Light and Sleep-Wake Cycles

A recent study, published in Science showed that 13,000lux of bright light applied to the back of each subject's knees could shift their sleep-wake cycles. Researchers used a small low-heat light blanket called a BiliBlanket. This blanket is used to administer phototherapy to newborn infants who have a toxic buildup of Bilirubin in the bloodstream. It costs over $2500 even with a physician's discount. If this is possible, then it might theoretically work for SAD. This study needs to be replicated with individuals of different skin types, and it needs to be specifically tested for SAD. If it were effective and if the price came down, one might be able to use a light blanket for a few hours before waking instead of sitting in front of a light box with eyes open.

Side Effects of Light Therapy

Potential side effects of light therapy are rare and most often include jitteriness, a feeling of eyestrain and headache. Light therapy, like antidepressant medications, occasionally will cause someone to switch into a manic state. There has been debate on whether there might be long term retinal effects, but none have been documented when lights with proper screening of UV wavelengths are used. Individuals taking certain medications such as Lithium, tricyclic antidepressants, and neuroleptics and individuals with conditions such as diabetes or retinal degeneration should be monitored by an ophthalmologist. Because this form of treatment is fairly new, many doctors recommend a baseline eye exam and annual monitoring.

References: Winter Blues by Norman Rosenthal 1993, Guilford Press
Seasonal Affective Disorder and Phototherapy edited by Rosenthal and Blehar 1989 Guilford Press

Additional Treatments for Seasonal Affective Disorder (SAD)

Outdoor Light

Outdoor light, even when the sky is overcast, provides as much or more light than a light box. There has been a study showing improvement in SAD symptoms when individuals took a one-hour daily walk outside. Outside light is often brighter than the light boxes. Spending an hour outside each day can often produce beneficial results in some individuals. However, one cannot get early morning outside light in the winter. Not everyone's job will allow for an hour-long outside walk. Only highly motivated people will continue their daily walk when it the rains or snows.

Medications for SAD

SSRI (Selective Serotonin Reuptake Inhibitors--Paxil, Zoloft etc.) have been shown to be effective in SAD and in some cases of PMS. Some people prefer to take a pill because it is less time consuming than sitting in front of a light box. Some individuals need a combination of light therapy, antidepressant medication, and psychotherapy. For those with winter depression and spring-summer mania, a mood stabilizer such as Lithium may be useful.

Exercise

Daily exercise has been shown to be helpful, particularly when done outdoors. For those who tend to crave sweets during the winter, eating a balanced diet may help one's mood. Conversely, as the mood improves, craving for sweets may abate.

Psychotherapy

Psychotherapy can help the depressed individual look at her depressive assumptions and negative expectations. It can also help one identify relationship difficulties so that interpersonal mistakes might not be repeated. Research has shown that cognitive psychotherapy does help relieve depression faster and more completely than no therapy.

Some individuals continue to have a certain amount of energy fluctuation with the seasons. If you're aware of this, you can plan for it and work the expected fluctuations into your life plans.

next: What We've Learned From Our Experiences of Living with Depression