Seniors — Dementia — Seasonal Affective Disorder (SAD) and Treatment Options

 

 

The Only Light You Really Need is the One Inside You!

 

 

Several days ago, I wrote about seasonal affective disorder and will focus on some treatment options today. Recently my wife, Pam, had some blood work done which revealed low levels of vitamin D. Recently there has been much talk in the medical community about whether the recommended daily requirement for vitamin D is sufficient. Vitamin D production is produced from sunlight. (But, wait)! We are also told to put on sunscreen to protect us from skin cancer. The sunscreen also acts as a barrier to producing vitamin D through the skin. Do we have a double whammy or not? Ironically, Pam tends to be very sensitive to sun deprivation!

 

In 1979, Norman Rosenthal, MD and Dr. Al Lewy headed research at the National Institute of Mental Health (NIMH) investigating the connection between light and mood. During the 1980s, I was most fortunate to have been mentored by Dr. Rosenthal in the theories of light and mood as well as in the treatment options available for mood disorders associated with light and dark cycles. Sometime, I will have to write down some specific examples of some of my patients who had a mood disorder and light therapy. Two individuals would not be alive today had it not been for light treatment.

 

I am sharing part of that information today. I have no intent to prescribe treatment to anyone. This is information only. Any attempt to treat SAD should begin with your physician. In this blog, I mention the use of light boxes or sun boxes. Dr. Rosenthal used the sun boxes from the SunBox company. Subsequently, that is the company I have relied upon during my psychiatric career. I do not have any financial interest in this company. However, there are other companies which sell light boxes as well.

 

Winter-onset seasonal affective disorder (SAD) or the winter blues is most likely caused by your body’s reaction to light deprivation (the lack of sunlight). In the dark days of fall and winter, you may turn your face to the afternoon sun, seeking out what little light filters through fading gray skies. You may throw open the blinds, leave lights on throughout your home or even head south for a vacation — anything for a little more light. Or you may even be unable to crawl out of bed in the morning. This can be a long walk outside or arranging your home or office so that you are exposed to a window during the day. Even being outside during a cloudy day provides more light than being indoors. Did you know that most rooms in our homes have little lighting? Even with lights on, most people’s brains interpret this small amount to be the same as being in darkness.

 

You may feel better if you get some exercise most days of the week. Being active during the daytime, especially first thing in the morning, may help you have more energy and feel less depressed. Gentle exercise such as walking, riding a stationary bike, or swimming is a good way to get started.

 

There are senior citizens residing in assisted living facilities, nursing homes, retirement homes or other long term care facilities. These individuals do not always have the luxury of being exposed to bright light. They may ask to have their bed near a window and to spend as much time as possible in a room with as much bright light as possible. Many dayrooms have large windows allowing for this. Light therapy has been found to be helpful to these elderly patients as well as those suffering from Alzheimer’s Disease, Lewy Body Dementia and vascular dementia (multi-infarct dementia). It is known that melatonin levels decrease as we age and there is a syndrome common in the elderly that is called “sundowner’s syndrome.” In winter months and summertime alike, when the sun goes down those with Alzheimer’s or dementia can become sullen, depressed anxious or morose as darkness approaches. Research published in the Journal of Geriatric Psychiatry and Neurology in 1997 and the American Journal of Psychiatry in 1992 are only two of the studies showing that light therapy can ameliorate symptoms in the elderly. Check out this article. Dementia Slowed by Light Therapy

 

sad1Light therapy is one option for treating this type of SAD because increased sunlight can improve symptoms. Doctors often prescribe light therapy (phototherapy) to treat SAD.

 

There are two types of light therapy:

 

 

  1. Bright light treatment. For this treatment, you sit in front of a “light box” or  “sunbox” for half an hour or longer, usually in the morning. The light box is a special fluorescent lamp.  
  2. Dawn or sunshine simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within 3-5 days or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don’t, your depression could come back. Once you stop using the sunlight therapy or sunbox, the depression can return in 3-5 days as well. I think of so many individuals who go to Florida or to another sunny location in the winter for 1-2 weeks of vacation. Upon leaving their homes, they would suffer from anxiety, depression and arthritic aches and pains. They would tell me, “Wow. All that salt water from the ocean really helped me feel better. It even helped my arthritis go away.” Well, it wasn’t the salt water. It was the sunlight which traveled through the eyes to the brain which caused a marked elevation in their mood! Depression always tends to make aches and pains worse.

 

Other treatments that may help include:  

 

—    Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.

—    Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn

          more about SAD and how to manage your symptoms.

 

If your doctor prescribes antidepressants, be sure you take them the way you are told to. Do not stop taking them just because you feel better. This could cause side effects or make your depression worse. When you are ready to stop, your doctor can help you slowly reduce the dose to prevent problems.

 

If you feel you are suffering from SAD, it is important to seek the help of a trained medical professional. SAD can be misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so proper evaluation is necessary. For some people, SAD may be confused with a more serious condition like severe depression or bipolar disorder.

 

However, if you feel the depression is severe or if you are experiencing suicidal thoughts, consult a doctor immediately regarding treatment options or seek help at the closest emergency room.

 

Tanning beds should not be used to treat SAD. The light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin.

 

Melatonin, a sleep-related hormone, also has been associated to SAD. This hormone, which has been linked to depression, is produced at increased levels in the dark. When the days are shorter and darker, more melatonin is produced.

 

Researchers have proved that bright light makes a difference to the brain chemistry, although the exact means by which sufferers are affected is not yet known. Some evidence suggests that the farther someone lives from the equator, the more likely they are to develop SAD. For example, approximately 25 percent of the population at the middle-to-northern latitudes of the U.S. experience winter doldrums, a sub-clinical level of SAD. These people notice the return of SAD-like symptoms each winter, but remain fully functional.

 

Drs. Rosenthal and Lewy eventually focused on the hormone melatonin. Melatonin is produced in the pineal gland, located in the midbrain. When research the early 1980’s pointed to melatonin’s role in promoting sound and restful sleep, as an anti-aging supplement and showing success in fighting cancer, the public started gobbling tons of the hormone, easily available in health food stores. Melatonin showed virtually no danger of side-effects. In fact, government researchers who set out to determine the “LD 50”, — the amount necessary to kill fifty percent of the animals tested — couldn’t produce a concentration strong enough to kill one mouse.

 

Other research found that taking melatonin helps airline employees deal with jet lag affecting their sleep. Melatonin in as small an amount as 5 milligrams helped them adjust.

 

Melatonin controls the function of many glands and Rosenthal and Lewy found that melatonin production is affected by exposure to light in excess of 2500 lux. (Lux is a measure of luminosity.) The link between sunlight and hormonal and mood function was made.sad7

 

Dr. Rosenthal and others demonstrated in research later published in the Archives of General Psychiatry in 1998 that the mechanism of melatonin affecting SAD may have to do with internal core temperature as well. Melatonin and serotonin are two hormones that regulate temperature while we sleep. The relative temperatures associated with sleep and waking may be part of the mood equation.

 

You can buy a light therapy box over-the-counter, without a doctor’s prescription. Internet retailers, drugstores and even some hardware stores offer a wide variety of light therapy boxes and other light devices for seasonal affective disorder treatment.

 

But take caution before buying. Not all light therapy boxes being sold have been tested to make sure they’re safe and effective. And different light boxes work in different ways, using different parts of the light spectrum and offering different illumination intensities. That’s why it’s especially important to understand what you’re buying and what features to consider. It’s also important to check with your health professional before buying a light therapy box.

 

Here are some features to understand and consider when buying a light therapy box for seasonal affective disorder treatment:

 

1. SAD-specific. Make sure the light therapy box is specifically designed to treat seasonal affective disorder. If it’s not, it may not be as effective in treating SAD.

 

2. Intensity. Look for a light therapy box that provides the right intensity of light when you’re a comfortable distance away. Some light boxes offer the preferred 10,000 lux only when you’re within a few inches of the box, while others can reach a distance of nearly two feet.

 

3. Minimal UV exposure. Many, but not all, light therapy boxes now filter out harmful ultraviolet (UV) light. UV light can cause eye and skin damage. Look for a light box that produces as little UV light as possible at high intensity or that carefully shields the UV rays it produces. If you’re not sure about the UV light exposure, ask the manufacturer for safety information.

 

4. LEDs. Traditionally, light therapy boxes have used fluorescent or incandescent lights. Some manufacturers are now selling light therapy boxes with light-emitting diodes (LEDs). LEDs can produce light in a narrower, more targeted wavelength. LEDs are also more efficient and lighter weight than standard lights.

 

5. Blue light. White light is the standard type of light used in light therapy boxes. But some newer light therapy boxes give off narrow-spectrum blue light. This blue light has a shorter wavelength, which some research shows is more effective at reducing seasonal affective disorder symptoms. On the other hand, blue light poses a greater risk than does white light of damaging your eye’s retina because your retina is more sensitive to the shorter blue wavelengths. To help reduce this risk, don’t look directly at the light source in any light therapy box. Check with the manufacturer if you have concerns about a light box’s safety.

 

6. Light direction. Light from a light therapy box should come from above your line of sight, not directly at it or below it. Make sure the light box you want can be positioned appropriately.

 

7. Dawn simulation. Some light therapy boxes simulate dawn — they turn on in the morning while you’re asleep and gradually get brighter until you wake up.

 

8. Cost. Prices vary greatly, from about $200 to $500, and more. Health insurance plans don’t always cover the cost of light therapy boxes. Check with your insurance company to see if your benefits will cover the cost.

 

9. Style. Some light boxes look like upright lamps, while others are small and rectangular. You can even buy a light therapy device attached to a visor, which enables you to receive light therapy while remaining active. However, keep in mind that scientific evidence about the effectiveness of light visors is lacking.

 

10. Convenience. Some light boxes are bigger than others, which can make them less portable. Find one that you can move easily and that fits the desired location in your home or office. Some light therapy boxes offer a variety of other features, such as programmable timers, clocks, carrying cases, stands, wall-mount options and extended batteries, among other features. Decide which features are important to you. Before plunking down any hard-earned cash, talk to your doctor, mental health provider or pharmacist about the light therapy box you’re thinking about buying. He or she may offer additional guidance or tips to make sure that seasonal affective disorder treatment with a light therapy box is both safe and effective for you.

 

Cautions

 

Light therapy may trigger episodes of mania in people with bipolar disorder. In addition, although rare, some people, particularly those with severe forms of depression, have reported thoughts of suicide after treatment with light therapy. Light therapy alone may not be fully effective. You still may need treatment with medications or psychotherapy.

 

David

                                                                     sadlady1

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4 Responses

  1. I remember reading articles about a Scandinavian
    country. It seems that people in the medical profession thought this particular country should have a high incidence of depression. Guess what! It seems the population did not have such a high rate of depression. Now scientist involved in this study think that even though there is less sunshine days in this country than others the people do not have depression as much as other countries. That includes ones with a lot of sunshine which are not next to the sea. Why is this so? The scientist think that it may because of the high content of fish in their diets. It may have something to do with the fish oil.

  2. Great post! Meaning I agree with almost all of it. 🙂 But you write “Melatonin in as small an amount as 5 milligrams…” Five milligrams is not a small amount! Three has been standard for a while, but for circadian rhythm and SAD purposes, 3 mg is also a much larger dose than necessary. I use one half mg which makes me sleepy in one and a quarter hours — just like the 3 mg did. Dr. Al Lewy, whom you mention, has stabilized blind free-running patients on only 0.1 mg daily.

    My blog, http://delayed2sleep.wordpress.com , is about circadian rhythm disorders. SAD seems to be a related condition even if it still is considered to be psychiatry and not neurology like the other circadian rhythm disorders.

    And to the commenter above: The “Scandinavian” country of which you speak is Iceland. (It’s a Nordic country but not exactly on the Scandinavian peninsula.) I’ve seen the fish oil speculation and there’s also been some mention of genetics. Whichever reason, people in Canada of wholly Icelandic descent have lower levels of SAD than their neighbors. Do those Icelandic Canadians eat more fish than their neighbors? I haven’t seen if that’s been studied or not.

  3. Another vote for great article with a few reservations! Blue light is not more dangerous than white light, as white light contains the same wavelengths as blue light. The best link I’ve seen on the subject is at http://www.psycheducation.org/depression/LightTherapy.htm#whole.

    Your checklist for buying a lightbox is excellent. I’d add a couple of things. The first is that many people find the traditional fluorescent lightboxes cause symptoms such as headaches, visual stress and so on; and on the other hand, there are a few people out there who don’t tolerate coloured light and thus don’t get on with blue LED lightboxes. The second is that since lightboxes are expensive and you don’t know which one will suit you, I’d always recommend that you try before you buy, either by using a hire-purchase system or by using a company who offers a free trial period.

    I write a blog about light therapy and darkness therapy for treating sleep disorders.

  4. Most informatable. Thank you very much.

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