Health Secrets	UPDATED: Tuesday, February 20, 2007
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Darkening Days, Darkening Moods

Posted on Friday, November 03, 2006

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

Do you find yourself falling into black moods as the days get shorter and then you feel better as spring arrives? If so, you may be experiencing a form of depression called Seasonal Affective Disorder, or SAD.

As the Days Shorten…

“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, director of mental health services at Erickson Communities.

“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 HealthSM physician at Sedgebrook, a community in Illinois built and managed by Erickson.

“Many of the symptoms for SAD are the same as those for depression, including irritability, feeling guilty, worthless, and a loss of energy. These symptoms have to last more than two weeks,” says Feldhausen.

The National Mental Health Association has developed this list of SAD symptoms:

• 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 non-seasonal depression episodes

• Seasonal episodes substantially outnumber non-seasonal depression episodes

• A craving for sugary and/or starchy foods

Keys to Doctor’s Diagnosis
“I think today’s primary care physicians (PCPs) are better trained to look for SAD. It isn’t unusual anymore for people to bring in questions about it to their doctors,” he says. “Depression accounts for 30 percent of what a PCP sees; 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,” says Kroger.

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That is why Kroger feels the key to proper diagnosis is knowing your patient. “In the Erickson HealthSM system none of our physicians sees more than 400 patients; I myself only have about 260 here at Sedgebrook. Erickson HealthSM 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 its first line of treatment is not a pill. “Light therapy is the most-recommended treatment for this disorder. It 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.

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. The higher the intensity of the lights (measured in luxes), the less time you need to spend in front of the box. “Today’s light boxes generally produce 10,000 lux, used for 30 minutes every day during the darker months (although some experts suggest working up to 90 minutes). A lower level might require up to two hours of therapy.

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 the box. Some people read during therapy, but don’t watch a 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 help some people awaken gradually by slowly increasing their room’s light level.

“Side effects from light therapy, including nausea, headaches, and eyestrain, tend to be mild and short-term. Be sure to check with an ophthalmologist if you have any eye problems before starting therapy.

Most people see some improvement in their mood within a week,” she adds. For many people, light therapy is all that’s needed. You may need a prescription from your doctor to get reimbursement for equipment like a light box, which runs from $250 and up.

There are studies suggesting that melatonin pills add to the lights’ effectiveness, while other people need additional help with antidepressant medications and psychotherapy. Again, make sure to talk to your doctor.

For more information on SAD and light therapy contact:

National Mental Health Association: 1-800-969- 6642; www.nmha.org Society for Light Treatment and Biological Rhythms: www.sltbr.org.