A SAD Winter
Winter is quickly creeping upon us. The chilling cold, frosty mornings are enough to make most of us want to stay under the covers, especially with the threat of snow looming. A few extra taps on the snooze button, fuzzy slippers and a cup of hot chocolate are usually enough motivation to get out of bed and face the winter tundra. However, for some people the winter blues are much more serious. The chronic fatigue, sadness and urge to sleep and eat are symptoms of a serious medical condition called seasonal affective disorder (SAD). SAD is a form of seasonal depression that most often begins in October or November and continues until March or April. According to the Cleveland Clinic, about 4-6% of Americans suffer from SAD. Individuals living in higher latitudes such as Minnesota are more likely to have SAD due to fewer hours of sunlight.
SAD has a cluster of specific symptoms that include anxiety, hopelessness, increased appetite, weight gain, difficulty in relationships and concentration problems at school or work. Dr. Stephen Zuckerman, an internist in Minneapolis, explains that individuals who are diagnosed with SAD often (but not always) have a history of depression, bipolar disorder or anxiety. The jury is still out on the origin and cause of SAD, but most hypotheses relate to changes in light exposure, circadian (biological) rhythms, and mood/sleep hormone production in the winter months.
According to the Journal of Psychiatry and Neuroscience, one of the most supported SAD theories is the phase-shift hypothesis. This theory relates to our circadian clocks, which reset every day to let our bodies know when it is time to eat, sleep, be active or work. This theory postulates that individuals with SAD have phase-delayed circadian rhythms. This means there is interference with their bodies’ natural timing cycles. Light is the strongest signal for the circadian clock and a deprivation of light can cause serious biochemical effects such as over or underproduction of important neurotransmitters (chemicals) in our brain related to sleep and mood. Supporters of this theory attribute the recurrence of SAD in the winter to the reduction of exposure to sunlight.
A controversial but widely studied theory is the hibernation hypothesis. Some scientists speculate that humans once had hibernation cycles similar to those of animals like bears and bats. The idea is that SAD sufferers have retained certain characteristics of hibernation and thus have extreme difficulty adapting to life in the winter. Support for this idea comes from the fact that hibernating animals secrete extra melatonin. Melatonin is the same hormone that regulates our sleep, and production increases in the winter. Dr. Zuckerman enthusiastically stated that a potential alternative treatment would be to take a three-month medical leave of absence from work and succumb to natural hibernation instincts. Specifically, he suggested that you paint the basement walls full of bears and sleep in a self-made cave. Although self-induced hibernation probably sounds great for those with SAD or those who simply hate the cold, a leave of absence from work is not a likely option for many of us.
Luckily, there are effective treatments available that allow for a productive life in the winter. Light therapy is the most popular and one of the most effective treatments available. A review of numerous studies indicates that 53% of individuals with SAD went into full remission with light therapy. However, it primarily benefited those with the least serious symptoms. Light therapy requires sitting in front of a full spectrum artificial light for a specific period of time every day. Most commonly, sessions of 30-60 minutes every morning are recommended. The morning is the most effective time to use the light as it helps to regulate circadian rhythms. The idea behind light therapy is that it is compensating for the lack of sunlight that occurs in the winter.
The most common and accessible type of light therapy is the light box. Vivian Klauber of Midwest Full Spectrum Lighting spoke to me about the different light therapy options for SAD. The two most popular options that she carries are the Sunlight Junior and the Aurora light boxes. The Sunlight Junior is a small, triangular box that can be placed horizontally or vertically on a table or desk. Due to its compact size, it is most useful for people who only have a small space for the box. Another type of light box is the Aurora, which is rectangular. This light box is larger, but has a handle for easy transport. Klauber said that flight attendants and pilots often choose these boxes because they can easily fit in suitcases.
Klauber stressed the importance of consulting with a professional when choosing the right type of light therapy. Factors such as: age, lifestyle, health and diagnosis will contribute to individualizing treatment. For example, Klauber spends about a half hour to an hour with each client when determining the right type of light therapy. She also mentioned that many of her customers report results after the first day of use. Positive results include less crankiness, improvements in productiveness at work and improved interpersonal relationships. Klauber also mentioned that physicians and psychiatrists/therapists occasionally write prescriptions for light boxes. Fortunately, insurance sometimes reimburses for light therapy, so be sure to check with your provider when researching treatment options.
Dr. Zuckerman postulated a different type of light therapy called the “SAD sun,” a name that he coined. This idea was created from seeing many patients with depression problems in his general practice. The SAD sun would be an overhead full spectrum light in his waiting room. All patients would reap the benefits of extra light exposure. Zuckerman explains the idea as a public health solution as it reaches a large amount of people for a small amount of money. Many patients are unable to afford a light box at home and this would be a great solution. A similar and even larger scale solution has been installed in the Norwegian town of Rjukan, which sits between mountains and lacks sunlight for about six months of the year. Last month, computer controlled mirrors (heliostats) were installed 1,500 feet above the town square. Now residents can sit outside, soak up some sun and hopefully enjoy better moods and energy boosts.
If you think you may have SAD, it is important to consult with a doctor for diagnosis. In addition to light therapy, medication and cognitive behavioral therapy are two treatment options depending on the severity and underlying causes of the condition. I would also be remiss if I left out Dr. Zuckerman’s top recommendation, which was a season-long vacation to a tropical island. I think that is a prescription that would make us all a little happier.
For questions about light therapy options or to schedule an appointment, Vivian Klauber of Midwest Full Spectrum Lighting can be reached at 612-721-4459.
Raina Goldstein Bunnag has a bachelors degree from Boston University and is currently a masters candidate in nutrition and public health at the University of North Carolina.She keeps abreast of the latest health news and addresses relevant wellness topics each month. If you have any questions or topics you would like to see covered in the column, please send her an e-mail at firstname.lastname@example.org.