DBSA-NOVA      July 19,2007

This is a recap of a free talk entitled "SAD: Light Therapy and Beyond" by Norman E Rosenthal, MD., on September 6 at George Washington University Hospital.

Light therapy is as effective as antidepressant therapy.  Light therapy helps "normal people" feel better, too.

In Seasonal Affective Disorder, SAD, there's a pattern of fall and winter depressions.  Spring and summer tend to be nondepressed.  No recurring social or psyhological reason explains the recurrent winter depression in SAD.

Adolescents  and children are sensitive to light, too.  After puberty, prevalence of SAD in young people reaches adult levels.

SAD triples after puberty in girls.  Women are afflicted with SAD at a ratio of 3:2 with men.  Women in their reproductive years are the most sensitive to changes in light.

Depressions are long lasting...up to five months with this condition!

Wellbutrin XL given in advance of symptoms has been proven effective against SAD.  Wellbutrin is FDA approved for SAD now.

During Dr. Rosenthal's decades researching SAD at NIMH, 1979-1999, he was pleased to recruit 600 patients.  Now SAD research at NIMH is shut down.  Government funding for SAD research has shriveled. 

In the last few years with pharmaceutical companies backing him up, Rosenthal recruited 2000 patients.  At NIMH, it took him 3X as long to recruit a fraction of that number.  Money matters.

Seasonal depression is widely unrecognized even by experienced clinicians.  It is underdiagnosed and undertreated in spite of tremendous media attention.  Seasonal depressions tend to be atypical...not only about sadness and anxiety. Symptoms may include:

Dr. Rosenthal and colleagues at NIMH developed the SPAQ, Seasonal Pattern Assessment Questionnaire.  Part of it is on Dr. Rosenthal's website:  http://www.normanrosenthal.com/winter_blues_2.shtml

Light therapy is fast acting.  Marked effect on mood occurs in 3-4 days.  Absence of light therapy produces equally dramatical effects.  Within 3 days of stopping light therapy, mood goes down.

Light is coming in through the eyes and not the skin according to Dr. Rosenthal's research. 

People do tell him that going to a tanning salon brightens mood.  He hasn't studied tanning booths, but worries about skin cancer there.

Dr. Rosenthal warns that homemade light boxes may be too bright and cause eye damage.

For the light to work, it's all about timing (morning is best), intensity, duration, wavelength, anatomical route (eyes).

Experimentation is necessary.  Some individuals need hours of light.  Some need light in the morning with a boost of light in the afternoon.  Using a light box in the evening may cause insomnia.

Bigger is better when it comes to light boxes.

Changing the kitchen light fixtures to full spectrum bulbs won't offer the level of intensity needed for therapy.

The new, small blue lights sold by Costco haven't been adequately tested.  Though the price is right, the blue light may damage the eyes and may or may not brighten the mood.

People with diabetes with advanced damage to the retinas of their eyes need to be careful with light therapy.  The same is true for those with cataracts or macular degeneration.

Dawn simulators were found to be effective in SAD.

Dr. Rosenthal is embarking on a new study of bipolar depression using light therapy and ion therapy.  He offered his phone number (301) 770-7375.  Study participants stay on all their meds.  The only change is to add light and negative ions.  He's recruiting patients in several areas across the country for this study: Portland, Oregon, Dayton, Ohio, Baltimore, Maryland, Washington D.C., New York, New York. 

Negative ions are found in nature near waterfalls and pounding surf.

Positive ions are found in the Santa Ana wind for example. 

Depression is complicated involving multiple neurotransmitters, circadian rhythms, etc.

Dr. Rosenthal became interested in studying light when he noticed that the length of the day is important for other animals.  He found that length of day strongly influences the behavior of life forms from algae to humans.

People with SAD seem to be more sensitive than others to light (are we more primitive?  lol).  SAD sufferers possibly have less sensitive retinas.

The most creative, sensitive people are seasonal.  [Dr. Rosenthal himself is seasonal.] 

Dr. Rosenthal lightened up and began talking about creativity.  He quoted this poem:

There's A Certain Slant Of Light
by Emily Dickinson

There's a certain slant of light,
On winter afternoons
That oppresses, like the weight
Of cathedral tunes.
Heavenly hurt it gives us;
We can find no scar,
But internal difference
Where the meanings, are.
None may teach it anything,
'T is the seal, despair,
An imperial affliction
Sent us of the air.
When it comes, the landscape listens,
Shadows hold their breath;
When it goes, 't is like the distance
On the look of death.

He showed the Edward Hopper painting, the sunbathers, on a slide.  Looks like this: http://img.photobucket.com/albums/v642/shakespeares_sister/peopleinthesun.png

He poked fun at an old advertisement for lithium that boasted lithium would've reduced composer Frederic Handel's symptoms.  The ad explained that Handel composed Messiah in twenty-three days one summer.  Dr. Rosenthal quipped we should all have "symptoms" like Handel.

Dr. Rosenthal had several slides of Vincent Van Gogh paintings to graphically contrast the artist's moods at different lattitudes in different seasons.  Dr. Rosenthal quoted from Van Gogh's letter to his brother Theo written in winter from Nuenen in the Netherlands:

I've hardly ever begun a year with a gloomier aspect, in a gloomier mood, and I do not expect any future of success, but a future of strife.

It is dreary outside, the fields a mass of lumps of black earth and some snow, with mostly days of mist and mire in between, the red sun in the evening and in the morning, crows, withered grass, and faded, rotting green, black shrubs, and the branches of the poplars and willows rigid, like wire, against the dismal sky. This is what I see in passing, and it is quite in harmony with the interiors, very gloomy, these dark winter days.

Here's another letter from Van Gogh written in summer from Arles in the south of France:

Now there is a glorious fierce heat, a sun, a light which for want of a better word I can only call yellow, pale sculpture yellow, a pale lemon gold.  How beautiful yellow is. 

Life is almost an enchantment.  Those who do not believe in the sun here are without faith!

Dr. Rosenthal took questions from the audience.

Dr. Rosenthal said something about a benefit of taking beta blockers in the morning.  I didn't write down the question!

Someone asked how much light is needed.  Dr. Rosenthal says it varies considerably by individual.  Some people need hours every day. 

I asked Dr. Rosenthal why do insurance companies refuse to help pay for light boxes after decades of proof that these lights work.

Dr. Rosenthal replied, "insurance pays for what they have to pay for and not for what works."  Light therapy can't be patented.  Big pharmaceutical companies have the money to pay for the type of drug trials required by the FDA.  Light box manufacturers do not have that kind of money.  Dr. Rosenthal has applied for FDA approval of light boxes.  He was turned down the first time, but he's thinking about trying again. 

In Winter Blues, Dr. Rosenthal offers some sample letters to send to insurance companies seeking reimbursement.  Kathy Colvin was reimbursed for her light box back in the 1980's by her insurance company on the strength of Dr. Rosenthal's letter.

Dr. Rosenthal spoke about the connections between mood disorders, creativity and the seasons.

He complained that much of the continuing education of doctors in this country is coming through pharmaceutical companies.

Dr. Rosenthal says the  light boxes should last forever, but that bulbs burn out wattage  in 2-3 years and must be changed.

He recommends this website of the center for environmental therapeutics for purchase of negative ion generators:  http://www.cet.org/

He recommends a field trip to SunBox in Gaithersburg, Maryland to check out light boxes: www.sunbox.com, (800) LITE-YOU

In conversations prior to the talk, Dr. Rosenthal suggests a low carbohydrate diet for people with SAD particularly when cravings for carbs are high.  Fight the cravings for more energy and a better mood, he suggests.

-- Jayson Blair, DBSA-Northern Virginia