- The Washington Times - Monday, November 21, 2005

Neal Owens’ on-the-job sales productivity declined as the autumn days shortened.

The Gaithersburg resident was a highly productive employee during the spring and summer, but in winter, he felt lethargic, ate and slept more, and couldn’t figure out why.

Mr. Owens contacted the National Institute of Mental Health (NIMH) in Bethesda in the early 1980s, believing he might have the then-newly identified seasonal affective disorder (SAD), a type of depression associated with a change in season and length of day.

The researchers allowed Mr. Owens to borrow one of their light boxes, which provides artificial light that mimics sunlight to lessen SAD’s symptoms, but the agency would not let him keep it. When he found out he could not buy a light box commercially, he made his own.

“I can enjoy the holidays. I can get up easier. I can maintain my weight,” Mr. Owens says. “It’s given me months back into my life.”

NIMH soon began sending referrals to Mr. Owens for his light box. He received so many orders, he decided to quit his sales job and founded the SunBox Co. in 1985 in Gaithersburg.

“We can trick our bodies with therapeutic bright light to make our bodies think it’s summertime,” says Dr. Daniel Z. Lieberman, associate professor of psychiatry and behavioral sciences at George Washington University Medical Center in Northwest.

The prevalence of SAD increases with higher latitudes and affects about 4 percent to 6 percent of the U.S. population, area physicians say. SAD affects more women than men, at a ratio of 4-to-1, the same as with depression, and affects mostly adults, they say.

The symptoms of SAD typically begin in the fall, as early as September, and continue through the winter months, typically ending in April, Dr. Lieberman says.

SAD also can occur with a seasonal change to warm weather in the summer months, says James Radack, senior vice president for public affairs for the National Mental Health Association, a mental health organization in Alexandria that provides information and support about mental health issues.

“We’re all affected by changes in weather and changes in the season. Some people are more profoundly affected,” Mr. Radack says.

A milder form of SAD is the winter blues, says Dr. Teodor Postolache, associate professor of psychiatry at the University of Maryland in Baltimore.

“With winter blues, you might not have the same degree [of] impairment in function,” Dr. Postolache says.

Winter blues affect about 15 percent of the population in this latitude, he says, compared to SAD, which affects about 1 percent to 5 percent. Both SAD and the winter blues have biological causes, while the holiday blues have psychosocial causes, he says, resulting from a realization of loss and comparisons with people who appear to be happy.

SAD’s symptoms are nearly the same as those for major depressive disorder, including a depressed mood, loss of interest in daily activities, feelings of worthlessness and hopelessness, loss of energy, irritability and decrease in concentration.

SAD interferes with functioning to a significant degree, and the winter blues interfere to a mild degree, Dr. Norman E. Rosenthal says in his book “Winter Blues.”

The winter blues last less than two weeks and cause a slight decrease in energy, says Dr. Rosenthal, clinical professor of psychiatry at Georgetown University Medical Center and a former NIMH research team member who coined the acronym for SAD.

“People begin to fail in the important areas of their lives. Their work suffers. Their relationships suffer. They withdraw,” he says about SAD.

In other ways, SAD is unlike depression, which can cause difficulty in sleeping and a decrease in appetite. SAD instead increases the need for sleep, increases appetite and causes a craving for sweet and high-carbohydrate foods.

Carbohydrates eaten in large amounts can boost the neurotransmitter serotonin and may provide temporary relief for those with SAD, Dr. Lieberman says. The exact cause of SAD, however, is not known, he says.

SAD may be associated with melatonin, a hormone that responds to daylight hours and regulates the sleep-wake cycle, he says. Light boxes provide a high-intensity light that affects the release of melatonin, he adds.

“The bright light doesn’t work for everybody. We don’t know why some people respond and some don’t,” Dr. Lieberman says.

When phototherapy or bright-light therapy works, however, it works quickly, usually within a couple of days, says Dr. Boglarka Szabo, a psychiatrist at Johns Hopkins Hospital in Baltimore.

“Light therapy should be used the same as medication is used, with the guidance of a physician,” she says, adding that light therapy, which should be free of ultraviolet rays, can have side effects such as irritability, nausea and headaches. Patients start with 15 minutes of light-box use a day and work up to 30 minutes a day, she says.

Patients, however, need to be dedicated to using the light box, says Dr. Joseph Schwartz, clinical director and vice chairman of the psychiatry department at Howard County General Hospital in Columbia, Md.

“People aren’t always able to fit it into their busy schedules,” he says.

Antidepressant medication and cognitive behavioral therapy are other options for treating SAD. Cognitive behavioral therapy teaches exercises and strategies to correct the distorted negative thinking that can come with depression.

“It has to do with light, but it also has to do with the severity of winter,” says James Olds, director of the Krasnow Institute for Advanced Study’s Center for the Study of Neuroscience at George Mason University in Fairfax.

People who live on the equator or in higher latitudes in Europe, which benefit from the more temperate winters caused by the Gulf Stream, are less likely to manifest SAD symptoms than those living in higher latitudes in the United States, says Mr. Olds, who holds a doctorate in neuroscience.

SAD may be explained from an evolutionary point of view, Mr. Olds says. In caveman times, women reduced their energy use in the winter months, when crops were less available, so the energy they did consume would help them give birth to healthy babies in the spring, he says.

“We have this legacy hardware leftover from when we were hunter-gatherers,” Mr. Olds says.

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