Light Therapy for SAD

Light Therapy for SAD

• Light therapy, also called phototherapy, is the exposure to sunlight or ultraviolet light for therapeutic purposes. Light therapy has been around a long time and considered acceptable for treating various health issues. When my middle child was born she had jaundice. In the hospital nursery she was placed under a sun lamp, and exposed to bright light to decrease her bilirubin levels, which protected her from developing brain damage.
•  Light therapy has been used to treat tuberculosis for many years. When my grandfather was a young man he was diagnosed with tuberculosis, and sent to a sanitarium in Cresson, PA for treatment. One aspect of that treatment was to spend as much time in the sunlight as possible. Whether that meant sitting on the sun porch on days you were too weak to be outside, or spending time out on the grounds in sunny weather, soaking up as much light as possible was an important part of the cure.
• Light therapy is used to treat some skin disorders, such as cutaneous T-cell lymphoma and psoriasis (Taber’s Cyclopedic Medical Dictionary, 2001).  Light therapy is also the recommended treatment for winter seasonal affective disorder (SAD)  (Eastman, Young, Fog, Liu, Meaden, 1998). For this paper I will be focusing on light therapy as it is used to treat SAD.
• Seasonal affective disorder (SAD) is a type of depression that occurs at the same time every year. SAD usually begins in October or November, and subsides in March or April, although most patients don’t feel they are back to normal until May (National Alliance on Mental Illness, 2012). SAD depression is usually mild to moderate, but can be severe. The symptoms of SAD include oversleeping, daytime fatigue, carbohydrate craving and weight gain, along with a lack of interest in normal activities, depressed sexual interest, lethargy, social withdrawal, a feeling of hopelessness, and suicidal thoughts.
•  Risk factors for SAD include being female, living far from the equator, a family history of depression, and experiencing other types of depression. Like most depression, SAD is diagnosed in women two times more often than in men. However, men may have symptoms that are more severe (Mayo Foundation for Medical Education and Research, 2011). Some people who have lived in different places say their depression lasts longer, and is more severe the farther north from the equator they have lived.
•  Because just about everybody suffers from the winter blues to some extent, (after all, we were designed to hibernate in the winter time!), it can be difficult to know where just the “winters blues” end, and SAD begins. Most people don’t realize how depressed they have been until the sun starts shining again for the spring. And that is one of the tests for SAD. If someone has suffered winter depression two years in a row, in so significant a manner that they felt as though they were coming alive again in the spring sunshine, they probably have SAD. If they spent most of their winter feeling drained of energy, napping any time they could, procrastinating on chores and projects, and just “wanting to be alone,” they probably have SAD. 
•  There are several online assessment tools available to help determine if someone is experiencing SAD. One is the Hamilton Depression Scale at www.cet-surveys.org. Another is the Seasonal Pattern Assessment Questionnaire provided by the Mood Disorders Association of Manitoba, Inc. found at www.depression.mb.ca. Whether someone would like to take advantage of these free online tools or not, the next step would be for them to talk to their physician about their symptoms.
•  Currently I work in an acute care setting where my patients usually stay only two or three days. Even so it is often evident they are depressed. Sometimes it is because they are in the hospital, and being sick is depressing. Sometimes it is because they receive a diagnosis they are not expecting. These are acceptable reasons for being sad or depressed during a hospital stay, and no one would suspect SAD.
•  I also work with many elderly patients and depression is often part of their diagnosis or medical history. Sometimes I see patients grow more depressed every day during their stay. It is very frustrating, when having a holistic viewpoint of nursing, attempting to care for the patient’s physical, mental, and spiritual health, to be aware of issues, and not have the time to address those issues in the acute care setting.
•  When I have told a doctor that I believe his/her patient is becoming depressed, or is struggling with depression, one of two things usually happens. One doctor may take the time to sit and talk about the issue with the patient. He will then call the patient’s family or caretaker to ask for their input, and to suggest a treatment plan. Another doctor may just order an antidepressant for the patient. Of course, I’m always so much happier to see the former, than the latter. But, either way, treating depression of any kind calls for follow up appointments after the in-patient diagnosis.
•  When I have a patient who is taking an anti-depressant, or who is exhibiting signs of depression, I try share my story with them. Nobody likes having depression, there is a stigma attached to the diagnosis that we have not overcome as a society. Many people also fight taking anti-depressants, as I did, trying several other alternative supplements, (St. John’s Wort, Sam-E, Krill Oil) before agreeing to try anti-depressants. I want to offer empathy to my patient by sharing enough of my story, so they understand that even though I’m their nurse, and they may think I have it all together, I too have a diagnosis of depression. I chose this topic because I recently started using light therapy, and I can now share with my patients that light therapy is the recommended treatment for SAD, and encourage them to discuss this with their doctors.
•  Light therapy is delivered through a light box. The light from a light box mimics outdoor light. This is thought to cause a chemical change in the brain that lifts your mood and eases other symptoms of seasonal affective disorder (Mayo Foundation for Medical Education and Research, 2010). Light boxes can be purchased over the counter, but you should discuss your SAD symptoms with your doctor, and get his advice on the type of box before buying one. You will want to get a box that is specifically designed for SAD.
•  When light therapy for SAD began light boxes that emitted 2,500 lux (a measurement of light intensity) were used and patients needed to be exposed to this light for two hours every day. It has now been determined that the 5000 lux for one hour is the optimal treatment. Now many light boxes are 10,000 lux and the recommended treatment is one half hour a day.  New technology has produced light boxes which give off blue light which has a shorter wavelength and may be slight more effective in treating SAD symptoms, but more research needs to be done before we know if blue light is a better option (Mayo Foundation for Medical Education and Research, 2010).
•  Light therapy works best for a true SAD patient. That is one whose symptoms have a clear onset in the fall and winter, and then have remission of symptoms when the sun begins to shine in the spring and summer. These are patients who crave carbohydrates, and have hypersomnia. They are always tired and sleep much more during winter months than spring and summer months. When I saw an interview with Dr. Nancy Snyderman on the Today Show, some time ago, she stressed the need to get a clear diagnosis from the patient’s doctor before using light therapy. She stated that Bi-Polar Depression is very like SAD and can have a seasonal component. However, if a patient has Bi-Polar Depression and uses a light box they can suffer from hypermania.
•  In an article by Levitan (2005), he states the importance of light therapy being used consistently on a day-to-day basis, even on weekends. Most studies indicate that early morning treatment (before 8 am) is optimal. Light therapy differs from standard antidepressant medication in having a more rapid therapeutic effect, usually within the first several days of treatment. Light therapy is usually implemented as symptoms begin to emerge, not as a preventive treatment. Treatment is typically continued through the fall and winter period, and discontinued at the time of natural remission in the spring and summer.
•  Light therapy comes with almost no side effects. In a study by Kogan and Guildford (1998) titled Side Effects of Short-Term 10,000-Lux Light Therapy, in which seventy subjects with seasonal effective disorder underwent brief 10,000-lux treatment, and were asked to report side effects, almost all the side effects were mild, transient and did not interfere with treatment. Headaches were the most common side effect but ceased after the third day. Eye or vision problems, including strain, blurred vision and irritation, were the second most common side effect, with most of these resolving after the first 2 days. Nausea occurred mostly on the first day only. These findings support the use of 10,000-lux therapy for newly diagnosed SAD patients, and for patients currently using the 2,5000-lux treatments who find them to be inconvenient or not effective.
 

 
•  As a nurse in the acute care setting there is not an effective means for me to evaluate follow up on this treatment. I see my role as encouraging the patients by telling them my story, and encouraging them to discuss their symptoms with their physician, and asking him/her for advice on light therapy. I may also be able to have an impact on the doctors who round on my patients, by discussing light therapy with them as a treatment they could suggest their patients consider. For many doctors light therapy is still considered a new alternative therapy that they need to research before prescribing it for their patients. I contacted the Behavioral Health Unit at my hospital, and they do not use light therapy for their patients. I would think, since many of their patients deal with depression, and often experience longer in-patient stays; light therapy would be an effective treatment to offer the patients who meet criteria for SAD.
•  In Gorman’s 2011 article for Today’s Health, she quotes Dr. Michael Terman, PhD, director of the Center for Light Treatment and Biological Rhythms at New York’s Presbyterian Hospital in New York City.

SAD is a serious condition, a subtype of major depressive disorder in which life can be severely compromised by fatigue, low mood, anxiety, reduced sex drive, and more. But SAD is really just the tip of the iceberg … Less exposure to natural light is at the root of the winter doldrums… Far more of us experience similar but less intense symptoms, becoming just short of clinically depressed. By my estimate, half of the U.S. population would benefit by using a light box for 30 minutes before work. It’s just a highly convenient and effective breakfast table routine. By the time you’re done with your eggs and the paper, you’ll likely have received enough light therapy to prevent any mood shifts and stay energetic throughout the day.

•  In conclusion, I am so thankful that I discovered light therapy as a treatment for SAD. In doing the research for this article I learned more about the timing of the treatment, and that knowledge has helped me use my light therapy more effectively. I’m feeling better each day I use it. Of course, the sun is shining today, which makes me feel optimistic about life in general, as I’m having a very good day!

References

• Eastman, C. I., Young, M. A., Fog, L. F., Liu, L. Meade, P. M. (1998). Bright light Treatment of winter depression. Archives of General Psychiatry, 55 (10), 883-9. Retrieved fromhttp://library.immaculata.edu:3072/docview/206085549?accountid+27548 
    
• Gorman, M. O. (2011). Dark days? Bright ideas for coping with winter. Retrieved from http://today.msnbc.msn.com/id/45194353/ns/today-today/health/t/dark-days- bright-ideas



• Kogan, A.O., Guilford, P. M. (1998). Side effects of short-term 10,000-lux light therapy.The American Journal of Psychiatry, 155 (2), 293. ProQuest Nursing & Allied Health Source.



• Levitan, R. D. (2005). What is the optimal implementation of bright light therapy for seasonal affective disorder (SAD)? Journal of Psychiatry & Neuroscience: JPN; 30, (1); ProQuest Nursing & Allied Health Source.



• Lurie, S. J., Gawinski, B., Pierce, D., Rousseau, S.J. (2006). Seasonal affective disorder. Retrieved from the American Family Physician web site at www.aafp.org/afp



• Mayo Clinic Staff, (2011). Seasonal affective disorder (SAD). Mayo Foundation forMedical Education and Research (MFMER). Retrieved from http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195



• Mayo Clinic Staff, (2010). Seasonal affective disorder treatment: choosing a light box.Mayo Foundation for Medical Education and Research (MFMER). Retrieved from http://www.mayoclinic.com/health/seasonal-affective-disorder-treatment/DN00013



• Remick, R. A. (2002). Diagnosis and management of depression in primary care: A clinical update and review. Canadian Medical Association Journal; 167 (11), 1253. ProQuest Nursing & Allied Health Source



• Termin, M. (2004). Seasonal Affective Disorder. [Review of the article]. National Alliance on Mental Illness (NAMI). Retrieved from http://www.nami.org.

Also:

• Center for Environmental Therapeutics’ Personal Inventory for Depression and SAD, an online self-assessment, can be found at www.cet.org



• Mood Disorders Association of Manitoba Inc. Seasonal Pattern Assessment Questionnaire, can be found at www.depression.mb.ca