The Light at The End of The Tunnel

Seasonal affective disorder (SAD) is a type of depression stimulated by the changing of the season. In previous articles, we have reviewed what SAD is, how it manifests itself, and the physiological and psychological approaches to understanding the disorder. The best ways to deal with SAD are to ensure you are aware of it, sleep well, and eat well. However, your physician may recommend you use a light box. This week, we will investigate light therapy and explain its uses when fighting SAD.

Light box therapy is an effective and non-invasive treatment for SAD – it stimulates your brain as much as sunlight does. It probably will not cure SAD, “nonseasonal” depression, or other conditions – but it may ease symptoms, increase energy levels, and make the condition more bearable as it has a positive effect on mood and helps with vitamin D deficiency.

Here are some tips on ensuring you get the most out of your lightbox:

·        Get the right light box. Brands like Lumie make fantastic products, but you need to know what specifications to look for.

·        Be consistent by sticking to daily routines of light therapy sessions. It’s better to do more frequent but shorter sessions than fewer but longer sessions.

·        Never look directly into the light as it can severely damage the retina. Ensure that you only look at something the light reflects off, such as a book or magazine.

·        Do not interrupt your schedule as the symptoms could return stronger. Ensure you follow a plan set out by your physician.

Your physician will advise you on how to best purchase and use a lightbox. They will explain to you: which brands are most suited for your personal condition, how long you should sit under it, at what point in the day, and how far from the box you should be positioned. Like any other prescriptive medicine, light box therapy should be taken in “doses,” and there is not a “one size fits all” approach. Each dose should be appropriately prescribed as per your personal situation.

If your symptoms do not improve you may need to consider additional therapy. Your physician will advise you about other treatment options, such as antidepressants or psychotherapy.

To see whether a lightbox could improve your quality of life, contact your physician or book into Mount Sinai for expert advice.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

SAD – Nature’s Effect on Nurture

Historically, Seasonal Affective Disorder (SAD) has been understood as being the result of one of two binary positions: biological (your genetic composition) or environmental (learned behaviours and other external influences). In more recent years, it has become widely accepted that the two elements feed into each other. That means that while people have predispositions toward depression, that depression is simultaneously affected by an external influence (in this case winter). SAD is made distinct from other types of depression due to its temporal pattern. Major episodes begin in the winter, and there is always a full emission in the spring.

Let’s take a quick look at the two factors before seeing how they link into each other.

Is It in The Genes?

The bracket of “Biological Vulnerability” covers a vast field of potential reasons one experiences SAD – but is generally understood as a rhythmic abnormality in the winter. This simply means, a biological composition or a natural disposition to biological changes in winter causes SAD. Some of the most well understood reasons are as follows: there could be a delay or advance in the release of melatonin (the hormone that tells us it’s time to sleep), a retinal sensitivity to light, a dysfunction between neurotransmitters (the chemical substance which sends messages between nerves), a genetic variation in brain composition, and a reduced release of serotonin. 

SAD can be a result of one or more of these biological aspects, but more often than not, they are emphasized by psychological factors.

How Our Environment Can Make Us SAD

Depression is understood as an interaction between a cognitive vulnerability to depression (as we looked at above) and a stressor. There are different cognitive models that propose different vulnerabilities, let’s take a look at the main ones.

Alongside the genetical predisposition, it is common for the sufferer to also be affected by one of the following: a dysfunctional attitude (learned negative attitudes and outlook on the world), rumination (focusing attention on dysphoric moods and/or potential negative consequences), and a negative attributional style (catastrophizing negative events to a global scale). These aspects are usually interwoven.

Once a predisposition is influenced by one of these negative cognitive aspects, this combinatorial (see below for a visual representation of this process). All of these cognitive aspects are stressors.

Combining the Two. 

Source: Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration. Kelly J. Rohan, Kathryn A. Roecklein, and David A.F. Haaga. Current Psychiatry Reviews, 2009, 5., 37-47

As we can see following the graph, the environmental aspect (on the left) can run its own path to SAD, as can the biological (on the right). It is widely accepted that the psychological vulnerability and the physiological vulnerability feed into each other (as seen with the double-arrow that links the two sides together).

If you would like to learn more about the symptoms of SAD click here.

If you would like an introduction to one of our physicians that specializes in SAD click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

A Physician That Can Stop You Feeling SAD – Dr Wayne A Gordon (PhD)

In a previous article, we explored Seasonal Affective Disorder (SAD), its manifestations, and some ways in which you can cope with this type of depression. As we said, symptoms tend to get better on their own, but sometimes they don’t. That is why this week we introduce Dr Wayne A Gordon, Mount Sinai’s response to SAD in the Department of Rehabilitation Medicine.

Dr. Gordon is the Jack Nash Professor and Vice Chair of the Department of Rehabilitation Medicine at the Icahn School of Medicine. He holds a PhD in Psychology from Yeshiva University alongside an internship in Neuropsychology from Rusk Institute. His specialization in Rehabilitative Psychology has finessed his clinical expertise toward dealing with SAD.

His clinical focus is centred around brain rehabilitation. That extends to fields of Anxiety, Concussion, Dementia, Insomnia, Parkinson’s, and all manifestations of Depression. His work in academia prove his profound understanding of how to help deal with SAD, and other types of Depression. He has published more than 100 articles and book chapters, and has received several awards during his career including recognition for “visionary work” in TBI (Traumatic Brain Injury).

When is the best time to see a physician about SAD?

One of the primary concerns with SAD is that it is difficult to diagnose, and equally sensitive to manage. The first step to dealing with SAD is diagnosis. This job is best done by a physician such as Dr Gordon, who can remove possibilities of other disorders that have similar symptoms. At this stage, it is possible to manage SAD using the step-by-step we supplied here. 

It is also important to see a physician if you feel the disorder is unmanageable. The step-by-step is helpful to some patients, but not to all. The symptoms of SAD don’t need to be managed alone. Dr Gordon has dedicated his life to helping people deal with SAD and equipping them with effective bespoke methods to deal with their personal battles. This can range from learning to deal with your symptoms to understanding what your symptoms are. SAD can manifest itself in “cycles” and become self-feeding. Dr Gordon can give you a metaphorical manual to your disorder which will help you understand what you are going through. This makes SAD manageable.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How Can We Deal with Being SAD?

We all feel unhappy sometimes, but depression is more than a feeling of unhappiness. It is a mental disorder that makes someone feel persistently sad for several weeks or months. Depression can be hereditary, triggered by another mental disorder such as a “low” in bi-polar disorder, a side-effect of drug abuse, but it can also be triggered by external forces, like the season. Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in the winter.

SAD manifests itself similarly to other types of depression. There is no way of accurately diagnosing depression without knowing a patient’s history and state-of-mind, as there is no “test” for SAD. Your health care provider can make a diagnosis by asking about your symptoms. There are two main ways SAD can affect your life, mentally and physically.

The mental effect of SAD can be as follows. As with all types of depression, sufferers will tend to experience a feeling of hopelessness in all facets of life and catastrophize events past and present. Due to this, sufferers of SAD will be unhappy and irritable, and may begin to withdraw themselves socially. The disorder may begin to make the patient feel the need to eat more (as weight loss is more common with other forms of depression).

SAD manifests itself physically as a need for more sleep, a loss of energy and ability to concentrate.

There is a loss of interest to the sufferer’s work, his partner and friends, and other activities (especially social activities). Their movements may become sluggish and, they will more likely than not become socially reclusive.

These symptoms are not mutually exclusive, and they usually feed into each other which make the disorder more difficult to cope with. The mental facets of SAD will reinforce the social behaviour and vice-versa.

If you, or someone you know, is suffering from a handful of these symptoms then it is worth visiting your physician. Your health care provider can make a diagnosis by asking a series of questions about your symptoms and history. They can also perform physical exam and blood tests to rules out other disorders that are similar to SAD such as chronic fatigue.

If you are struggling to make an appointment, or are unable to see a physician for whatever reason, we have some tips that will help manage your depression at home. Remember, it is always better to see your physician.

Some tips on dealing with SAD

Firstly, make sure you are getting enough sleep. A fully-grown adult should get between seven to eight hours a night – although some people may need as few as five, and some as much as ten. Know how much sleep you need, and make sure you are getting it. Oversleeping is never advised.

Make sure you are eating healthy foods. This doesn’t mean you need to eat bland food, it means you need to have a balanced diet. For example: make sure you are getting a healthy dose of vitamins and minerals every day and avoid binging on sugar and hydrogenated fats.

Do not use alcohol or illegal drugs, these often make depression worse – and have been correlated to suicidal thoughts during episodes of SAD.

Try to exercise often. Proven time and time again, exercise is a fantastic way of battling depression. Force yourself to start a social sport or activity, but most importantly – do activities that make you happy.

Learn to watch your symptoms and understand that you are dealing with a disorder. This is especially effective in the early days of SAD, it will allow you to take control of your disorder, change your routine, and book in to see your health care provider.

Finally, if you have seen your health care provider, make sure you take your medicines right away, and ensure you ask your provider how to manage any side effects. There is a multitude of ways of dealing with SAD that your health care provider can offer. Symptoms tend to get better on their own, but there is no “cure” for SAD. Tackling SAD is a matter of managing symptoms and learning to with the disorder.

Get medical attention immediately if you have thoughts of hurting yourself or anyone else.