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WINTER DEPRESSION

There was a little article 12/1/2015 in NYT science section where a study showed that treating Depression with a light-box worked even in people who were not seasonal.

The two main ways to treat winter depression are:

#1: get a light box and sit 1 foot away from it every AM as soon as you wake up, at the same time every morning, for ½ hour. You have to be just one foot away from fluorescent light such as are in office ceilings.

#2: less effective, but easier and also proven to also work: put a timer on a lamp next to the bed and have the light go on ½ hour to ¾ hour before your alarm. This also has a dramatic benefit in making it easier to wake up and get out of bed. This, of course, would work much better if combined with the light box (#1) above. There is also a dawn simulator called Sun Up, which is discussed in Norman Rosenthal’s book Winter Blues, with sources. A good source is sphereone.com, a site that the Columbia researcher Michael Terman, PhD, uses.

NOTE : #3 Avoid sleeping in late, as this allows the melatonin cycle to be “phase delayed”, which is the trigger for winter and makes you more depressed.

GENERAL INSTRUCTIONS ON WINTER DEPRESSION:
If you get a little gloomy in the winter, make a trial for one week of taking the dogs out for a half hour instead of 15 minutes–you’ll find the benefit in one week, if there’s going to be benefit.

Other ways to deal with SAD:

After 6PM: nothing exciting and no exercise
—read a book or watch something something non-stimulating–e.g. a nature program
–low lights, especially as it gets later. –no arguments
–if you cannot fall asleep one night, get up and do something unexciting, like reading, and still keep the lights very low; don’t lie in bed more than 15 minutes–then get up and read until a wave of sleepiness hits you again.
–try to never sleep past 10AM–though that will make your natural bedtime 1am or 2am
–if you still have a problem take about 0.5mg melatonin (which is 1/4 of most pills) when you home after school or whatever. If it makes you sleepy, you’re taking too much
–if melatonin doesn’t cause any drowsiness at all, you can shift the dose to 1:30 to 2PM. If it doesn’t help sleep or depression in a week then it won’t help. So you don’t need a long trial. (What it helps best with sleep is getting up earlier the next morning.)

General Methods of Dealing with Winter Slumps (or Winter Depression) and Dealing with Over sleeping in the Morning:

1. Keep the lights low in the house after 6:00 or 7:00 p.m., preferably dimmer as time goes on. Do not do anything exciting like watching aliens on T.V. or going out for a jog. Read a boring or difficult book.

2. Do not close the drapes in your bedroom.  Allow the light to flood inside the room in the morning. Ideally, move your bed next to the window, with the head of the bed right under the window. 

3. As soon as you wake up in the morning, walk outside and stay out there for a half an hour, if possible. You might sit on a bench while drinking coffee and reading a newspaper, as long as you allow a lot of light to come in through your eyes (NO SUNGLASSES!)

4. An inexpensive method to simulate dawn is to buy a light timer at a hardware store and one or two 150 watt flood lights with one or two appropriate holders and clamps for the light(s). Attach these to a chair and aim them at the head of your bed. Set the light timer to activate at least one to two hours before you are scheduled to wake up. Naturally, set the light as close to you as possible, i.e., a foot and a half to two feet away from approximately where your head usually is when you are sleeping.
If you are going to use lights for ½ hr in lieu of going outside, then you should put two 150 watt bulbs about 1 foot away on each side. If this produces too much heat, of course you will have to move it a little further away. (Remember that the amount of light that one receives is one over the distance squared. So, if one has a light that is two feet away, then the distance is doubled to four feet away, the amount of light you will receive is one over two squared, which is 1/4th the light. If you go from two feet away to six feet away, the amount of light you will receive is one over three squared, or 1/9th the light. If you go from two feet to 12 feet away, the amount of light you will receive is one over six squared, or 1/36th the light. Therefore, it is important to keep the light as close as possible.) If you use fluorescent lights, set up banks of 4-8 lights 1 foot in front of you.

5. Take one quarter or less of a two or three mg melatonin tablet at 2:00 to 3:00 in the afternoon. (If the store is selling 300 mcg tablets, that means it is a .3 mg pill, and you should take that whole pill or less. If this dose makes you drowsy, take a smaller dose.) This will make it easier to wake up the next AM.

6. Apparently, negative ionizers help people with “winter slumps” (they may also help other types of depression, but have not been researched yet.) If you do use one of these machines, use it for a half an hour a day, at any time of the day. Results should be evident in three to four weeks.

Note: 1st weekend of April: “spring forward” time change
October, the weekend before Halloween, changes back.

10/1/02: Michael Terman, PhD does research at Columbia on using light and negative ions in winter depression, including with pregnant women.

See: www.light-and-ion-therapy.org or call 212 543 6118
Also: sphereone.com has the negative ionizer and lights

–to find out when to use light treatment: www.cet.org/AutoMEQ.htm
NORTHERN LIGHT TECHNOLOGIES
8971 Henri-Bourassa W.
Montreal, Canada H45 1P7
Tel 514 335-1763 Toll free 1 800 263-0066 Fax 514 335-7764
Email: info@nothernlight-tech.com Website: www. Northernlight-tech.com

Lighting Resources
1472 Mulford Road
Cols, OH 43212-3444 1 800 875-8489 1 614 488-6841
Evergreen Health and Light Company, Inc.
45 E. City Line Avenue, Suite 329
Bala Cynwyd, PA 19004 477-9452 James M. Lichtman President
Happy Light from Orvis, Veralux brad, 10,000 lux
 a good, comprehensive book: Winter Blues by Norman Rosenthal, MD

Light therapy information as treatment for Winter Depression light tearapy

Michael Terman, PhD wrote this letter to Columbia psychiatrists on a listserve on 6/11/2006 :
Light augmentation of antidepressant drugs is rapidly becoming de rigueur in Europe. See editorial consensus statement in Psychol Med 2005 (PDF attached).

We have done this clinically for years, also in inpatients (even light + drug + ECT), and are planning two clinical trials in the coming year (light + MAOI).

Important to keep in mind that light has antidepressant activity in both nonseasonal and seasonal depression. Timing of the light may be critical (see the AutoMEQ on-line determination at www.cet.org).

Irritability and revving are almost always controllable by reducing light dose (e.g, 20- rather than 30-minute sessions, increasing the seating distance from light box, scheduling light later in the morning). Under early morning light — the preferred interval — we have observed mixed states in some bipolar pts, resolved with light at noontime.

For long-term use, we urge a precautionary structured eye exam (filed with the chart) in order to ascertain any pre-existing ocular pathology. While there are no definite ocular contraindications to light therapy (other than for the retinopathies), patients with abnl eye exam should repeat the test once or twice a year. Copy of form attached. A talented, low-cost ($45) expert who administers this exam for our pts is Dr. Henry Tanzil, Westway Vision, 732 9th Ave @49 St, New York NY 10019, 212-245-0686. Pts bring the form for him to complete. He will fax the completed form if he detects any problems. In making appointment, pt should state “Columbia light therapy exam.”

For long-term maintenance especially, it is important to select a light box that screens out all UV and does not over-emphasize short-wavelength visible emission (watch out for blue light boxes or fluorescent sources with color temperature above 5500 Kelvin). Criteria for light box selection are listed at www.cet.org. Cumulative exposure in the short-wavelength region can increase blue-light ocular hazard, especially above age 50. For good background on this issue: www.mdsupport.org.

Bright light therapy should not be administered to patients using blue photosensitizing medications incl. first-generation neuroleptics and antiarrhythmics, or the green-photosensitizing supplement hypericum(! ). The total daily photon exposure from bright light therapy typically vastly exceeds the spontaneous exposure in everyday life. An alternate strategy is low-level dawn simulation delivered in the bedroom (paper in press in Am J Psychiatry).

Our Columbia clinic recommends (and uses) the CET/UpLift Day-Light, which has been tested effectively in a long series of clinical trials and has optimum screening of UV radiation and minimal glare at 10,000 lux. Available at www.cet.org. This nonprofit site also has extensive guidance on use of the treatment.—Michael Terman, PhD

something new 1/2009: for PMS depression it helps to use light therapy in the evening for ½ hour

[at 6 or 7PM—if too late, it causes insomnia]; using both AM and evening light therapy is probably best for this.

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