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SAD season: If your gloomy mood matches the wintry skies, several approaches can help

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

December 27, 2005

Lighten up to fight SAD

One of the most recommended treatment options for Seasonal Affective Disorder is light therapy. There are dozens of lights and products on the market. Here's what experts advise:


• Get a phototherapy unit with fluorescent lighting that shines at 10,000 lux, a measurement of light intensity. That's the amount of light on a cloudless day at sunrise. By comparison, typical office overhead lighting is 500-700 lux. The best studied and most recommended is white fluorescent lighting.


"White light has a long history" of safety and effectiveness, says Dr. Norman Rosenthal, author of "Winter Blues" (Guilford, $15.95).


• The best units are two feet wide by 18 inches long and contain a plastic diffusing screen that filters out ultraviolet rays that can cause eye damage and skin cancer. They are tilted forward to allow more light to enter the eyes. Sit 2-3 feet in front of the light, facing it. There is no need to stare directly into it. Try to use light therapy at sunrise or early morning, for at least a half-hour. The best time to begin is in the fall, about 2-3 weeks before the beginning of Daylight Saving Time.


• Phototherapy lamps range from a bedside light attached to alarm clocks to table, desk and floor models.


Spin-offs


O-ZONELite, by a Deerfield, Fla., firm, is a light bulb with titanium dioxide coating that produces a reaction that reduces tobacco smoke, mold and allergens, and eliminates SAD symptoms too, the owners say. It requires an adaptor to fit into an ordinary lamp.


NOT THE REAL THING


Tanning parlor lighting does not help with SAD and exposes patrons to harmful ultraviolet rays that can cause damage to the eyes, as well as skin cancer.


WHERE TO BUY


Costs for proper lighting range $250-$300. Some insurance may cover them. Lighting is available through craft and lighting stores and these Internet sites:


www.sunbox.com, 800-548-3968. SunBox Co.


www.apollolight.com, 800-545-9667. Apollo Health Inc.


www.bio-light.com, 800-222-3296. Enviro-Med.


www.ozonelite.com, 800-494-8292.


Patricia Anstett

What is SAD?

Seasonal Affective Disorder, or SAD, is a consistent pattern of depressive symptoms that occur with colder weather and shorter hours of daylight.


Symptoms


• Excessive sleeping, difficulty staying awake, overeating and weight gain during the fall or winter months.


• Feelings of extreme fatigue, inability to maintain regular lifestyle schedule.


• Depression (feelings of sadness, loss of feelings, apathy) combined with irritability.


• Lack of interest in social interactions, losing interest in activities of enjoyment.


• Remission of symptoms in the spring and summer months.


Source: American Psychiatric Association


Resources


• To find help, go to the American Psychiatric Association's site, www.healthyminds.org, or go to www.mentalhealthscreening.org, to locate a depression screening site near you.


• "Winter Blues, Everything You Need to Know to Beat Seasonal Affective Disorder," revised edition, by Dr. Norman Rosenthal, (Guilford; $15.95). Rosenthal's Web site, www.normanrosenthal.com, also offers resources.


WEB


www.cet.org: Center for Environmental Therapeutics, a comprehensive Web site from leading specialists in the field about a wide range of SAD issues.


www.light-and-ion-therapy.org: Columbia University Medical School Clinical Chronobiology program, comprehensive research site with "Ask the Doctor" link.


www.sltbr.org: Society for Light Treatment and Biological Rhythms, helpful summary of SAD research.


Patricia Anstett

A little grouchy, aren't we? Perhaps you feel sluggish, less creative or withdrawn. Maybe you're eating more than usual. Join the club, the one with 14 million Americans who live with Seasonal Affective Disorder, or SAD. A type of depression, SAD and its milder form, the winter blues, are caused by shortened exposure to daylight. Symptoms begin in the fall, as daylight hours dwindle. Five or six months later, the blues are gone with the snow, only to return the next fall. Sorry to report, folks, but SAD's peak season starts in five days and runs through all of February, according to the American Psychiatric Association. You've got enough to grouse about. We want to help you understand the problem and remedy it, on your own or with professional help.

The problem

Some 6% of the U.S. population has SAD, and another 14% cope with winter blues, says Dr. Norman Rosenthal, the nation's leading SAD expert and author of the newly revised "Winter Blues" (Guilford, $15.95). What causes it?

Our bodies have internal cycles and clocks. Come fall, our brains and our behavior change with shorter days and less exposure to daylight. We produce more melatonin, a hormone that is made almost exclusively at night. Some call it the hormone of darkness, Rosenthal says.

People with SAD are more susceptible to the extra melatonin, which affects their mood.

Sometimes, a move from a southern climate to a colder, northern one with fewer daylight hours may bring on symptoms. For reasons that aren't clear, women outrank men 3-to-1 with the problem.

SAD can sneak up on you, Rosenthal, a Georgetown University psychiatrist, said in a telephone interview. "It starts with feeling sluggish. You start sleeping in. You aren't as pumped up as usual."

Dearborn Heights resident Jennetta Helton started noticing the problem shortly before she was diagnosed seven years ago.

"I start feeling down; I just don't want to do anything," says Helton, 37, a homemaker with a 12-year-old son. "I could sit around, pretty much all day." Today, she uses both antidepressant medicines and light therapy to help reduce the symptoms.

Each morning, after her son leaves for school, she turns on her phototherapy unit and watches television. "It seems to give me the kick I need to keep going," she says. She also tries to exercise more and spend time outside when it's sunny. "I'm doing pretty well," she says.

Treatment options

There are three known therapies: anti-depressant medicines, light or phototherapy and a type of counseling known as cognitive behavioral therapy, or CBT.

CBT helps people take negative thoughts and turn them into realistic ones, says Dr. Jed Magen, chairman of the Michigan State University Department of Psychiatry. "People who are depressed have lots of negative thoughts," he says. "Everything seems worse than it is. You ask people, 'What's a more realistic thought?' You give them homework."

An example: A student worries about flunking a test. A more realistic thought is, you are doing well in school.

Anti-depressants like Prozac work in 50%-60% of people, and light therapy is effective in as many as 70% of patients, says Dr. Alireza Amirsadri, a psychiatrist and SAD specialist at Wayne State University School of Medicine and Detroit Receiving Hospital.

Drugs are the main choice for people who want a quick, convenient option and whose insurance does not pay for light units or counseling, he and others say. In the long run, a light unit that costs $200-$300 is significantly cheaper if a person has no insurance drug coverage.

Dr. Neel Jolepalem, a child and adult psychiatrist at St. Joseph Mercy Hospital in Pontiac, said he finds his patients opt for the drugs because they are not willing to take the time necessary to sit in front of a light box. Receiving Hospital has the Cadillac of treatment settings for SAD: a room brightly lit with overhead fluorescent lights. It's for hospitalized patients only. Some patients even sleep there, oblivious to the bright lights.

Take flight

For some, there's the option of escaping someplace with more winter sunshine. For the rest of us, try an outdoor sport like skiing on sunny winter days. Cultivate indoor plants in a sunroom. Visit places like the balmy butterfly exhibit at the Detroit Zoo. Drink your morning beverage in the sunniest spot in your home.

Or take a day now and again and roll up on the couch, cover yourself with your favorite blanket and watch television.

Who says humans aren't entitled to a little hibernation?

Contact PATRICIA ANSTETT at 313-222-5021 or anstett@freepress.com.

Copyright 2005 Detroit Free Press Inc.