Finding a cure for the winter 'blahs'

Termed Seasonal Affective Disorder (SAD), this malaise is triggered not by the frigid temperatures or piles of snow or even holiday stress, but by the shortened days that start before winter begins.

"Seasonal affective disorder is not the best name for it," said Dan Oren, an expert on SAD and member of Yale's Department of Psychiatry. "It seems to be light deprivation disorder."

First documented in the medical literature about two decades ago, SAD has likely afflicted people ever since humans started hunkering down inside in the winter, cutting whatever exposure to natural daylight we could hope to get.

Clinical psychologist Lois Levin just suffered through the symptoms -- a tendency to oversleep as the winter progressed and an intense yearning to visit Costa Rica. Then, about a decade ago, she tried a light box.

"I had a real `a-ha' experience," said Levin, an instructor in Harvard's psychiatry department. "It cures the blahs. . . . It's the same experience you have if there's been a cloudy or rainy day and then the sun starts coming out."

Levin liked the device so much, she started selling them mostly through word of mouth. Six years ago she formed the Lightbox Company of New England to produce boxes that emit strong light without ultraviolet radiation.

In New England, where days are short, an estimated 5 percent to 8 percent suffer from the full-blown disorder and another 17 percent to 20 percent endure a less severe form of the syndrome.

SAD can manifest itself in a variety of ways; a person might have mood swings, depression, feel suicidal, or experience a drop in energy and or a change in sleeping patterns, often craving sleep and finding it difficult to struggle out of bed each morning. Some people will stack on weight, with a decided craving for carbohydrates.

But the signature symptom for the disorder remains its timing. People with SAD experience the onset of the depression sometime late in fall or early in the winter. These persist through the winter months and then disappear in the spring.

"It's more than just an attitude about winter. It's real changes in the body," said Janis Anderson, director of the Seasonal Affective Disorders clinical service at Brigham and Women's Hospital. "While scientists don't yet know exactly what mechanisms lie behind SAD, some suspect that the lack of light may trigger an overproduction of the hormone melatonin, which encourages sleep. Light exposure, then, counteracts this process by resetting the body's clock.

Though the light box "cure" sounds simple enough, it's not as easy as plopping down in front of a lamp and waiting for the blues to turn to pink. Different people have different light requirements, though most people appear to respond best to using their light box in the morning, experts say.

"The three basic dosing dimensions of light therapy are the intensity of light, how long you use it, and the time of day you use it," said Michael Terman, director of the Winter Depression Program at the New York State Psychiatric Institute at Columbia University Medical Center. "All of these parameters need to be juggled for optimizing an effect in the individual."

Light therapy cures about 80 percent of people diagnosed with SAD. Other remedies include anti-depressants, which appear to work as well. Early dawn simulation in which a low-level light mimics a rising sun and turns on while you sleep can also help, Terman found in a recently completed trial of about 150 patients.

Light therapy can have side effects, too. Too much light can lead to headaches, early-morning insomnia, or the jitters. About 5 percent of people report a mild queasiness.

Children can have SAD, but often escape diagnosis, says Carol Glod, director of developmental studies at McLean Hospital in Belmont. Because school stress ramps up when daylight diminishes, parents may attribute warning signs to external factors.

Grade patterns can serve as a clear indicator that something's amiss, Glod said. If a child typically starts out doing fine in the fall, dips mid-winter, and then "turns around" in the spring, parents should pay closer attention.

"This is a form of depression. If it's not recognized or treated, it may continue every year. Usually it does not get better and at times it can turn into a year-round depression," said Glod, a professor of nursing at Northeastern University.