light therapy..Yes or no?

September 28, 2005 5:41 PM

Seasonal Affective Disorder - real or nonsense? If real, what about light boxes?

I spend a lot of time in my office with no windows and fluorescent lighting. Don't really like hot weather and stay out of the sun even in the summer but when fall comes along, I do get crankier and depressed. It's not the work; I like what I do.
Got any experience with these light boxes & lamps and any product recommendations?

posted by lois1950 to health & fitness (34 comments total)

It's real. I have it along with my other issues.

I can't help with the recommendations but I would go to the about.com forums (either the bipolar one or the depression one) and either site should have suggestions.

Till then bite the bullet and go outside at lunch if you can.
posted by konolia at 5:49 PM on September 28, 2005

It could just be the flourescent flicker that makes you feel bad. I get very tired at work, and I'm pretty sure it's the flourescents. If you can, just bring incandescent desk lamps in to work, and use them to light your office rather than the overheads.
posted by odinsdream at 5:51 PM on September 28, 2005

It's real, but is classified as a "subtype" of other depressive disorders (unipolar and bipolar) according to the DSM-IV.

UpToDate suggests that there have been few well-designed studies on light boxes, but concluded that they probably do show efficacy. Exerpted from the treatment section:

Administration — Light therapy involves exposure to visible light that produces a minimum of 2500 lux at eye level. Early studies used a two-hour session of 2500-lux exposure, but subsequent studies have found that 10,000-lux for 30 minutes per day is equally effective

...

Light therapy is initiated with a 10,000-lux box. The patient's eyes should remain open throughout the treatment session. Staring directly into the light source, however, is not advised. Treatment is started with one, 10 to 15 minute session per day, gradually increasing the session's duration to 30 to 45 minutes, depending upon response. Sessions should be increased to twice a day, if symptoms remain unresolved or worsen. Although there is no apparent reason for limiting the duration of sessions if the side effects are not severe [38], ninety minutes a day remains the conventional daily maximum duration of therapy.

To reduce risks associated with poor quality construction, commercially available fixtures are recommended over homemade devices. Fluorescent light is preferred over incandescent, primarily because the small point source of the latter is more conducive to retinal damage. In addition, patients are advised to seek fixtures with features designed to protect the eyes such as light dispersion and screens that eliminate UV rays. Contrary to initial belief, "full-spectrum" light is unnecessary. Intensity, not spectrum, appears to be the critical factor in attaining an antidepressant effect [35].

The optimal time of day for light therapy has not been established. Some studies have reported that morning sessions produced better outcomes [31,39], while others have failed to show any significant difference between times of administration [40,41]. Convenience should dictate the decision since there are no clear indications supported by controlled data.
posted by NucleophilicAttack at 5:52 PM on September 28, 2005

Oh it's absolutely real - suicide rates in areas north of the arctic circle where they have 24hr darkness in winter are particularly high.

I know that iGuzzini make lights to counter this, and I'm sure Philips do to, but you'll have to take a look around....
posted by forallmankind at 5:54 PM on September 28, 2005

I would love to hear first-hand experiences with different makes/models of these lightboxes.
posted by Jairus at 6:11 PM on September 28, 2005

Here is a nice article about Vitamine D(s). Florecent lights and other natural light depravation can a decres the bodies absorbtion of 'stuff' in light that makes vitamin D(s).

I personally expirence decresed NRG and fatiege if I do not get enough natural light. I will be talking to my psycologist to see if a light box can be submitten under my insurance.

The actual light boxes I have been shown and told about that are made for SAD are the only lights I have heard that do the expected job.
posted by johnj at 6:49 PM on September 28, 2005

...I have used Philips 'Natural Light' bulbs. They are nicer quality of light but I do't think they emit the necessary UV intensity.
posted by johnj at 6:51 PM on September 28, 2005

Another vote for real. When I lived in northern Norway as a child, my mom not only suffered from severe depression during the sunless arctic winters -- she also had physical changes to her menstral cycles. You want a real light box to counter SAD.
posted by croutonsupafreak at 6:53 PM on September 28, 2005

lois,

I can attest to the experiences of two patients with severe, intractable depression whose response to light therapy was phenomenal. I can't tell you that I know much more, but SAD is definitely something real.

Check these guys out.

I think that's who one of the local psychologists has recommended.
posted by docpops at 9:02 PM on September 28, 2005

Then again, I (retrospectively) am more depressed during summer and spring than during autumn or winter. Maybe I just hate it when people around me are chipper.

/liking the Autumn weather now that it's here
posted by PurplePorpoise at 9:06 PM on September 28, 2005

How do they do placebos when studying light boxes?
posted by smackfu at 9:27 PM on September 28, 2005

kind of related,a cure for jetlag ,shine a flashlight, behind your knees! strange as it sounds, and there is this
posted by hortense at 10:08 PM on September 28, 2005

Is there any way for a layperson to distinguish between SAD and just feeling sad during the winter?
posted by box at 10:40 PM on September 28, 2005

Normal sadness comes and goes; depression, including SAD, sets in like concrete. There are hundreds of online depression tests that you can take to evaluate how severe a jag is. (The best-known clinical self-evaluation is the Beck Depression Inventory, but it's under copyright. You can find simplified versions in some books, e.g. Feeling Good by David Burns, the bible of cognitive therapy.)

If you've ever had Major Depression, then self-testing is an essential procedure, and distinguishing between depression states that are manageable and not manageable is a skill you develop over time.

How do they do placebos when studying light boxes?

Non-medicative therapies require different procedures. Efficacy of different therapies can be compared against each other.
posted by dhartung at 11:27 PM on September 28, 2005

If you do suffer from SAD, perhaps a task lamp at work will lessen your symptoms. Googling "SAD lamp" turned up a number of sites, including this one. Can't vouch for such lamps, but may be worth a shot.
posted by rob511 at 1:33 AM on September 29, 2005

As dhartung mentioned, the Beck DI is under copyright, and cannot be downloaded freely and legally.

Interestingly, Google indexes a few dozen pages on the subject.
posted by Jairus at 2:34 AM on September 29, 2005

Something still smells fishy about SAD.

Do blind people get SAD -- do they have it all the time from not seeing light, or do they get it seasonally because it has something to do with light on the body? Can sighted people wear light goggles, maybe even glasses that emit enough safe, low-level light all day to prevent SAD? Or if it needs to be full-body light projection, why? What is the light doing to my skin? Is it a vitamin D deficiency we're talking about (and could you then just take a pill instead of sitting under a light)? Or is it a lack of warmth that could be made up for by turning up the heat or wearing a good sweater? What is the proposed mechanism behind the idea that light prevents depression and lack of light causes it?

And about the depression and suicide rates in the Arctic Circle during the winter -- is it certain that people are not bummed out about being locked up together all winter in a cold place with little to do and nowhere to go because it's too cold and snowy to go outside? Because light or no light, I think I might get a little crazy in such circumstances.
posted by pracowity at 4:13 AM on September 29, 2005

I spent a year in Gothenburg, Sweden, where there's plenty to do year round, and I could feel (and see in others) the effects of having such short days in winter that you see no sun during the week if you work or go to school. Even when it's not severe, the short temper and lethargy are a grind. It wasn't even particularly cold that year, and it was dry, but I was still starting to feel a little unleashed by February.

I'm far away from windows at work and often don't leave until dark, and I use lamps instead of the harsh overhead lights in my office. I've been switching my bulbs over to natural light compact fluorescents and can tell a difference. Other people in the office have Ott lamps (quilters use them so they can see colors true). You can get full-fledged vitamin D type bulbs at pet stores (certain reptiles require them), but they also get really hot so I wouldn't want to use one in close quarters.

If you think using a lightbox will help, absolutely look into it, but make general environmental changes to imitate natural light wherever you can.
posted by Lyn Never at 5:51 AM on September 29, 2005

IMHO this is one of those times that whether it's "real" (i.e. has a firm basis in scientific fact) or not, if a lightbox makes people who are depressed in the winter feel better, then they should use it.

Few things worse than sitting at home alone being depressive during weeks when its dark at 4:30.
posted by softlord at 5:51 AM on September 29, 2005

IMHO this is one of those times that whether it's "real" (i.e. has a firm basis in scientific fact) or not, if a lightbox makes people who are depressed in the winter feel better, then they should use it.

But if it's not doing more than a placebo pill would do (yes, I've read recent reports about placebos) but companies are selling special expensive light boxes and telling people that inexpensive normal lights and a vitamin tablet won't do the job, depressed people who are desperate to feel better may be being unnecessarily separated from their money.
posted by pracowity at 6:20 AM on September 29, 2005

Seasonal affective disorder is real and is linked to secretion [or lack thereof] of the hormone melatonin which is all tied in to pineal gland activity. Here's some links

- A National Institute of Mental Health [US] study on treating SAD.
- the explanation of the biological roots of SAD from the American Medical Association
- The Mayo Clinic talks about light therapy
- this interview suggests that blind people also have circadian rhythm disturbances and sleep disorders, often more than sighted people though it doesn't specifically talk about them and SAD. I've read anecdotally that people with even partial sight still have pineally-established cicadian rhythms which would seem to imply that they also grapple with SAD.
- This article, though mostly about pineal gland stuff, has a bibliography that points to other good articles that relate melatonin and light exposure to mood.
posted by jessamyn at 6:57 AM on September 29, 2005

I rented the silverlite from here one winter and I felt like it made a real difference - I came away from the light each morning with that kind of deep feelgood glow that you get from sunbathing (without the skin cancer), and my better mood seemed to last through the day.

But I was also aware of various other factors which may have been a part of my improved mood:

1. By the time I realised I felt crappy, thought about it, and rented the box, I was half way through the winter, so before long it was getting light again anyway, albeit still not very light. You should apparently start with the light as soon as the nights start to draw in, even if you feel fine.

2. I'm terrible in the mornings, and when I had the box my mornings were much more pleasant generally: I got up a wee bit earlier to give myself 20 minutes in bed with the box on, made myself a fruit smoothie the night before and sat it in the fridge so I could sit and drink it and listen to the radio with the light on, instead of skipping breakfast. It was all in all a much happier way to enter the world every day.

3. The inevitable boost out of depression that comes from taking active steps to help yourself.

If you're trying to choose from the big range available, the time taken to give a 'treatment' is a big factor - brighter lights which work much faster are more expensive. Size, portability and aesthetics are also important factors to consider for something you're using every day for several months. Most places will let you hire them out for the winter months and ship them to you - you pay the return courier costs in the spring. IIRC, with The National Light Hire Company, if you subsequently buy one, some or all of the hire costs you paid will be taken off the purchase price.

If you're in the UK, you can sign a self-certification form to say it's for medical purposes and it's tax free.

I don't know where you're located, but I would definitely recommend the company, they were very helpful, human, and efficient.

The only reason I haven't gone back to them is that I moved somewhere with a much sunnier winter than the UK (yes, people, the Falkland Islands are sunny!)
posted by penguin pie at 7:00 AM on September 29, 2005

Hmm. It doesn't seem to be as cut and dried as some sources quoted above would have it.

From Seasonal Affective Disorder:

Dr. Michael Terman, a psychiatrist at Columbia University in New York, compared light therapy to treatment with high- or low-density negative ion emitters. (His ion machines were working.) He found that light-therapy patients did 30 percent better than those who got the low-density ions. Patients who got high-density ions did just as well as light-therapy patients, indicating that the high-dose ions might also be helpful in treating SAD.

Also, this:

It was once hypothesized that irregularities in melatonin secretion might explain SAD--that is, until it was shown that winter melatonin rhythms do not differ between SAD patients and other persons. [...]

Apparently it is the eyes, not the skin, that mediate the effects of bright-light therapy.

and this:

Phototherapy or bright light therapy has been shown to suppress the brain’s secretion of melatonin. Although, there have been no research findings to definitely link this therapy with an antidepressant effect, many people respond to this treatment.

and this:

The cause of SAD is not known but is thought to be related to numerous factors such as body temperature, hormone regulation, and ambient light. [...]

As with other types of depression, antidepressant medications and talk therapy can be effective. Light therapy using a special lamp to mimic the spectrum of light from the sun may also be helpful.

posted by pracowity at 7:56 AM on September 29, 2005

I have always been dubious of this disorder myself. I've always viewed it as a sort of "disease du jour." So I decided to find out just what the difference in winter and summer were as far as sunlight in reality. I, of course, knew there was a difference in hours of sunlight, but I just didn't know what exactly that difference was.

After finding an astronomical chart I calculated that at 40 degrees North latitude, roughly an average latitude for the northern US (NYC is around 42 degrees). I calculated that at the winter solstice we receive about 9 1/4 hours of sunlight. At the summer solstice 40 N gets 14 1/4 hours of sunlight, a difference of 5 hours per day. So from peak to peak you are getting 35% less sunlight. If you live south of there the difference is less, north, you're getting a bigger difference.

Anyway, take that as you will, I just wanted to report what I found.
posted by Pollomacho at 8:00 AM on September 29, 2005

Well, I didn't believe in SAD until I started charting my moods when I had hard to treat depression. Even on very cloudy days in spring and fall, I droop.

Increasing sources of natural light works best for me, a lightbox is "okay" and better than nothing. I definitely felt better when it was the 80's - early 90's and I was using a tanning bed throughout the winter months, but I stopped that when my sister developed a melanoma. This year, I'm going to try replacing my light bulbs with full spectrum lights and see how that works. I try to cut down on the amount of time away from work that I spend in front of the TV and computer screen.

I can't be outside in high summer either, when the sun is too intense or the temperatures too high. There is something that is called "summer depression" that is related more to excessive heat than the quantity of light. Who knows? I knew something was wrong for years before I knew it had a name, so I wasn't reacting to an article or segment about the "disorder du jour".

With my thyroid complicating all of this (it definitely contributes to my depression and I have to take meds for it), I've always wondered if my body just has a very hard time adjusting to extremes in temperature...almost as if my personal thermostat is "futzy".
posted by jeanmari at 8:16 AM on September 29, 2005

pracowity, the third article you link to is from 1993. The study that many of the other articles refer to [and I updated my link to the AMA article] is based on research done in December 2001 [link goes to abstract] a month after the second article you linked to. I'm not a "Go go SAD exists!" booster, but it does seems that recent clinical studies support it. Delving through the archives, however, there is this article which suggests that light therapy doesn't do better than placebos.
posted by jessamyn at 8:30 AM on September 29, 2005

As to the suicide rates up in the Arctic Circle: I am from the Arctic circle, and let me tell you - the lack of light is only one reason among many to kill yourself during the winter. The Northwest Territories has very high incidences of drug and alcohol abuse, physical abuse, incest, etc, all associated with the isolation. If you want to look at SAD and suicide, you have to take into account the confounding factors.

Not to discount SAD, I (who am normally a very well-adjusted person) went absolutely crazy in the winter. I was over-emotional, I stopped sleeping, I hallucinated, all that fun stuff. I don't know if what I had was SAD, but I know that it went away when the sun came back.
posted by arcticwoman at 9:28 AM on September 29, 2005

It is real. I have it. The best thing I ever did for myself was moving back to New Mexico, after years of forcing myself to live in Portland and New York. Light boxes are a good temporary fix, but eventually I just really needed actual sunshine.
If you have it, or know someone who does remember that it is not you, you are not going actually insane, it is just the season. Even more important than the light boxes is to keep perspective, that this is seasonal, that it will pass.
posted by Sara Anne at 9:36 AM on September 29, 2005

My plan to deal with this is that we are moving farther south (DC to Austin) - the long days are longer in DC, but the short days are longer in Austin.

Also, fewer rainy and cloudy days, according to Weatherbase.com (DC, Austin):

                                            DC       Austin
Average Possibility of Sunshine             56%        60%
Average Number of Clear Days                97        116
Average Number of Cloudy Days              163        135
Average Number of Partly Cloudy Days       105        114
Average Number of Rainy Days               112         84

posted by Irontom at 9:39 AM on September 29, 2005

Pollomacho, I believe it also has a lot to do with the strength of light in different seasons as well as the duration, so the difference at the latitude you give is actually much greater than 35%: summer sun is stronger than winter sun - in places that you wouldn't worry about getting burnt if you went outside for an hour on a sunny day in December, you would definitely slap on the sun screen if you did the same thing in July.

Thanks for the figures though, I'd never seen the daylight hours quantified and am mathematically incompetent so would never have bothered to work it out myself.

As for the placebo effect, I tend to think "Who cares?" If I want something to relieve my depression, I don't care whether it's done by the light, or by the sense of optimism and positivity generated by taking treatment that I enjoy.
posted by penguin pie at 9:43 AM on September 29, 2005

As for the placebo effect, I tend to think "Who cares?"

I suppose it depends on how much time and money you have to throw away. These lamps and their replacement bulbs go for quite a bit of money and generally require that you sit around in the light rather than go to work or take care of the kids. If corporations are going to fool you into thinking their products work, it would be nice if they fooled you into thinking something less expensive and more convenient works.

I'm betting light boxes work mainly or entirely as placebos -- they put people in a good mood because they offer a little summery light and warmth in the dark winter and because they make people sit still in the morning and take care of themselves instead of running around worrying about everything and everyone else. Melatonin or no melatonin, that sounds like a potential way to cheer up sad (if not SAD) people.
posted by pracowity at 12:10 PM on September 29, 2005

Hm. I don't want to see this one run and run, but, since pracowity seems to be saying "You bunch of lazy, gullible twats, you just want an excuse to sit on your arses while the rest of us get on with the serious business of worrying about the world and take up your slack":

generally require that you sit around in the light rather than go to work or take care of the kids

Is complete nonsense: A daily treatment time of around 20 minutes for some of the boxes isn't going to make anyone leave work/bring up a bunch of feral monsters (unlike, say, serious, untreated depression). There are also portable lights in little sunvisory things (which, admittedly, might make you look stupid, but wouldn't stop you going to work/doing laundry/playing with the kids) and plenty which are designed to sit on or around a computer monitor.

Also

they offer a little summery light and warmth in the dark winter...

...that sounds like a potential way to cheer up sad (if not SAD) people

I don't get it - if this is the case, where's the placebo?

Likesay, I'm reasonably convinced but could be unconvinced by evidence (rather than snarking, which doesn't help shed much light (HAR HAR) on the subject).

(Sorry)
posted by penguin pie at 3:41 PM on September 29, 2005

penguin pie, you're overdoing it a bit, don't you think?

You said you wouldn't care if it was a placebo. I responded that if it does turn out to be a placebo, they could have at least made up a cheaper and faster ritual, not one which requires you to purchase fancy lamps and plunk yourself down in front of said fancy lamps while you have other things to do. All the rest, your imagination filled in.

And momentarily cheering someone up ("Oh, isn't that light nice!") rather than treating some underlying medical cause of illness -- that would be a placebo.
posted by pracowity at 11:00 PM on September 29, 2005

*Looks around*

I think we're the only one's left here, pracowity. The janitor's jangling his keys at the door...

See ya later.
posted by penguin pie at 5:56 AM on September 30, 2005