Winter Blues

Everything You Need to Know to Beat Seasonal Affective Disorder

By Norman E. Rosenthal

The Guilford Press

Copyright © 2013 Norman E. Rosenthal
All rights reserved.
ISBN: 978-1-60918-185-7

Contents

Cover,
Praise for Winter Blues,
Title Page,
Copyright Page,
Preface,
Introduction,
Part I Seasonal Syndromes,
ONE Discovering SAD,
TWO All about SAD,
THREE How Seasonal Are You?,
FOUR What Causes SAD?,
FIVE SAD in Children and Adolescents,
SIX "Summer SAD" and Other Seasonal Afflictions,
Part II Treatments,
SEVEN Light Therapy,
EIGHT Beyond Light Therapy: Other Ways to Help Yourself,
NINE Psychotherapy and SAD,
TEN Antidepressant Medications,
ELEVEN Meditation for SAD,
TWELVE A Step-by-Step Guide through the Revolving Year,
THIRTEEN "How Can I Help?": Advice for Family and Friends,
Part III Celebrating the Seasons,
FOURTEEN A Brief History of Seasonal Time,
FIFTEEN Polar Tales,
SIXTEEN Creating with the Seasons,
SEVENTEEN Winter Light: Life beyond SAD,
Part IV Resources,
Websites of Interest,
Where to Obtain Light Fixtures and Other Devices,
Support Groups,
Further Reading,
APPENDIX A Daily Mood Log,
APPENDIX B Core Belief Worksheet,
Acknowledgments,
Index,
About the Author,
About Guilford Press,
Discover Related Guilford Titles,

CHAPTER 1

Discovering SAD

Whether by the diagnostic term "seasonal affective disorder" or the informal term "winter blues," you have probably heard about this condition.

SAD AND LIGHT THERAPY: THE EARLY YEARS

Although individual cases of SAD have appeared in the psychiatric literature for over a hundred years, and although the use of light to treat depression was suggested even in ancient times, the description of SAD as a syndrome and the systematic development of light therapy to treat it occurred as recently as the early 1980s, at the National Institute of Mental Health (NIMH). These developments involved several individuals, each of whom made an important contribution to the story. I consider myself fortunate to have been at that place at that time and to have played a key part in these events, which I describe below. And since each of us experiences our world from our own particular vantage point, it seems easiest to begin this tale of scientific discovery with my own SAD story.

My Own SAD Story

I trained as a doctor in South Africa, a country that, for all the turbulence of its politics, can truthfully boast about its climate. In Johannesburg, where I grew up, there were really only two seasons: summer and winter. During summer, one could swim outdoors and eat summer fruit: peaches, papaya, mangoes. During winter, one could not do these things. It was warm outdoors during the day, though at night you needed a sweater. Spring and autumn were transition times. After several months of winter, the blossoms would appear, and you knew it was spring. Likewise, when the long summer was over, the leaves would turn a simple brown and fall off the trees without much fuss or fanfare, and winter was there. But despite the mildness of the seasons, I was aware at some level of the effect they had on my mood. I had even considered writing a novel in which the mood of the central character changed regularly with the seasons. The novel was never written, but the seed of the idea stayed with me, germinating quietly. It required the intense seasonal changes of the higher latitudes to which I moved to activate that germ of an idea, as well as encounters with some inspiring people, who are central to this story. I arrived in the United States in the summer of 1976 and began both my psychiatric residency at the New York State Psychiatric Institute and research into disorders of mood regulation. The summer days felt endlessly long, and my energy was boundless. I had never experienced such long summer days in Johannesburg, which is far nearer to the equator than New York City.

As the months passed, I was struck by the drama of the changing seasons. I had been unprepared for the brilliant colors of the autumn leaves in the North, the crisp days and cold nights, and most of all, the disappearance of the light. I had not anticipated how short the days would be. When the sun shone, its rays struck the earth at a strange, oblique angle, and I understood what Shelley meant when he wrote:

Bright Reason will mock thee
Like the sun from a wintry sky.

Then daylight savings time was over and the clocks were put back an hour. I left work that first Monday after the time change and found the world in darkness. A cold wind blowing off the Hudson River filled me with foreboding. Winter came. My energy level declined, and I wondered how I could have undertaken so many tasks the previous summer. Had I been crazy? Now there seemed to be no alternative but to hang in and try to keep everything afloat. I understood for the first time the stoic temperaments of the northern nations. Finally, spring arrived. My energy level surged again, and I wondered why I had worried so over my workload.

I registered all these impressions, but I did not put them together into a cohesive story—and I probably would never have done so had it not been for the events that followed and the remarkable people I was to meet. At the end of my residency I went to the NIMH in Bethesda, Maryland, to undertake a research fellowship with Frederick Goodwin, whom I had heard speak on the topic of manic–depressive illness from both biological and psychological points of view. Goodwin made the subject come alive, describing how our shifting moods and fluctuating perceptions of the world correspond to certain changes in our brain chemistry. Since mind and brain seemed equally fascinating frames of reference, I wanted to use both models to try to understand mood disorders.

Shortly before my first visit to the NIMH, I met Alfred Lewy, one of several psychiatrists working with Goodwin at the time. Lewy had just developed a technique to measure the hormone melatonin, in collaboration with Sanford Markey. Melatonin is produced by the pineal gland, a pea-sized structure tucked underneath the brain. Each night, like clockwork, the pineal gland releases melatonin into the bloodstream in minute quantities and continues to do so until dawn. The secretion of melatonin signals the duration of darkness and thus serves as an important seasonal time cue in animals. Although it is unclear whether melatonin is instrumental in causing seasonal changes in humans, research in this area proved to be a critical step in the description of SAD and the development of light therapy.

Lewy and I spoke about our common interests and the various directions in which our research might take us. On occasion, we chatted over a mass spectrometer, the instrument he had used to develop his technique for measuring melatonin. It looked like a very large washing machine. He injected samples of clear fluid into a small hole in the top, and reams of paper rolled off it, while inked pens traced out a graph upon the paper. He pointed to one blip on the graph and said, "That's melatonin." I was suitably impressed.

After I joined Goodwin's group, I was assigned to work most closely with Thomas Wehr, an outstanding clinical researcher who had for some years been studying biological rhythms in an attempt to learn whether abnormalities in these rhythms might be the basis of the...