Bright Light Therapy can help!
Now that the rush and adrenaline of the holidays are over, we all settle down into the doldrums of winter…cold weather, short days, early sundown, and dark nights. Does the winter get you down? Do you feel like “hibernating” until springtime?
Light therapy pioneer Norman E. Rosenthal, M.D., director of light therapy services at the National Institute of Mental Health and clinical professor of psychiatry at Georgetown Medical School, wrote, “Surveys have shown that most people experience some alteration in mood or behavior with the changing seasons, and that for as many as one in four persons, these changes are a problem.” (p 3, Winter Blues)
One possible presentation of this mood change can be Seasonal Affective Disorder, or SAD. The diagnosis of SAD is established when patients exhibit the symptoms of major depression and the more specific symptoms occurring in the wintertime (a much rarer occurrence can manifest at other times of the year, but the predominant season for SAD is winter). A milder version of this seasonal affliction is called simply “the winter blues.”
According to Dr. Roy Stefanik, M.D., the occurrence of SAD is usually related to major depression or bipolar disorder, and in about 20 percent of patients the symptoms worsen in the winter.
What causes SAD?
The exact causes of SAD are not known, but there are several similarities among people who suffer from the disorder. In the wintertime, SAD sufferers can exhibit lower levels of serotonin (a neurotransmitter associated with mood) in the brain. They may overproduce the hormone melatonin, which regulates sleep, during the wintertime. People with SAD may produce less vitamin D (which is believed to play a role in serotonin activity and is thus associated with the symptoms of depression) in the winter. (NIMH)
However, according to Rosenthal, there is one proven culprit in seasonal depression: decreased exposure to sunlight, which occurs during shorter winter days and daylight savings time. You know how it is; by the time you get home from work it is dark, and even on weekends it’s cold and miserable and you are less likely to participate in outdoor activities.
What is the difference between major depression and the winter blues?
According to Dr. Stefanik, major depression is an impairment which often prevents the person from getting out of bed or functioning in normal daily life. It can also include feelings of hopelessness, despondency, and suicidal thoughts. In the winter blues, the person is often able to function adequately but feel chronically down, with low energy and fatigue being predominant symptoms.
Can SAD be treated? YES!
Effective treatment is comprised of four possible components, usually used in some combination. One component of treatment can be SSRIs (Selective Serotonin Reuptake Inhibitors), antidepressant medications that increase the levels of available serotonin in the brain. Psychotherapy, specifically cognitive behavioral therapy, is the primary therapy used for SAD. Vitamin D supplements are a possible but unproven component.
Another proven effective treatment is bright light therapy, which can mitigate the effect of drastically reduced exposure to sunlight during those dark winter days. Dr. Roy Stefanik, M.D., said, “I often recommend light therapy for patients who have depression and who notice that the winters are particularly difficult. Quite a few of my patients have found it helpful.” The light box is usually used as a supplement to other treatments, but occasionally can help on its own. It can be a first line of defense for patients who wish to avoid medication.
So what is light therapy?
It’s not just turning on more lights in the house, although that can certainly make things feel more cheerful. It involves sitting in front of a specialized light box for 20-60 minutes each day, as prescribed by your doctor or therapist. Light therapy boxes emit 10,000 lux of white fluorescent light (significantly higher than standard indoor lighting which usually emits 100-300 lux) with a diffuser which filters out ultraviolet wavelengths (so it is not harmful to your eyes). You do not need to stare directly into the lights, so it is possible to eat, read, or work on a computer during therapy. But no, you cannot sleep during light therapy…it is necessary for the light to reach the retina of the eye. Additional sunlight can’t hurt either; doctors also recommend getting outside for the light, fresh air, and exercise, all of which may help alleviate the symptoms of depression.
Should you go buy a light box and start therapy on your own?
No. Dr. Rosenthal wrote emphatically, “Any depressed person should obtain the help of a qualified professional, and the person with SAD is no exception.” (p. 96, Winter Blues)
Are there side effects of bright light therapy?
There are a few, but in general it is considered a very benign treatment. According Dr. Stefanik, one side effect he’s seen is irritability, although he notes some irritability can be due to the patient being frustrated at having to sit still in front of the light for the prescribed amount of time.
The time of day for therapy is provided is also important. Light boxes can promote the release of the neurochemical orexin, which increases daytime wakefulness, so light therapy is best done in the mornings. Using the light box in later in the day can disturb sleep patterns. It is also important to use this treatment for the prescribed amount of time and no more. Some people find it helpful to set a timer.
There is hope for seasonal depression and the winter blues. According to Rosenthal, over 80 percent of people who suffer from SAD or the winter blues benefit from light therapy, which can in some cases start to help within a few days, although it is unusual for all symptoms to completely disappear. He wrote, “If the light therapy works, you should begin to feel more energetic. Suddenly, chores and daily activities no longer feel like drudgery. Along with a physical sense of lightness, the burden of living, of carrying your body around from place to place, seems to lift, and the overwhelming need for sleep subsides. Suddenly, you feel less driven by cravings for sweets and starches… Thinking becomes more efficient…exercise becomes less onerous…there is once again a wish to communicate, to call friends… In short, you feel human again.” (p 108, Winter Blues).
Symptoms of major depression:
- Feeling depressed most of the day, nearly every day
- Feeling hopeless or worthless
- Low energy levels
- Loss of interest in activities you once enjoyed
- Sleep problems
- Appetite or weight changes
- Feeling sluggish or agitated
- Difficulty concentrating
- Frequent thoughts of death or suicide.
Symptoms of the winter pattern of SAD include:
- Low energy
- Excessive sleepiness
- Craving for carbohydrates
- Weight gain
- Social withdrawal
This article is meant as a helpful resource, not a diagnosis or recommendation.
- Winter Blues, Seasonal Affective Disorder: What it is and how to overcome it. By Norman E. Rosenthal, M.D., Copyright 1993, published by the Guilford Press, New York, New York.
- National Institute of Mental Health, Seasonal Affective Disorder: https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml
- Interview: Dr. Roy Stefanik, M.D., Fairfax Mental Health
Resource for light boxes: