SEASONAL AFFECTIVE DISORDER, excerpts from a report on a presentation1 by Norman E. Rosenthal M.D.,2 Smooth Sailing, Fall 1994, pp. 3,4.

Many people who do not have SAD feel a pang of sadness as they set their clocks back to standard time. . . . For more than 10 million Americans, [however,] the shorter days of the winter season cause a change in brain chemistry, which in turn can change appetite and sleep patterns, and cause mood disturbances severe enough to affect quality of life.

Dr. Rosenthal, a native of South Africa, . . . noticed a strong seasonal pattern in himself when he moved to New York to begin his psychiatric residency: his first experience with the very short winter days that far north of the equator profoundly affected his mood. He felt tired, sluggish, and overwhelmed by his work schedule. When spring arrived, his mood lifted—he felt renewed and energized. . . .

When Dr. Rosenthal was completing his residency at NIMH, he met Herb Kern, a research scientist with a background in engineering who had recognized and documented a decidedly seasonal pattern in his own mood. Mr. Kern had theorized that this pattern could result from the seasonal reduction in sunlight and had contacted NIMH to see if its researchers had an interest in testing his theory.

Dr. Rosenthal's research team took on the project. They decided to simulate the light Mr. Kern received during the summer season by exposing him to three hours of bright light in both the morning and the evening. After three days of this light therapy, the team noted a considerable improvement in Mr. Kern's overall mood. The exposure to light also seemed to trigger the arrival of Mr. Kern's "springtime rejuvenation" much earlier than normal. That success [in 1979] began Dr. Rosenthal's pioneering involvement in the research on SAD.

"Diagnosis is the key," Dr. Rosenthal stresses. "In conquering this illness you first have to recognize that it is an illness. . . ." Millions of people who have varying degrees of SAD don't even realize they have a treatable illness. Many assume that they are simply not winter people and don't pursue treatment because they know their condition will improve with the arrival of spring.

The symptoms of SAD are very similar to those of nonseasonal clinical depression: change in appetite, weight gain, drop in energy, tendency to oversleep, difficulty with concentration, and irritability. The key factor in diagnosing SAD is its seasonal pattern: the above symptoms fade away with the arrival of spring and return in the fall.

Another characteristic of the illness is a strong craving for foods rich in carbohydrates, which increase the level of a neurotransmitter (brain messenger chemical), serotonin, that is thought to influence mood. It is theorized that people with SAD have difficulty in regulating serotonin levels during the winter and that their craving for carbohydrates is a way of compensating. This theory also explains why many patients respond favorably to selective serotonin-reuptake inhibitor (SSRI) antidepressants such as Prozac or Zoloft. However, the cornerstone of treatment for SAD is light therapy.

"It's not the kind of light, it's the intensity," Dr. Rosenthal says. Although the original light box . . . used full-spectrum fluorescent tubes, his later research showed that light from incandescent and halogen bulbs was just as effective. The standard for professionally made light boxes seems to be full-spectrum nonultraviolet fluorescent tubes because of their even disbursement of light and cool operating temperatures.

A typical treatment strategy . . . begins with having the patient set up a light box on a table and sit directly in front of it while eating breakfast or reading the newspaper. Exercise is also a critical element of treatment. Dr. Rosenthal suggests taking a quick walk during lunch breaks. Even on overcast days, the sunlight filtering through the clouds is beneficial, so the walk accomplishes two treatment objectives. If the weather doesn't permit a walk, having lunch next to a window provides some exposure to light. In the evenings the patient can have another session in front of the light box, perhaps while eating dinner.

. . . It's not necessary, or even recommended, to stare into the light. The entire retina responds to light, so it's possible to get the full benefit of light therapy while reading, talking on the phone, or even watching television—as long as the patient sits close enough to the light, facing it with eyes open and glancing into it every now and then.

The amount of time a person needs to spend by the light box varies greatly among individuals and changes as the seasons progress. Some patients need as little as 40 minutes of exposure daily; others require several hours of exposure, combined with psychotherapy and medications. For light as for medications, a qualified physician is needed to determine the necessary dosage. Dr. Rosenthal recommends asking for a referral if your doctor doesn't have experience in the treatment of SAD.

Though light boxes seem like a simple technology, Dr. Rosenthal cautions people against constructing their own. Too little light is not of therapeutic benefit, and too much can cause eye damage in some patients. Another drawback of homemade light boxes, Dr. Rosenthal pointed out is that "if [the patients are] not qualified electricians, it's difficult to tell if they'll get light therapy or shock therapy."

In his summation, Dr. Rosenthal again stressed that winter doesn't have to bring a bleak and dismal season. Exercising, eating a diet that balances protein and carbohydrates, and simply shedding a little light where needed can help SAD patients to find a little wonderland in their winter. . . .

_______________

1 Presented at a DRADA educational meeting, November 15, 1994.

2 Chief, Section of Environmental Psychiatry, Clinical Psychobiology Branch, National Institute of Mental Health

More on SAD from Dr. Rosenthal—

THE Q & A COLUMN [ON SEASONAL AFFECTIVE DISORDER], excerpts from the answer to a question about symptoms and diagnosis, Smooth Sailing, Fall 1996, p. 5.

Although the majority of patients with the winter form of SAD complain of overeating, oversleeping, carbohydrate craving, and weight gain, a significant minority (perhaps as much as one-third of SAD patients) experience the opposite symptoms. . . . Patients with these less usual symptoms—early morning waking, decreased appetite, and weight loss—generally respond well to light therapy.

It is the seasonal occurrence of symptoms, rather than the direction of the changes in eating and sleeping, that makes for the diagnosis of SAD and suggests that light therapy might be the treatment of choice . . . However, light therapy alone may not be sufficient, and other treatments such as exercise, antidepressant medications, or psychotherapy should be considered as well. Fortunately, these treatments generally work very well together, making SAD one of the most treatable of psychiatric conditions.

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