Dealing With SAD

Scott Hoover Comments
Posted : 03/01/2000

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Dealing With SAD

by Scott Hoover

Back in the early 1980s, a handful of experts at the National Institute of Mental Health had a wild idea--if people get depressed when the days get darker, why not just give them more light. Today, more than 15 years later, studies continue to show the effectiveness of light therapy for patients with winter depression, known medically as Seasonal Affective Disorder (SAD). And, one of the most popular destinations for the more than 10 million Americans who suffer from the disorder is their local indoor tanning salon.

Who Gets SAD?

Although researchers are not entirely sure what causes SAD, they believe one culprit is the reduction in daylight hours during the fall and winter, which can disrupt the balance of the body's internal clock.

"SAD has been linked to an imbalance of the chemicals melatonin and serotonin, which can lead to feelings of depression," says Ross Black, M.D., a family physician at Millpond Family Physicians in Cuyahoga Falls, Ohio.

Melatonin is a light-sensitive hormone released from the pineal gland in the brain, which is stimulated by decreases in light. The hormone has been associated with regulating the body's internal clock, decreasing body temperature and causing drowsiness. Serotonin is a neurotransmitter thought to play a role in regulating mood and improving memory, attention and focus.

Not surprisingly then, the incidence of SAD varies by environment. For example, up to 10 percent of Alaskans suffer from winter depression, whereas less then 1 percent of Floridian's do. Other factors influence the chance of developing the disorder. Specifically, women tend to be more vulnerable to SAD than men by a 4:1 ratio; people between the ages of 20 and 40 are more likely to experience symptoms than others; and, those who have a family history of depression or mood disorders are at higher risk than those who don't.

The symptoms of SAD can include feelings of depression, sadness and irritability; excessive eating or sleeping; lethargy; cravings for sweet or starchy foods; weight gain; impaired concentration; and, loss of interest in normal or pleasurable things. Symptoms typically arrive in fall or winter and then enter a full remission during spring and summer, after which the cycle repeats.

Does Light Therapy Help?

Three studies published in the Archives of General Psychiatry answer a number of questions surrounding SAD, as well as pushing light therapy solidly into the mental health mainstream.

"Light is as effective as drugs, perhaps more so," writes Anna Wirz-Justice of the Psychiatric University Clinic in Basal, Switzerland. Although some psychiatry purists have sniffed that light therapy is merely a placebo response, Wirz-Justice says now there is proof that light therapy is for real.

One of the studies by Charmane Eastman, a psychologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago, tested 96 SAD patients and found that 61 percent of people who received morning light therapy and 50 percent of the people who received evening light therapy experienced nearly complete recovery from SAD after four weeks of treatment. Only 32 percent of people who got a placebo treatment enjoyed the same degree of remission.

"There was a little black cloud of doubt hanging over light therapy," says Eastman. "I'm sure people are saying now that if I believe in it, it's got to be true."

Dr. Al Lewy is a Portland-based researcher who pioneered the use of bright light to treat winter blues in the Northwest, an area that is fast becoming ground zero for research on winter depression.

For the most part, Northwesterners pride themselves on braving the region's harsh winters. They stave off the blues by exercising, racking up hours in tanning salons or taking day trips to sunnier parts of the Northwest. However, researchers also have discovered the power of light therapy where 30 minutes of indirect exposure is enough to restore patients to their normal, active selves.

One of the negatives of light therapy is the cost, and as stated earlier, many people turn to indoor tanning salons as an alternative. According to Dan Oren, M.D., associate professor of psychiatry at Yale University School of Medicine, approximately 50 percent of U.S. insurers reimburse the more than $300 it costs for the light box needed for the therapy, although often only after a battle.

Thus, many people have turned to indoor tanning salons to receive the needed ultraviolet light they believe reduce the effects of SAD.

Taken together, these studies, as well as the indoor tanning industry, have provided a 1-2 punch in favor of light therapy and indoor tanning, at least for winter depression. It is less costly than antidepressant drugs, patients like the results and the side effects are relatively mild.

Although advertising that indoor tanning can help alleviate SAD would not be allowed by the Food and Drug Administration, providing your clients information, such as recent studies concerning the disorder, only can help bring more clients into the salon.

Symptoms of Seasonal Affective Disorder

The symptoms for SAD are rather specific to avoid misdiagnosis for other depressive disorders:

  • Regularly occurring symptoms of depression (sad, anxious or "empty" moods; decreased energy and interest during fall/winter months of at least three different years--two of them consecutively.)
  • At least three times as many instances of depression within a two-month time frame as during other times of year.
  • No other factors that could account for regular changes of mood (for instance, becoming unemployed every winter).
  • Excessive eating and sleeping; weight gain.
  • Decreased sex drive.
  • Carbohydrate craving.

references: Healthtouch Online, National Mental Health Association.


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