Blog Post

Seasonal Affective Disorder

Ned Presnall • Jan 07, 2017

Seasonal Affective Disorder (SAD) is a type of depression that starts in the fall and lasts through the winter months. In addition to typical symptoms of depression (sadness, hopelessness, fatigue, crying spells, anhedonia and problems concentration) SAD often presents with some atypical symptoms: increased sleep, increased appetite (especially carb cravings) and a heavy, "leaden" feeling in arms and legs. These atypical symptoms are also frequently encountered during the depressed phase of bipolar disorder. In fact, many bipolar patients tend to get depressed in the fall and winter months, and get manic or hypomanic during the spring and summer. It is therefore important to screen SAD sufferers to rule out the possibility of a bipolar disorder diagnosis.

The efficacy of light therapy has been scientifically documented since the 1980s, that include over 2,000 sufferers. Numerous carefully controlled studies have shown the potential efficacy of light therapy for SAD. In a 2004 Canadian study (CAN-SAD), for example, light treatment was essentially identical in its efficacy to fluoxetine (Prozac) after 8 weeks of treatment.

Light therapy for SAD consists of exposure of the open eyes to an adequate light intensity, at an adequate distance, and for an adequate time period. Standard recommendations include light boxes that emit 10,000 lux of UV-filtered light. Staring at the light is not recommended; a tilted lamp indirectly bathing open eyes is sufficient. Standard light therapy devices are widely available commercially, and typically emit 10,000 lux. At that intensity, most patients respond to 30-minute daily morning sessions at arm's length. At 2,500 lux, much longer exposure times (up to 2 hrs) may be needed. Light intensity is a critical component of successful treatment.

It is best to concentrate on activities taking place on the surfaces illuminated by the light and not on the light itself. Indoor lamps and ceiling light fixtures are inadequate treatments for SAD, since they fail to reach the eyes at an adequate intensity. Therefore, increased exposure to normal room light tends to be insufficient. Most patients report improvement when sessions are in the morning. During long winter nights, early morning exposure (6:30 am, while it is still dark outdoors) can be particularly helpful. In most studies of light therapy for SAD, improvement may appear as early as after 1 week of treatment. It also takes about 1 week for the benefits to vanish once light therapy is stopped. Therefore, for most SAD sufferers, daily light exposure since the onset of symptoms and throughout the winter seems to be the best option.

In addition to light therapy, other treatment options being explored for SAD include Dawn Simulation and Negative Ion Therapy.

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