Light Therapy for Seasonal Affective Disorder SAD

More than 8 million people live in New York City and some of them are SAD, all winter long.  As the October leaves begin to change and glide from their branches the days become increasingly shorter and darker. This is when many people begin to feel the nudge of Seasonal Affective Disorder or SAD. This is the season when many seek the help of a mental health professional such as a psychotherapist or psychologist. Yes, the holidays ignite issues for people such as loss and family conflicts, but for many, the depression and lethargy are the result of insufficient sunlight. To make matters worse, many of us leave for work early in the morning when it is dark, have lunch in the conference room and return home in the evening.  Some never see the light of day and office lighting is never a replacement for natural light.

So what is SAD or Seasonal Affective Disorder?

According to the Mayo Clinic, SAD is “a type of depression that occurs at the same time every year.” Symptoms of SAD include depression, hopelessness, anxiety, loss of energy, social withdrawal, appetite and sleep changes, disinterest in sex, immune system suppression and lack of interest in normal activities.

How can you differentiate SAD from other types of depression?

Symptoms of SAD tend to come back year after year (Fall), with mood and energy levels returning to normal when the season ends (Spring). There is a pattern to the dips in mood and energy that people experience seasonally. Friends and family may notice changes in loved ones and women or those with a biological relative diagnosed with SAD are more vulnerable to developing the disorder. It is important to note that changes in mood are not necessarily connected to situations (the loss of a job, or a disruption in a relationship would make anyone sad during the winter, for example).

What causes SAD?

The 24-hour sleep-wake cycle also known as the circadian rhythm, is controlled by the regular rise and fall of hormones, especially melatonin. Melatonin is known as the master sleep hormone and is produced in the pineal gland. Our overall pattern of sleep-wake depends on the proper functioning of the internal circadian clock, which lies deep in the brain. This circadian clock works in concert with photosensors in the eyes to sense darkness. At night, the body begins to secrete melatonin, which is one of the natural factors that cause sleep. Melatonin continues to be secreted throughout the night. As the sun rises, melatonin secretion slows and the wake cycle begins. According to research, people with SAD, like those with most other types of depression may have low levels of neurotransmitters, including serotonin (a precursor to melatonin) dopamine and acetylcholine. Some research suggests that the change in serotonin levels may result from reduced levels of vitamin D (which we get from sun exposure).

What kind of help is available if you suffer from SAD?

If any of the symptoms listed above seem familiar to you, and they tend to occur during the darker months of the year then you may need seasonal help.  There are a number of options and what is best for you may depend on the severity of your symptoms and your particular situation. Recommended treatments include working with a therapist, medication and/or light therapy and lifestyle changes that support health, hormones and mood.  Some examples are as follows:

• Psychotherapy to help you identify and change negative thoughts and behaviors, as well as help you develop healthy ways to cope with seasonal affective disorder symptoms such as depression, anxiety and stress.
• Antidepressant medications may be prescribed to treat SAD, particularly if symptoms are severe.  See your medical doctor or a psychiatrist to discuss medication as an option.
• Light therapy (or phototherapy) involves using a special light box to mimic outdoor light.  Some insurance companies will cover the cost of purchasing a light therapy lamp. It’s very important to have medical supervision when using light therapy.
• Get sunlight on your lunch hour by going for a walk.
• Keep window treatments open and sit closer to the windows if possible.
• Make sure you are exercising regularly and eat a balanced diet with plenty of omega-3 fatty acids for mood support.
• Supplement your diet with vitamin D3 to make up for inadequate or inconsistent sunlight.
• Consider adding mood-boosting activities such as yoga, meditation, acupuncture and massage therapy.

Individuals who wish to begin light therapy should do so under medical supervision as light therapy may trigger hypomania or mania in some people with undiagnosed or diagnosed bipolar disorder. As an important precaution, patients with Bipolar I disorder who use light for depressed cycles are at risk for switching to full-blown manic episodes and should be on a mood-stabilizing drug while using light therapy.

More about full-spectrum lamps

Light therapy for Seasonal Affective Disorder and circadian-rhythm disorders involves sending visible light through the eyes so that it reaches, and triggers, the pineal gland. The sun is the ultimate source of full-spectrum light, which means it contains the spectrum of light, from infrared to ultraviolet. Generally speaking light therapy involves the use of equipment that sheds either full spectrum or bright white light.  In most cases, the purpose of light therapy is to increase the amount of light to which we would otherwise be exposed. Bright light therapy consists of looking at special broad spectrum lamp, generally in the early morning hours. One should not stare directly into the lights because of possible eye damage. One popular brand isVerilux many other light boxes can be found on Amazon.

Reverse Seasonal Affective Disorder or Summer Depression

Rarely, some individuals experience summer depression which is an annual relapse of symptoms that occurs in the summer rather than winter. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety. Patients with such “reverse SAD” may benefit from the use of an antidepressant combined with a mood stabilizer. In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each Fall and Spring, around the equinoxes.

Information from the Center for Light Treatment and Biological Rhythms – Department of Psychiatry at Columbia University

The Center for Light Treatment and Biological Rhythms is a unique clinical program in the United States, with its coordinated focus on circadian rhythm, mood and sleep disturbances.

• Establish normal sleep onset time for people who cannot fall asleep until it is too late, or have trouble waking up because of fragmented sleep
• Relieve winter depression (seasonal affective disorder, or SAD, or the milder winter doldrums or winter blues)
• Alleviate symptoms of unipolar and bipolar depression, whether or not the depression is seasonal
• Increase daytime alertness and reduce slumping in the afternoon and evening
• Substitute light therapy for drugs during pregnancy
• Improve cognitive performance, mood and sleep in adult attention deficit hyperactivity disorder
• Work effectively when drugs have not worked, worked only partially, or cannot be tolerated
• Work effectively in conjunction with antidepressants and mood stabilizers

Outpatient services begin with an extended diagnostic evaluation session in which an individualized treatment regimen is generated to follow at home. Over six weeks, we actively monitor progress and, if necessary, hone the treatment regimen to achieve maximal response. Many of our patients are referred by their primary mental health provider. In those cases, we work as a team to coordinate treatment. We work with outpatients across the country and abroad as long as they can visit New York for the evaluation workup. The Center also offers services to inpatients at Columbia University Medical Center.

Light Therapy for Depression - New York Times Health Blog

Hear about Dr. Terman’s research on National Public Radio.

Department of Psychiatry – Columbia University Center for Light Treatment and Biological Rhythms

1051 Riverside Drive, Unit 50, New York, NY 10032,  email at: doctors@columbia-chronotherapy.org

Resources on the web:

http://www.nami.org/Content/ContentGroups/Helpline1/Seasonal_Affective_Disorder_(SAD).htm

http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195

Read more about light therapy and the treatment of depression

Light Therapy For Depression

New York Times by Roni Caryn Rabin (reprinted)