Light Box Therapy for Seasonal Affective Disorder — SAD
Researchers aren't sure what causes seasonal affective disorder. Three main theories have been put forth, and there is evidence both for and against each of these theories...
Melatonin Hypothesis: The Melatonin Hypothesis argues that SAD is due to too much melatonin being secreted in response to the long, dark days of winter. Some studies have supported this theory, while others have not.
Phase Shift Hypothesis: Advocates of the Phase Shift Hypothesis, first proposed in 1986, contend that in patients with SAD, circadian rhythms [see Sleep Disorders page] have been desynchronized to the light-dark cycle, and that appropriately timed bright light reverses SAD symptoms by realigning these rhythms. Again, there is evidence on both sides of this debate.
Serotonin Hypothesis: In the Serotonin Hypothesis, the reasoning is that serotonin levels in the brain are much lower during the winter months in patients with SAD than they are either in people without SAD. This hypothesis came about from researchers observing that SAD patients tend to feel energized after carbohydrate consumption (which increases serotonin levels), whereas people without SAD generally feel more lethargic after eating carbohydrates. Whether serotonin is 'the cause' of SAD or not, there is currently a wide body of evidence to suggest that it plays a major role in the disorder. Other neurotransmitters may also be involved (such as dopamine and noradrenaline) as well as other hormones (such as thyroid and corticotrophin-releasing hormones). However, defining the role of these other neurotransmitters and hormones will require further research.
Anyone deprived of regular sunlight exposure or adequate indoor lighting can suffer symptoms of SAD. Even in the summertime, a series of rainy or overcast days can trigger depression caused by light deprivation, as can a move from a bright location to one with low light.
Most of us are aware of winter depression, but until recently there hasn’t been a lot of data providing exact numbers. In the United States there seems to be a strong corellation between latitude and incidence of SAD. It's estimated that over 28% of the population of Alaska experiences symptoms of SAD, as do 17% of New York residents, and 4% of those who reside in Florida. In other parts of the world the relationship between latitude and frequency of SAD is looser. 
In the 15-43 age group, women outnumber men by nearly 3½ to 1. After age 44, the number of women starts to decline and the gender ratio equalizes. SAD in children is a small but significant percentage, with the female-male ratio being about equal.
Symptoms of SAD
The symptoms of Seasonal Affective Disorder manifest themselves differently for different people. The "classic" SAD symptoms, which are considered atypical symptoms of non-seasonal depression, are sleep problems, including changes in sleeping patterns—oversleeping and poor sleep; and appetite changes—increased appetite, carbohydrate cravings, and subsequent weight gain. Other SAD symptoms may include depressed mood and low energy level, social withdrawal, low sex drive, anxiety, irritability and the inability to concentrate or be productive at work.
In younger persons, symptoms of SAD may be slightly different than those in adults. Symptoms of SAD in children and teenagers often include the inability to concentrate, irritability, anxiety, low energy and fatigue; and also commonly include crying spells, difficulty in getting out of bed for school, and a lowering of grades and self-esteem. Because these problems are similar to those caused by laziness, Attention Deficit Disorder (ADD) and learning disabilities, as well as stereotypical teenage behaviors, it is important for parents to note whether the symptoms tend to recur year-after-year during the fall and winter months and ease up in the spring.
Bright light, such as that produced by light therapy boxes, is highly effective in treating SAD. According to the Journal of the American Medical Association, "Treatment [for SAD] with bright environmental light is generally a first-line therapeutic approach." Four out of five people with seasonal difficulties should expect to benefit from bright light therapy.
Light boxes and seasonal affective disorder have long been studied together, and the research offers hope for those who have suffered from SAD. "Several qualitative reviews of the literature...have concluded that [bright] light therapy, administered by fluorescent light boxes...is an effective treatment for SAD, with response rates of 60% to 90%." According to Norman Rosenthal, former Chief of Clinical Psychobiology at the National Institute of Mental Health, "The most effective, practical, and best-studied way of enhancing your environmental light is by means of a special light fixture or light box, the most commonly used method for administering light therapy."
TREATMENT: Bright light therapy recommended by researchers and clinicians for most people is 10,000 lux for 30 minutes per day. An alternative treatment would be 2,500 lux for at least 2 hours. Because light diminishes with distance, lux is measured at a specific distance away from a light source. For light therapy devices, this distance is measured from the user's eyes. The best lights for bright light therapy are metal fixtures containing white fluorescent light bulbs behind a diffuser, and tilted forward so that the light is angled downward, permitting more light to enter the eyes and decreasing the apparent brightness of the light, in turn creating less glare and improving user comfort.
Beyond Light Therapy Boxes—Lifestyle Changes: Other treatments that may be helpful in treating SAD include changes in diet and exercise, stress management, sleep restriction, psychotherapy and antidepressant medications.
It's a fact: the winter blues, also known as winter depression, is a real condition affecting millions of Americans of all ages. Whether you or someone you love suffers from winter depression, there is a cure! Since 1985, The Sunbox Company has been dedicated to helping people conquer winter depression. Their award-winning, nationally-recognized natural lighting products make getting over the winter blues easier than you ever imagined. From desktop and floor lamps to light boxes that can light an entire room, bright light therapy can help you feel great all year long. Just a few minutes’ exposure per day is all it takes to combat the winter blues and regain your enthusiasm, energy and concentration.
 Rosenthal, Norman E: Winter Blues, Revised Edition: Everything You Need to Know to Beat Seasonal Affective Disorder. New York: The Guilford Press, 2005, p63-64.
©2002 The SunBox Company
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