By George F. Wilson
If you feel depressed, you are not alone.
Millions of people in the United States and around the world suffer from seasonal affective disorder (SAD), a depression that occurs at the same time every year.
SAD can be a debilitating condition that can interfere with daily living and cause sufferers to miss school, work and social activities.
Understanding SAD
SAD is characterized by recurrent episodes of depression, usually beginning in early to mid fall and subsiding in March or April. This depression is triggered by the shortening of the length of daylight and changes in the spectrum of fall and winter light.
However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.
Up to 6 percent of the U.S. population suffers from SAD, with women more at risk for the condition than men, according to the National Institutes of Health. SAD typically begins in a patient’s 20s, but can also be first diagnosed in children and adolescents.
Many people with SAD report at least one close relative with a psychiatric condition, most frequently severe depressive disorder or alcohol abuses, according to the National Alliance on Mental Illness.
Recognizing SAD
Symptoms of SAD can range from mild to severe and may build gradually. These include:
* Increased appetite with weight gain
* Increased sleep and daytime sleepiness
* Less energy and ability to concentrate in the afternoon
* Loss of interest in work or other activities
* Slow, sluggish, lethargic movement
* Social withdrawal
* Unhappiness and irritability
If you experience these symptoms, consult a mental health professional about SAD. It is important to make sure your symptoms aren’t a result of a more complex psychiatric condition.
At Princeton House Behavioral Health, a unit of Princeton HealthCare System, board certified psychiatrists and licensed therapists provide treatment and care for people who suffer from SAD and other psychiatric conditions.
Treating SAD
Light therapy is often the first line of defense against SAD and has been proven to be an effective treatment. Light therapy should begin as soon as the first changes in mood or energy are noted rather than waiting until the full depressive picture has developed.
Some patients may not have full remission with light therapy alone and may benefit from adding antidepressant medications such as bupropion (Wellbutrin XL), which has FDA approval for treating and preventing SAD.
In addition, taking long walks outside during daylight hours, sitting near windows at home or in the office, eating a well balanced diet, and exercising can also help relieve symptoms. In some cases, talk therapy can also be helpful.
Using light therapy
Light therapy is a powerful tool in treating SAD. With this type of therapy, light which mimics the spectrum from the sun is delivered by a device containing white fluorescent light tubes covered with a plastic screen to block ultraviolet rays.
This device called a lightbox typically sits on a stand on a tabletop so that the light is delivered at eye level. The patient does not need to look directly into the light. In fact, many patients read or eat while sitting in front of the device at a distance of two to three feet. Moreover, lightboxes have evolved to become portable so patients can carry them around their home as they get ready for work or school.
There are three main factors to consider in the delivery of light therapy: light intensity, light duration and time of day.
* Light intensity The intensity of light from the lightbox should be at least 10,000 Lux, significantly higher than normal home lighting fixtures.
* Light duration Daily sessions of about 30 minutes are typically required for optimum effectiveness.
* Time of day Light therapy is usually best delivered in the morning as the light helps reset the internal circadian rhythm clock, which has an antidepressant effect. Most patients benefit by resetting this clock earlier in the day rather than later.
With light therapy, patients typically show improvement in as few as two days and realize the full benefits within two to four weeks.
Though few patients experience side effects with light therapy, in rare cases the treatment can cause minor eye strain, headache, irritability, fatigue and insomnia. As with any medical treatment, talk with your doctor before beginning light therapy.
Also, a word of caution, tanning beds are not a safe treatment for SAD, as they can cause eye and skin damage.
Princeton House Behavioral Health provides treatment and personalized care for people who need mental health support, have chemical dependencies or who struggle with a combination of emotional and addiction problems. For more information or to schedule an appointment, call (800) 242-2550 or visit www.princetonhouse.org.
George F. Wilson, M.D. is an outpatient staff psychiatrist at Princeton House Behavioral Health and the past chairman of the Psychiatry Department at the University Medical Center at Princeton.

