Posted: November 23, 2010 08:32 AM
It was about 25 years ago when Sam consulted me about what had become almost a clockwise event in his life, and an unwelcome one. He lived in northern New England and was an executive in the hospital industry. For a number of years as the days grew short in the fall so did his mood. By late October, or early November, his energy began to wane and his usual can-do attitude became riddled with doubt. He felt depressed and discouraged. He fought to deliver at his usual high level of performance, but it was really hard to do. Regardless of what he did there was no relief until April or May when the depressive shroud lifted and he was back to being his usual self.
Seasonal Affective Disorder (SAD), sometimes called “winter depression,” became widely recognized as a psychiatric diagnosis in the mid-1980s. Medical literature on this condition dates back to the early 1970s and was familiar to its sufferers well before the mid-1980s. SAD is more than having lower energy in the doldrums of winter — it is a clinical depression – but one characterized by seasonal variation and that returns like a bad dream for more than one year. That was what Sam had and there was relief in sight.
When I told Sam that he could try bright lights to help his depressive symptoms, he liked that idea. He was not keen on medications and while better disposed to therapy, particularly problem solving therapy, the prospect of waking early and sitting before a lamp and doing his paperwork fit far more into his already overscheduled routine. And it also made sense to him since when nature’s light dwindled so did his usual internal blaze.
A very reliable questionnaire for depression that individuals can use is called the “Patient Health Questionnaire-9” (the PHQ-9). This simple test asks you nine questions about mood, energy, sleep, appetite, concentration and feelings about yourself. Each question asks the respondent to score from “not at all” to “nearly every day” so there is a composite score that can be as high as 27. Over 10 is suggestive of a depression, and over 20 is highly suggestive of a severe depression. Almost like a blood pressure, this short questionnaire can identify a problem with very high confidence.
What makes SAD different is not its symptoms of depression, but its seasonal nature. It is a seasonal depression. Sometimes there is a seasonal heightening of mood in the spring (though this is far less common). What also makes SAD different is that it can be treated with light.
I suggested to Sam that he get hold of full spectrum lights and sit before them for at least a half hour first thing in the morning. Back then the technology was far less advanced and the devices far clunkier than they are today. After a couple of weeks he noticed he felt better. He looked forward to his light treatments — even getting a morning head start on the unending paper work that seems to bedevil all of us, not just administrators. When spring came he carefully and slowly decreased his use of the lights and nature took over. But when October came the following fall he had his light box ready to go. He needed it and it served him well.
Twenty-five years later has led to considerable research on SAD and what are optimal wavelengths of light that should be delivered at what times of day for how long. Early morning light for 30 minutes, with the convenience of administering at home, seems to work best for most people, but not all. The best time to begin is usually shortly before a person normally awakes, but there can be considerable variation from person to person at the very least related to when someone goes to sleep. The choice of wavelength and device are best discussed with the doctor who is making the diagnosis and treating the depressive condition.
Right now, all around the northern hemisphere, some people are noticing that the shortening of days is affecting their mood. When seasonal mood problems reach the level of a clinical depression, something needs to be done — and can be done. What often gets left off the list of treatments for depression, which typically are antidepressant medications and therapy (especially cognitive-behavioral therapy or CBT), is light. For many with SAD, light treatment will be safe, effective and affordable. If you think you have this condition, talk to your doctor about lighting up your day, and your mood.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.