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If fall and winter have got you down, you may be suffering from seasonal affective disorder.
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Some people start their mornings in front of the TV.
For Lou Ann Barnett, it’s a light box.
The innocuous-looking silver-framed box, about 2 feet wide and 12 inches tall, sits on a table next to the living room couch in Barnett’s East Sacramento home. On workdays, she crawls out of bed around 5:30 a.m., grabs her coffee and newspaper, and spends the next 30 to 60 minutes getting her daily dose of 10,000 lux.
For Barnett and many others, light therapy has been almost a miracle cure for Seasonal Affective Disorder, a type of depression associated with seasonal variations of light. If you’re someone whose mood dips when fall and winter hit, and you perk right up in spring, you may be one of some 5 percent of U.S. adults who suffer from SAD.
SELF-DIAGNOSIS CAN BE KEY
While the mental-health community has long recognized SAD as a psychiatric condition—you can find the diagnostic criteria mapped out in the “bible” known as the DSM (Diagnostic and Statistical Manual of Mental Disorders)—it appears to be less well known among primary docs, as Barnett found.
For some 20 years, the 54-year-old had suffered “little bouts of depression,” as she describes it. But it wasn’t until about six years ago that she put the pieces together. “I had never really associatedconit with seasonal changes,” Barnett says. But after trying to get into better physical and mental shape by losing weight (she had 60 pounds to lose) and finding herself fighting carb cravings like crazy, she realized something else was going on. In addition to the cyclical blue mood that came and went like clockwork, it was a whole constellation of symptoms—distractibility and irritability, carbohydrate cravings and winter weight gain—that rang a bell in Barnett’s brain.
When she hopped online to do the research, bingo: Her symptoms all pointed to SAD. She went to see her primary doctor, who went on the CDC website to confirm the diagnosis.
But what to do about it? Exposure to light helps, though moving to a sunnier climate (Vegas, anyone?) is not an option for everyone. Psychotherapy and antidepressant meds also can be useful. But Barnett didn’t think she had any issues warranting therapy, and she didn’t want to take Prozac, which is what her doctor suggested.
“I wanted to try the holistic approach,” she says. That’s what led her to the light box. She first tried to get insurance to pay for it, but when that proved tricky, she found one online for about $300. Bada-bing. Simple, effective, and cheaper and safer than prescription drugs, artificial light therapy seems too good to be true, which may be one of the reasons many mainstream primary care docs don’t prescribe it, suggests psychiatrist Mark Servis, M.D.
A strong advocate of light therapy, Servis admits even he initially was skeptical of what sounded at first like a “magical” solution. “Doctors are trained to be skeptics, and in psychotherapy you get a lot of quack kinds of therapies that are plentiful in the media,” says Servis, a professor of clinical psychiatry and vice chair of UC Davis’ Department of Psychiatry and Behavioral Sciences. “As doctors, we’re supposed to be very sophisticated consumers of therapy—winnow out the things that are crazy from the things that truly work.”
The rampant skepticism has had an unfortunate upshot, says Servis. “I believe light therapy is terribly underutilized treatment. And that’s a shame.”
Light therapy is not effective for those with other forms of depression, he cautions. But for patients with true SAD, Servis says, “it’s a no-brainer that you would try this first.” While some are not good candidates for light therapy, including those with eye conditions such as macular degeneration, it can be used safely and effectively by the vast majority, says Servis.
Still not convinced? Get this: Light therapy, used properly, has been found as effective as antidepressants in treating SAD. In one of the few studies directly comparing the two treatments, 96 patients were randomly given either light therapy plus a placebo capsule or a placebo light treatment plus 20 mg of fluoxetine (Prozac) a day. The conclusions, reported in The American Journal of Psychiatry in 2006, were clear: All patients showed overall improvement with time, and there were no significant differences in outcome. But light therapy provided faster results, and antidepressants were associated with more adverse side effects, including agitation, sleep disturbance and palpitations.
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