Wind Crest	UPDATED: Thursday, January 31, 2008
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Winter blues

Posted on Friday, February 01, 2008

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

Do you find yourself falling into black moods as the days get shorter, then feeling better as spring arrives? If so, you may be experiencing a form of depression called seasonal affective disorder, or SAD.

“SAD’s symptoms occur around the same time each year, starting in September/October and going into full remission through the spring and summer,” says Roberta Worrall Feldhausen, A.P.R.N.-PMH, BC, Erickson HealthSM director of mental health services.

“You have to exhibit the symptoms for two consecutive years for it to be classified as SAD. Your doctor has to see a pattern,” adds Elliott Kroger, M.D., Erickson Health physician.

“Many of the symptoms for SAD are the same as those for depression [see Symptoms of seasonal affective disorder],” says Feldhausen.

Keys to doctor’s diagnosis
Depression is the root cause of 30% of what a primary care physician sees,” Kroger says. “Then you have to determine what form of depression you are seeing. It takes patience, and you need to ask the right questions, but if you persist your patient will provide clues.”

Kroger thinks knowing the patient is key to proper diagnosis. “In the Erickson Health system, none of our physicians sees more than 400 patients; I myself only have about 260. Erickson Health physicians average 25 minutes with each person, and that’s a big help in diagnosing a subjective condition like depression,” he says.

Let there be light!
The good news about SAD is that its first line of treatment is not a pill—it’s light therapy.

“Light therapy has been shown to enhance mood, fight depression, and aid sleep in people who are light-deprived. We aren’t exactly sure why, but some evidence indicates it has to do with regulating the release of a hormone called melatonin into the system,” says Feldhausen.

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Light therapy doesn’t mean turning on all the lights at home. “You need a light box. It contains white fluorescent bulbs covered with a screen to block ultraviolet rays,” she says. The higher the intensity of the lights (measured in luxes), the less time you need to spend in front of the box—from 30 minutes to two hours daily.

“Therapy is usually done in the morning, so as not to interrupt your sleep cycle, but each person needs to get individualized recommendations from their physician,” says Feldhausen.

“Correct position is important. You want to sit close enough, with your head and body facing the box, but it isn’t recommended you look directly into it. Some people read during therapy, but don’t watch TV or use a computer,” she says.

Other types of light therapy include light visors worn on the head (which generally start at a lower lux level) and dawn stimulators, which awaken people by gradually increasing their room’s light level.

You may need a prescription from your doctor to get reimbursement for equipment like a light box, which runs from $250 and up.

What are the effects?
“Side effects from light therapy—including nausea, headaches, and eyestrain—tend to be mild and shortterm. Be sure to check with an ophthalmologist if you have any eye problems before starting therapy,” says Feldhausen.

“Most people see some improvement in their mood within a week,” she adds.

For many, light therapy is all that’s needed. Others may require antidepressant medications and psychotherapy.

For more information on SAD and light therapy, contact the National Mental Health Association at www.nmha.org or the Society for Light Treatment and Biological Rhythms at www.sltbr.org

Symptoms of seasonal affective disorder (SAD)

• Regularly occurring symptoms of depression (excessive eating and sleeping, weight gain) during the fall or winter months
• Full remission from depression occurs in the spring and summer months
• Symptoms have occurred in the past two years, with no nonseasonal depression episodes
• Seasonal episodes substantially outnumber nonseasonal depression episodes
• A craving for sugary and/or starchy foods Source: The National Mental Health Association.