a special program of the National Emergency Medicine Association (NEMA)

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Week: 601.7

Guest: Dr. Gordon Wallace, (former NIH) light therapy expert, Bio-Bright Inc.

Topic: Seasonal Affective Disorder/Winter Blues

Host/Producer: Steve Girard

NEMA: The weather's gotten cold, you go to work when it's dark and come home when it's dark...you're pretty much living indoors, and what proves it is that you know the last several Jeopardy weekly champions. Yep, it's winter. And you feel it very deeply, in fact, you are tired more than usual, you're not eating the same, and you're really down. Is it a natural thing? Or is it something that adversely affects your life each year at this time? Do you tell yourself, "This is just the way winter is". ? Today we're addressing the Winter blues and some things you may be able to do to overcome it...with Dr. Gordon Wallace, a former sleep expert with the National Institutes of Health, and now a consultant to a company that makes light therapy products. Dr. Wallace, what makes Winter Blues, or Seasonal Affective Disorder unique?

WALLACE: Seasonal Affective Disorder differs from non-seasonal major depression primarily by vegetative signs and symptoms...and these are: craving for carbohydrates, hypersomnia...wanting to sleep a lot. Or as with non-seasonal major depression, a lot of people suffer from insomnia. This desire for carbohydrates leads to carbohydrate stuffing, weight gain...obesity. And these are some signs and symptoms that can distinguish the syndrome the problem, from non-seasonal major depression. Of course, the fact that it is seasonal, and occurs seasonally...and that's part of the definition and the diagnosis, is that people suffer this more than one season, and it is seasonal.

NEMA: The signs of major depression...having trouble getting motivated, interpersonal problems, problems at work, even family problems...those can be major signs of depression. Those can also be included in SAD too, right?

WALLACE: That's true indeed. And a lack of energy is prominent or dominant. There's a clinical spectrum with this, like there is with most disorders. And the people that are seriously clinically depressed with Seasonal Affective Disorder....perhaps around 10 % of the population at this latitude. There's a lot of other people who do not have these serious symptoms, particularly major depression, whereby they would see a therapist or a physician. A lot of people, during the wintertime, with what we call Sub-Syndromal SAD, or S-SAD...and these people just do not function as well during the wintertime. they're not as productive, they sleep more, they're more lethargic...and these people can also benefit from light therapy, which is the choice of therapies for treating Seasonal Affective Disorder.

NEMA: When did we start to use light as a therapy, either to prevent a beginning form of SAD from worsening, or to use as part of overall therapy for someone with full blown SAD?

WALLACE: It dates back to the early 80Õs, and when people, the scientists at the National Institute of Mental Health saw one patient in particular who had kept a long record of his problems ... and they were seasonal, and that kind of opened the door, and they did a lot of very good, pioneering research work. And came up with light therapy. And patients with Seasonal Affective Disorder - probably between 70 and 80 percent - will respond to bright light therapy, and therefore do not have to be on chemotherapy. Some patients will respond to light therapy but will need some backup like chemotherapy. But by and large, people with this problem...if it's properly diagnosed, do respond to light therapy, and they don't have to be on chemotherapy. Which most people prefer, obviously, and also it's much less expensive than having to stay on chemotherapy for long periods of time. Also, people respond much more rapidly - just within a few days - so they can actually, if they're aware of their problem, they can actually prevent it with light therapy in the fall. Whereas with chemotherapy, it takes four to six weeks for people to respond, if they're going to respond.

NEMA: Does someone with sub-syndromal SAD...or full blown SAD for that matter, stand a pretty good chance having it diagnosed by their GP? I mean, are physicians up to date on the disorder?

WALLACE: It's embraced by the General Practitioners that are aware of the literature on Seasonal affective Disorder, SAD & Sub-SAD, and light therapy. It's very firmly established medically and scientifically now. A few years ago, there were raised eyebrows..."alternative medicine", and that sort of thing. But now, It's well accepted, well established by those who are aware of it. There is still some educational efforts that need to be done, particularly with General Practitioners, but the psychiatric community, by and large, is aware of it and uses it.

NEMA: Can this therapy help in regular, non SAD cases?

WALLACE: Something that is interesting That's developing now is the use of bright light to treat major non-seasonal depression. Bio-Brite supported a trial, done in California, that was done during the Summer and the Spring to rule out Seasonal Affective Disorder, in non seasonal major depression in women. It was a nicely done, controlled trial. The light source for our trial was our Light Visor, and the data is very promising from that trial. The number of people who responded, about the same level as people that would respond to drug therapy. There's been other, small studies done here and there...and when you put it all together, I think light therapy looks very promising for treating non-major seasonal depression, or as an alternative treatment to drug therapy. There is a seratonin connection, and as You're well aware, on the treatment for depression...one of the major treatments now...is seratonin reuptake inhibitors, enhancing the affectivity of seratonin That's already there. And the drugs do that, they increase It's level. But light seems to have an affect too, in enhancing seratonin, which is as you know, a very important, major neurotransmitter.

NEMA: Yes, and if you can get something naturally, it sounds sensible to take that path first.... 

WALLACE: Most people don't want to take drugs unless they have to. I think the other...there are other applications for bright light. For sleep disorders, for example, "dawn simulation" has been investigated clinically with some good, control trials. In fact, dawn simulation...That's simulating dawn in your bedroom with gradually increasing bright light...has been shown to have some efficacy for treating SAD. Particularly for less severe SAD, like the sub-syndromal SAD that we talked about a minute ago. So, that is something that I think is quite exciting, and continues to be investigated, and I think it will have a lot more application. For people who have this problem during the winter...and they oversleep - Also we found that in adolescents who have real problems getting up in the morning, just waking in the morning...dawn simulation with our Sunrise Alarm Clock, for example, is a much more effective way for them to awaken. Physiologically, dawn simulation does suppress melatonin, changes the pattern of sleep, and allows one to wake up from a light sleep, instead of a deep sleep...such as when You're jarred out of bed by a loud sound. So I think this is something that people are going to be more and more interested in using. 

NEMA: And there's a product out there that provides light therapy on the run, right? 

WALLACE: The visor light is fixed close to the eyes, so it does not have to have as high intensity. We don't say it's more effective than the light box, but it's more efficient than a light box. So, it does allow a person who needs that mobility...as you know, it's battery operated - they can, in 30 minutes...most people do respond to about 30 minutes of light in the morning with the visor. So, they can do what they need to do: get the kids off to school, work at the computer, get ready for work...whatever, and be mobile and not stuck in front of a light box if that's the problem. 

NEMA: And the intensity of a light that close to your eyes isn't a problem? 

WALLACE: it's not a problem, unless you're operating in a dark room, walking around in a dark room. If you're in a normally lit room, it's not a problem for most people. You can still be mobile, get around and do most usual activities.

NEMA: Dr. Gordon Wallace, scientific consultant for Bio-Bright, Inc. of Columbia, Maryland. One thing we should say right now...you don't need what's called "full spectrum" lighting to handle bouts with the Winter Blues. "Full spectrum" light of course, has Ultraviolet rays...which we don't need in the light therapy...you'll see it in tanning salons...but not in Winter blues.

Finally, let's get a little checklist of Seasonal Affective Disorder symptoms:

  1. For several years, this has been a Winter phenomenon, and clearly breaks in the Spring...  
  2. Am I having difficulty sleeping. either not getting enough sleep, or sleeping a large amount of time. sleeping 14 hours instead of 8.
  3. Am I losing interest in my hobbies or my friends or my social activities?
  4. Is my concentration impaired in any way? 
  5. Has my energy level dropped?
  6. Do I feel fatigued?
  7. And how has my appetite changed? People with seasonal disorder may often crave sweets or some other carbohydrates.  
  8. A feeling of pervasive hopelessness, helplessness, worthlessness, and of course, on the worst end of that, feeling like you don't even care whether you live or die anymore.

And that's the time to seek professional help...or for a parent or friend who notices these changes to intervene.

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362. 

NEMA: Thanks for joining us for today's program. If you have any comments or suggestions, contact this station. Or visit our home page at: www.nemahealth.org/ ...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.