eyes. It might require an adjustment of the time spent with the light or the distance from the lamp to alleviate depressive symptoms.
It is important to discuss depression with a medical professional prior to beginning treatment with light therapy. This is particularly true for people who have bipolar disorder. In some studies, patients undergoing light treatment have become manic as a result.
Check with your medical provider if you are taking any medications that react poorly to bright light (certain antibiotics or anti-inflammatories).
The lights can be expensive (between $180 and $300), but the bulbs have thousands of hours of light capacity and will likely last for years.
Dr. David Avery, a psychiatrist at the University of Washington, has done research with dawn simulators. This is also light therapy, but delivered in a different way.
Dawn simulators are set to gradually fill the bedroom with light, approximately 90 minutes prior to the normal waking time, imitating a natural sunrise. This light gently tells the body it is time to awaken – even if it is still dark outside.
“We think the light signal through the eyelids connects to the hypothalamus in the brain and in essence resets the body’s clock,” Avery said in a Radio National interview.
Use of a SAD light must be consistent. Once the symptoms of depression have diminished, regular use of the lamp will likely be needed until springtime, when sunlight increases.
What else can you do? There may be a number of things that help:
• Go outdoors and walk briskly if we do have a sunny day. Remember – don’t wear sunglasses. Or work out in a brightly lit gym.
Exercise increases the body’s endorphins (“natural morphine”) and fights depression. Look forward to an outdoor activity such as ice skating, skiing or sledding.
• Open blinds and curtains and turn on lamps during the day in your home or office.
• Eat foods high in omega-3 fatty acids. Examples are wild salmon, flaxseed oil, walnuts, oysters, sardines, beans, olive oil, soy products and halibut. Fish oil supplements are inexpensive and easy to take.
• Avery emphasizes good sleep habits. Try to go to bed and arise on a regular schedule. Make the bedroom completely dark and cool. Dim the lights in the evening, signaling the brain the day is winding down.
• Start a gratitude list. Even simple things can be appreciated: a good cup of coffee, a call from a friend, a new experience, the love for your pet. Focusing on the positive gives a perspective that reduces depression.
• Do something for someone else. Give an anonymous gift. Give your time to a good cause.
• Don’t go into hibernation mode. Continue making and accepting social connections. Schedule fun activities.
• Schedule a winter vacation to a sunny place.
• Increase your Vitamin D intake. Recent studies show that vitamin D protects against depression, osteoporosis, heart disease, multiple sclerosis, rheumatoid arthritis, infections and cancers.
Good sources of vitamin D are fortified milk, salmon, tuna and eggs. A lab test can measure vitamin D levels and then the proper dosage can be prescribed.
• Talk to a mental health provider. Psychologists have found that therapy, particularly cognitive behavioral therapy, can be very helpful for depression.
If depression isn’t alleviated with these suggestions, visit with a medical professional to discuss medication. The FDA recommendation for SAD is Buproprion XL, or one of the drugs in the SSRI class such as Prozac or Zoloft.
Once a person recognizes the pattern of SAD, it can be a relief to know there is help. Checking with a medical practitioner prior to beginning the above treatments can be important.
And if symptoms become intolerable, don’t wait to call for help.
Linda Higley is a licensed psychologist in Spokane.