With the shortening of the days and the falling of the autumn leaves…with the scurrying of the squirrels gathering their Winter food supply so they might withdraw to the safety of their nest, so too does the mood of individuals with Bipolar Disorder who are also affected by Seasonal Affective Disorder (SAD), fall.
According to the NIMH (National Institute of Mental Health) approximately 10 percent of Americans have SAD. The incidence is higher in Northern Latitudes and lower in Southern Latitudes. (For example 10 percent in Seattle, WA compared to 1 percent in Los Angeles, CA.).
Individuals already diagnosed with Bipolar Disorder, especially Bipolar II and other depressive illnesses are more at risk for SAD. SAD also seems to affect women much more often than it does men, often beginning in their twenties.
According to the DSMV-IV the essential feature of SAD is its characteristic pattern of onset and remission. In most cases, episodes begin in September to December, with October and November being the most common months for onset. Less commonly there may be recurrent summer episodes. These episodes typically remit in March or April.
Diagnosis of seasonality can be made if there has been onset or worsening of mood within the same sixty-day period in two successive years And
Recovery has occurred within the same sixty-day period in the spring (no later than June) in two consecutive years. (Spring/Summer hypomania or mania may or may not appear)
Symptoms of SAD
· Feeling sad or depressed
· Difficulty concentrating
· Carbohydrate or sugar cravings (often accompanied by weight gain)
· Difficulty waking in the morning
· Sleep disturbance (usually hypersomnia – sleeping too much 2 or 3 hours a day more than usual)
· Social withdrawal
· Reduced productivity
· Feeling worthless, hopeless or guilty
· Reverse diurnal variation of mood (afternoon or evening “slump” as opposed to more severe morning symptoms)
What Causes Seasonal Affective Disorder?
Change in light exposure is the key. The amount of daylight exposure one receives and the changes in sunrise/sunset reducing the daylight hours in the fall affects people with SAD. It is commonly believed that even though the body has natural daily rhythms, they are not precise and depend on the intensity of sunlight for adjustment. The cues for these adjustments originate in the retina at the back of the eye and create signals which pass through the optic nerve to the hypothalmus and set in motion a number of chemical changes including increasing the neurotransmitter serotonin which is necessary for a sense of well being, and regulating and suppressing melatonin, a factor in normal sleep patterns.
Treatment of Seasonal Affective Disorder
It is reasonable to assume that if the lack of light is causing SAD, the replacement of light will solve the problem. This, in fact is the hallmark of the treatment available. Although the individual experiencing it often correctly diagnoses SAD, it is wise to seek the advice of a qualified medical practitioner prior to purchasing a light box or other device for treatment. There may be other illness present, or reason that would contraindicate such therapy. The therapeutic effect of light is sometimes evident within days, but often several weeks are therapy is needed to obtain good remission of symptoms. Individuals with Bipolar Disorder who have noticed a seasonal variation to their mood disorder should bring this to the attention of their psychiatrist.
Light boxes, which are effective in about 50 percent of cases of Seasonal Affective Disorder were the first and still the most researched and accepted method of treatment. Light boxes expose a person to bright light in either the morning or evening. Individuals with SAD sit in front of these boxes every day for varying lengths of time throughout the winter months. Patients with Bipolar Disorder must use light therapy cautiously because it has been known to precipitate a manic episode. Side effects are otherwise generally minor and may consist o headaches, eyestrain, or dryness of the eyes or nasal passages. These side effects respond quickly to reduction of light.
There are many companies who manufacture light boxes. Photo Therapeutics and Light Box Company are just two examples of web sites where you may view light boxes. Many people ask if they can build their own light box and the answer is yes, but only if you are a skilled electrician. For those who do have these skills and the time you can find some guidelines here. Follow your physician’s advice when choosing a light box.
Light Visors are similar to light boxes but are an apparatus worn on the head.
Dawn Simulators are a less known form of therapeutic light. They work by easing the shock of waking in the darkness by slowly turning on your bedside lamps to simulate the rising of the sun, so that when you wake up it is to full light. To see a dawn simulator and other photo therapy lights see Pi-square’s sun-rizer> or go here to make your own
MedicationFor severe cases of SAD antidepressant medication may be prescribed by your doctor. This medication will normally be of the SSRI (selective serotonin reuptake inhibitors) class or wellbutrin (bupropion).
Something to Think About
We have assumed that the eyes are the only, or the best method of transmitting light signals to the body’s biological clock. Research done in 1998 showed that the circadian rhythms of volunteer subjects could be altered by a three-hour pulse of light to the back of the knee joints. It isn’t so far fetched to imagine that the entire surface of the body can collect light and transmit it, perhaps through the blood, to the biological clock in the brain. After all, plants don’t have eyes and sense photo light changes extremely well.
There is still work to be done, but treatment for Seasonal Affective Disorder is available now. If you suspect SAD see your physician or psychiatrist.
***The above websites showing samples of light products are samples only and this is not to be construed as an endorsement of any of them.