Mood
Seasonal Affective Disorder - "Winter" Depression
Many of us have decidedly unsunny dispositions.
I stood in a steady drizzle, the rain beating on my exposed head like a Chinese water torture. But my physical discomfort was nothing compared to the subtle process taking place from within the other side of my skull. Months before, without knowing it, I had said goodbye to the sun forever, and it was beginning to have a very pronounced effect on my psyche.
In the fall of 1975 I had moved to Vancouver to be with my fiancée. There, in Kitsalano, where the hippies hung out, one could wake up to a breathtaking view of the ships in the harbor and the snow-capped mountains behind North Vancouver. But nine days out of ten, the clouds dropped to treetop level, discharging a light mist that carried the intoxicating scents of the nearby forests into the city but also creating a filmy shroud that settled over every landmark in the vicinity.
"They took away the mountains," I would half-joke to my fiancée, not used to a force that could turn mighty peaks invisible. Then December approached, and with it a Stygian darkness that descended at four in the afternoon and snuffed out the murky gray that passed for light in this part of the world.
So it came as a welcome relief to spend Christmas with my folks in Connecticut, where the temperatures were much colder, but where there was light in abundance. How resplendent it was reflected off the snow, in brilliant blues with gold highlights. Light, light, glorious light. I drank it in the way a dehydrated person might immerse himself in water.
Then it was back to the gloom of Vancouver. I literally felt my own lights going out. It got so bad that I actually flunked a drivers test twice. As the darkness settled in, I could feel the whole city turning against me. It was as if everyone in the phone directory had entered into a secret pact to make my life miserable. Every time a Canadian said, eh, I knew it was a personal insult directed at me and me only.
"I hate this city!" I screamed in the rain to my fiancée.
Don't get me wrong - Vancouver happens to be one of the most beautiful cities in the world, as well as being one of the best places to live. And, according to the natives, I had a spectacular summer to look forward to. This year, however, the summer never materialized. The only sign of a change in season was the Stygian darkness modifying back to muted grays.
Thankfully, though, I could now see light at the end of the tunnel - literally. We were moving to New Zealand and into a Southern Hemisphere spring. I could actually feel the clouds lift as I boarded that plane. And down at the other end of the world, I landed on my feet. I had been delivered. I was going to make it.
Little did I know that nearly the whole time I spent in Vancouver, I was experiencing a winter depression known as seasonal affective disorder (SAD). Even science was stupid to the phenomenon back then. Now, the University of British Columbia in Vancouver has one of the leading programs devoted to SAD, but a quarter century ago that same august institution would have found fault with me, as if my slow unraveling over mountains they whimsically took away when I wasn't looking had nothing to do with a cruel and insidious force of nature.
To make matters worse, I had undiagnosed bipolar disorder, which made me a sitting duck. People with mood disorders are far more likely to be affected by the change in seasons, with estimates of likelihood ranging as high as 38 percent. Looking back, it was amazing my relationship survived that year in Vancouver. It almost certainly wouldn't have lasted a second year there.
A year or two after my experience, South African psychiatrist Norman Rosenthal MD of South Africa moved to New York, where he experienced the same kind of mood change I went through. He also noticed his depression lifted when spring arrived. Not long after, at the NIMH, he met Herb Kern, a research engineer who had been through similar experiences. Dr Rosenthal began exposing Kern to light, and almost immediately noticed a marked improvement in his mood. In 1984, Dr Rosenthal authored a ground-breaking article, and not long after the psychiatric profession gave the new condition its official seal of approval, complete with an entry in the DSM-IV.
Seasonal Affective Disorder Symptoms
The DSM-IV does not list SAD as a separate disorder, but rather as a "seasonal pattern" for depression and bipolar disorder. According to the DSM-IV, there must be a "regular temporal relationship" between the onset of major depression and the time of year (fall or winter), accompanied by a full remission (or change to mania or hypomania) in the spring. People with SAD often experience symptoms associated with atypical depression, including increased sleep, increased appetite and carbohydrate craving, weight gain, irritability, interpersonal difficulties and heaviness in the legs and arms.
Approximately four to six percent of the population experiences SAD. Women are four times more likely to be affected than men. People with a long history of depression or bipolar need to be especially mindful of the change in seasons, many who await the turning of the leaves with a trepidation that borders on terror.
SAD is most likely to affect people in higher latitudes and coincides with the darkest months of the year, making the seasonal reduction in light the obvious culprit. But how this registers on the brain is still a matter of speculation. One theory is that serotonin levels drop off in winter. Another is that melatonin secretion may be the cause. Yet another theory posits that circadian rhythms are thrown out of whack.
Seasonal Affective Disorder Treatment
One thing that science agrees on is that light therapy is the treatment of choice, and that the eye and not the skin responds to the light. A light box is the standard device (in units ranging from 2,500 to 10,000 lux), but light visors are also effective. Patients keep their eyes open and glance toward the light, but avoid staring directly into it. Sessions should start at 10 or 15 minutes a day, and gradually increase to 30 to 45 minutes a day in the morning or evening. Maximum duration is 90 minutes, though many trials have used durations of two hours or more. The most common side effects are eyestrain and headache. The major disadvantage is the time commitment, that is unless you can set up your light box at your work station or while you're eating a meal or reading the paper.
A number of studies have found morning treatment to be more effective than evening treatment, possibly due to coinciding with the dawn. Evening light can also keep some people awake at night. People with bipolar respond well to light therapy, but need to be mindful of the possibility of the light inducing mania.
Outdoor walks and indoor activities by the window should be considered a form of light therapy. Even an overcast day produces light equivalent to a light box.
A study comparing light therapy to Prozac found a 70 percent response rate in the light therapy group compared to 65 percent in the Prozac group, with faster rates of remission. A study of 332 patients found that bright light therapy of two hours a day reduced depression scores by 50 percent in the course of a week.
Light boxes can be purchased for approximately $200 to $250. Some insurance companies may cover the costs. Whatever you do, don't use a tanning bed as your light source.
Light therapy is also effective for non-seasonal depression and can be used effectively in combination with antidepressants. Equally, antidepressants are effective against SAD, though it takes anywhere from four to six weeks before the drugs start working.
A Google search readily turns up a list of light box manufacturers. But keep in mind that depression, like other medical matters, is not entirely a do-it-yourself operation. Let your doctor know what you're doing, and work closely with him or her on your treatment plan.
First published 2000, reviewed Feb 10, 2008
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