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

Advertisements

Winter Blues? Feeling Sad? Dementia and Seasonal Affective Disorder (SAD)

 

 

“This little light of mine…”

 

sad6

 

Do you or your loved ones suffer from:

 

 

 

∞  Feeling sad, grumpy, moody, or anxious

∞  Avoiding social situations and feeling a loss of interest

     in the activities you used to enjoy

∞  Eating more and craving carbohydrates, such as bread

     and pasta

∞  Weight gain

∞  Sleeping more and feeling drowsy during the daytime

∞  A drop in energy level and fatigue

∞  A tendency to oversleep

∞  Difficulty concentrating

∞  Increased sensitivity to social rejection

∞  Feeling that your physical problems worse (even if they aren’t)

 

Then you may be suffering from the winter blues or seasonal affective disorder (SAD). It is a type of depression that affects a person during the same season each year. If you get depressed in the winter but feel much better in spring and summer, you may have SAD. Anyone can get SAD, but it is more common in:

  1. People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons.
  2. Women.
  3. People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age.
  4. People who have a close relative with SAD.

It is possible for an individual to experience many or all of the above symptoms but yet do not feel depressed. I used to see this more frequently with patients who have more difficulty being in touch with their feelings.

For someone suffering from aging or dementia along with SAD, whether mild or severe, their behaviors and moods may be markedly worsened and more difficult to understand. He/she may feel more confused earlier in the day (sundowners) than usual. Their aches and pains might be worse or they might become more withdrawn. Their dementia may not be getting worse. This is because we turn the clocks back one hour and the days are ‘shorter’ which result in less sunlight.

As many as half a million people in the United States may have winter-onset depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. Although some children and teenagers get SAD, it usually doesn’t start in people younger than 20 years of age. For adults, the risk of SAD decreases as they get older. Winter-onset SAD is more common in northern regions, where the winter season is typically longer and more harsh.

When I practiced psychiatry in Pennsylvania, the phone calls always increased during October and particularly after Daylight Saving Time ended. Ironically, I saw very little SAD in patients where I lived in California where it could even be sunny in the winter.

SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and a lack of sunlight in winter. Just as sunlight affects the seasonal activities of animals, SAD may be an effect of this seasonal light variation in humans. As seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. For those who care, research locates the clock in the suprachiasmatic nucleii of the hypothalamus. It’s common to all mammals and that is rather interesting since the hypothalamus is our primitive brain. That primitive part of our brain is very concerned with basic survival and knowing instinctively when darkness is coming, how long the days are, or when it may be time to seek shelter from predators; just the kinds of things that concerned primitive man.

Symptoms come and go at about the same time each year. For most people with SAD, symptoms start in September or October and end in April or May.

Symptoms of SAD keep coming back year after year. They also tend to come and go at about the same time every year. The changes in mood are not necessarily related to obvious things that would make a certain season stressful (like regularly being unemployed during the winter).

 

sadlady

A modest improvement in symptoms of dementia has been associated with the use of bright light in daytime, in an effort to improve their circadian rhythms, according to a study released on June 10, 2008 in the Journal of the American Medical Association (JAMA). Additionally, the use of melatonin resulted in improved sleep.

 

Not to worry! Tomorrow, I will discuss some of the treatments for SAD. I am still impressed with some of the results my patients and I would see when they received the appropriate treatment! They ended up feeling as happy as this smiling lady in the picture.

 

 

 

And a new vocabulary word today.   adumbrate  [a-duhm-breyt, ad-uhm-breyt]

  1. to produce a faint image or resemblance of; to outline or sketch
  2. to foreshadow; prefigure
  3. to darken or conceal partially; overshadow

 

Do you know the 80/20 rule?

— This is one of the best ways to make better use of your time. The 80/20 rule – also known as The Pareto Principle – basically says that 80 percent of the value you will receive will come from 20 percent of your activities.

 

— So a lot of what you do is probably not as useful or even necessary to do as you may think.

 

— You can just drop – or vastly decrease the time you spend on – a whole bunch of things.

 

— And if you do that you will have more time and energy to spend on those things that really brings your value, happiness, fulfilment and so on.

 

I utilize the 80/20 rule when it comes to managing my desk. 80% of the time I only use 20% of ‘stuff’ on my desk. The other 80% of my ‘stuff’ gets used only 20% of the time.

 

 

David

 

 

 

 

%d bloggers like this: