Have you taken out your lightbox? The change to Daylight Savings time often signals the recurrence of mood conditions. This year there appears to have been an earlier onset, with the recent weeks of uncharacteristic gloomy rainy days in regions of the USA. Overall there seems to be an associated increase in complaints by individuals reporting worsening moods, lack of energy and motivation.
Seasonal Affective Disorder Defined
Seasonal Affective Disorder (SAD), as defined by the National Institutes of Health (NIH), is a diagnosable medical condition in those with symptoms of either major depressive disorder, or bipolar disorder, but only during certain months of the year. The prevalence of a major depressive disorder is more common than bipolar disorder among people with a seasonal affective diagnosis
Affected individuals describe a very predictable onset of symptoms that are triggered by the change in season. Most symptoms occur in the fall and continue through the winter months. There is a minority of about 10 percent who report the onset of SAD symptoms in the spring and summer months.
Why me?
A review by NIH states that “for those affected, it is estimated that symptoms of the seasonal affective disorder are present during 40 percent of the year. In some individuals, the seasonal affective disorder does not recur every year. Thirty to 50 percent of affected individuals do not show symptoms of the disorder in consecutive winters. In about 40 percent of individuals with the seasonal affective disorder, depressive episodes continue after winter and do not alleviate in the summer months, leading to a change in diagnosis to either major depressive disorder or bipolar disorder.”
Hibernation Time
The symptoms associated with this type of depression are both predictable and familiar. My favorite analogy is that affected individuals seem to acquire bear-like attributes, with a tendency to hibernate due to the shortened days. The reduction in daylight hours is associated with complaints of a lack of energy, increased carbohydrate craving, and the need for more sleep, often with an increase in daytime naps. The problematic mood symptoms associated with SAD include depression, irritability, loss of interest in activities, social withdrawal, and weight gain.
Causes
What causes Seasonal Affective Disorder or SAD? The actual cause is still undergoing rigorous research. Most recently, genetic analysis has identified a potential gene is associated with the disorder. This preliminary finding may explain the increased incidence of this disorder in blood relatives. Fluctuating levels of the hormones melatonin and serotonin is also an area of ongoing research. The melatonin hypothesis suggests that sufferers produce excess levels of this hormone during the long winter days.
Meanwhile, the serotonin hypothesis suggests that too much serotonin is produced in winter. Another hypothesis is that the biological clock, commonly known as the circadian rhythm, may be disrupted with the reduction in sunlight during the fall and the winter months. However, the actual cause of seasonal affective disorder remains a mystery.
Treatment
Your health provider should be consulted to determine the appropriate SAD therapy. Potential treatment for SAD includes a lightbox appliance, medications and psychotherapy. It is essential to discuss the use of a lightbox with your health professional, as the lightbox industry is not industry regulated by the Food Drug Administration (FDA). For safety reasons, precaution should be shown when using a lightbox.
The standard recommendation is exposure to a continuous light source for limited periods of time. When using a lightbox, it is very important not to stare directly into the light source. There have been reports of problematic side effects with the use of a light box, including headaches and cataracts. It is essential for those with bipolar disorder to share their diagnosis and symptoms before using a lightbox or antidepressants.
The original SAD research was based on light appliances that used 10,000 lux of white light intensity. NASA uses blue light to address the complexity of the body’s circadian rhythm in space. There is a growing debate regarding the therapeutic differences of blue versus white light. Some recent studies, with small sample sizes, suggest that blue light treatments are as effective as bright white-light treatments.
Research has not yet established which light source produces the most side effects. Nonetheless, one should never stare at the light source, regardless of the type of light. Manufacturing information should be reviewed for UV light intensity and the optimum distance from the box to obtain maximum effectiveness.
SAD is real.
Bottom line – SAD is a real illness. A light box can be expensive, with the cost ranging from $100 to $500. Not all insurance plans will pay for its use. My usual recommendation is to first read the book, Winter Blues, by Norman Rosenthal for conversations about the symptoms and their impact on daily life. Dr. Rosenthal was the researcher and psychiatrist who lead the team that first described this disorder.
The cost of the appliance is expensive and may have potential health risks. Reading about SAD gives you the opportunity to acquire a deeper understanding of the potential benefits and risks of treatment. Nonetheless, your health provider’s recommendations should be followed for your ultimate treatment decision.