Light Therapy Pros and Cons

The Mayo Clinic has an excellent article on the use of light therapy for treatment of Seasonal Affective Disorder, depression, obsessive compulsive disorder and some sleep disorders. The article includes the benefits and side-effects of using light boxes as well as instructions on using a light box.

The Mayo Clinic makes the point that the effectiveness of using light boxes vary, from being as good or better than medications for some people, while others get little or no benefit. This is possibly due to the large range of light boxes available and the different theories on the appropriate spectrum of light to use and the duration of treatment.

Light boxes can be expensive to purchase, however it is also possible to rent them on a trial basis to see whether they are effective for you. The Apollo GoLite box is a popular model that a lot of people have recommended (I've never used one as I find the winters here are quite mild and I can usually get enough natural light to keep depression at bay). In addition to using the light boxes there are also special light bulbs and desk lamps you can purchase.

Once you have purchased the light box, most models will last a few years, but it pays to check out the replacement at the end of this time. Some will allow you to replace the bulb, other models require you to replace the entire box which can be costly. However, if you don't have insurance the light box can still be cheaper than medications without the stigma or side-effects of anti-depressants.

This doesn't mean that light boxes don't have side-effects, however most people find them tolerable. Some people with bipolar disorder may experience manic episodes, while others may find that the light box affects their skin, or induces headaches or eyestrain but the majority of people that I've spoken to have nothing but praise for their light box.

Shorter Fall Days = SAD Symptoms Kick In

It doesn't take many days of sunsets at 7:50 p.m. for my own mild SAD to kick in. Even though the daytime temperatures are still hitting the 80s, I'm pulling out the wool throws and thinking about making a vat of mac and cheese. This is a common response as we head into Fall. Most of us occasionally suffer from the "Winter Blues," but SAD or Seasonal Affective Disorder is more than that.

According to Mental Health America (formerly National Mental Health Association) , a diagnosis of Seasonal Affective Disorder can be made after 3 consecutive winters of the following symptoms if they are followed by complete remission of those symptoms in the spring and summer months:

• Depression
• Anxiety
• Mood changes: extremes of mood and in some, periods of mania in spring and summer
• Sleep problems: desire to oversleep and difficulty staying awake or disturbed sleep and early morning awakening
• Lethargy
• Overeating: craving for starchy and sweet foods resulting in weight gain
• Social problems: irritability and desire to avoid social contact
• Sexual problems: decreased libido and decreased interest in physical contact

Causes

SAD may be a result of seasonal light variation. As seasons change, there is
a shift in our "biological internal clock" or circadian rhythm due partly to
these changes in sunlight patterns. This can cause our biological clock to
be out of step with our daily schedules.

There has also been research linking the sleep-related hormone, melatonin to SAD. Results of some of these findings can be found on NIMH's (National Institute of Mental Health) site.

Treatment

An excellent resource, for both health professionals and lay people is Winter Blues: Seasonal Affective Disorder: What Is It and How to Overcome It by Norman E. Rosenthal, MD. Dr. Rosenthal explores several treatment options, including the most popular, light therapy, but also herbal, vitamin and antidepressant options. Light therapy is usually recommended, utilizing a 10,000 lux light box, which contains fluorescent light tubes covered with a plastic screen blocking ultraviolet rays. The Cleveland Clinic offers a more extensive exploration of light therapy for SAD. This article also has a list of sources for light boxes. The model shown below is from goLITE.

Most cases of SAD are mild to moderate. But with any possible diagnoses, if you believe you are experiencing symptoms of SAD, you should see your doctor or a mental health professional. Many of the symptoms of SAD can also be indicators of a more severe depression or other disorder.

December is US Seasonal Depression Awareness Month

Lucky me! It's summertime here and I'm looking at the window at all that wonderful light bathing my garden. But for people in the Northern hemisphere December is a time when many start to experience symptoms of Seasonal Affective Disorder (SAD) or Winter Depression.

The symptoms include persistent feelings of sadness, lack of motivation and lack of interest in the things you normally enjoy. People with SAD may also experience feelings of hopelessness and withdraw from social activities. Changes in eating and sleep patterns are another indicator. For me SAD leads to increased eating - I find myself fondling the cakes in the supermarket and making trips to the local pizza joint - but some people will be the opposite. They may lose their appetite and feel listless and sad.

According to the Georgia Department of Human Resources eight in every hundred people experience Winter Depression but most are misdiagnosed.

The National Institute of Mental Health recommends treating Winter Depression with light box therapy first thing in the morning or melatonin pills to realign the night-day body clock.

Resources:
You can take a free Seasonal Affective Disorder quiz here
Read more about depression here

Sunlight reduces Seasonal Affective Disorder but can also induce Mania

Here's an interesting twist on the benefits of sunlight from Julie Fast at Bipolar Happens.

People who experience winter sadness, also known as Seasonal Affective Disorder are very familiar with the benefits of sunshine. Not only does the warmth make you feel good, but the full spectrum light affects your biochemistry triggering feelings of happiness and well-being.

You can increase your exposure to the feel good rays by purchasing light boxes or spending more time in the sun. The light enters through the eyes, either directly or by reflecting off other surfaces.

But apparently for some people too much of a good thing can lead to summertime mania, an abnormally elevated mood accompanied by grandiosity, racing thoughts, increased risk taking and inappropriate behaviours. This probably explains why drinking alcohol in the sunshine appears to potentiate or magnify the effects of the alcohol. A couple of glasses of wine on a sunny day and you start to feel REALLY good!

According to Julie

It often feels so good to finally have some energy and a renewed interest in life once the summer starts, but this good feeling is often the result of mania and has to be monitored carefully. Mania is so tricky. It can sneak up on you in just a few hours and before you know it you’re staying up all night for a week (at the expense of your job and relationships) working on a project you just know will change the world while everyone around you is asking, “What in the heck is wrong with you? Have you lost your mind?”

Julie recommends wearing sunglasses to limit the risk of mania and asking your friends,family and colleagues to be aware of any indications that your mood is excessively elevated.

Talk about bad news! It's our fifth official day of summer here in New Zealand and I have been looking forward to all those feel-good endorphins being stimulated by the longer days. I guess that's another good reason to slip, slop, slap - slip on a shirt, slop on sunscreen, and slap on a hat.

All depressive illnesses are not created equal

At last! A doctor that differentiates between different types of depression…

Most doctors rate depression according to its severity. They may state that you are experiencing a major depressive episode or a mild depressive episode, or perhaps you have seasonal affective disorder (SAD).


Dr Henry Emmons has a different approach. He classifies depression as follows:

• Anxious Depression


• Agitated Depression


• Sluggish Depression

This is a potential break-through in diagnosis and the possibilities it offers for treatment. According to Emmons you may be a combination of the above three types but most likely show a preference to one type or another.

More significantly, each type of depression is attributed to an excess or deficit of chemicals (neurotransmitters) in the brain. Many people will already know that low levels of serotonin, otherwise known as the happiness brain chemical, can lead to depression and disrupted sleep patterns. However Emmons suggests that dopamine and norepinephrine also have a role in depression. This is not entirely new, however the attribution of specific types of depressions and tailored treatment is new.

Anxious Depression is characterised by low levels of serotonin and feelings of inadequacy and excessive worry, together with insomnia and potential carbohydrate cravings.

Agitated Depression is said to result from an excess of dopamine and norepinephrine resulting in restlessness, anger, irritability and digestive problems.

Sluggish Depression is characterised by increased sleep, withdrawal and passivity due to low levels of dopamine and norepinephrine.

In Emmons’ book The Chemistry of Joy he suggests eating plans for each type of depression, together with generalised recommendations for vitamin supplementation. Most of the information on vitamin supplementation will be familiar and include the usual mainstays, such as B complex, folic acid, omega 6 (fish oil) and the like.

Interestingly Emmons speculates that Selective Serotonin Reuptake Inhibitors (SSRIs), which are commonly prescribed for depression, are not effective long term. This contradicts accepted wisdom, however his reasoning is sound. He hypothesizes that SSRIs simply manipulate existing stores of serotonin and do not help create new sources of serotonin. Accordingly, if an individual has difficulty manufacturing serotonin then over time the existing stores will be depleted as the SSRIs can not stop re-uptake indefinitely. It’s an interesting theory. I couldn’t find any source for this from published research and it appears to be based on Emmons’ observations of his patients but I think the theory has merit.

Emmons favours a combination of lifestyle changes and supplements to treat depression. He does not rule out medication but seems to prefer a diet rich in tryptophan (the precursor to serotonin) together with 5-HTP. If you have a deficit of dopamine and norepinephrine then dopamine/norepinephrine enhancing foods and supplements are recommended.

Emmons’ book also recommends ‘Mindfulness Mediation’ and making lifestyle changes according to your Ayurvedic body type, a philosophy made popular by Deepak Chopra in several books including Perfect Health.

Do you experience depression? I'd like to know what has helped you MOST in your recovery from depression. Please register your votes at my poll

Check out part 2 of this article on The Chemistry of Joy: Mindfulness Meditation