Feeling SAD

CURWOOD: And speaking of the weather, it's late in the afternoon on a gray winter day. You're alone in your living room. And as you stare past the drizzle on the window to a dim landscape of leafless trees silhouetted against a steel gray sky, you're overcome by a sinking feeling. A feeling of hopelessness, hopelessness bordering on despair. You're feeling sad. You may call it the blues. Medical experts call it Seasonal Affective Disorder, and it's our body's natural reaction to days with less and less natural sunlight. Our internal biological clocks are out of synch with the natural rhythms established by the rising and setting of the sun. For some reason we may crave carbohydrates: sweets for some, alcohol for others. Whatever gets you through the twilight. Gila Lindsley knows about SAD. She's a psychologist who specializes in sleep disorders, and has been treating people with SAD for years. Dr. Lindsley says SAD can affect almost all of us, and it can range from a mild case of the winter blahs to clinical depression with severe consequences.

LINDSLEY: When I had my sleep center in a psychiatric hospital, we saw some patients who came in suicidally depressed. There was one woman who actually had made a suicide attempt. She came to me because they couldn't get her out of bed; she was sleeping all the time, they wanted to see what was wrong. When I took her history I found out that she'd had this every year since she was about 17, and this was a woman with several school-aged kids at this point. And I said, "Have you ever been hospitalized before?" and she said, "No." I said, "But this happens every year?" and she said, "Yeah?" and I said, "This severely?" and she said, "Yeah." And I said, "Well, why the suicide attempt this year?" She said well, she could always hang on until February vacation, and then they'd go down to the Bahamas and it would all go away, because by the time they got back it was spring. And she said this year, February vacation came in March, and she just couldn't hang on any longer.

CURWOOD: How common is SAD?

LINDSLEY: Severe SAD of the kind we are talking about probably isn't terribly prevalent, but you just throw out a number, I'd bet it was as high as 15% of the population in the Northeast.

CURWOOD: Can't function at some times because of the Seasonal Affective Disorder.

LINDSLEY: Yeah. And in fact there have been some real interesting studies coming out of Alaska, and the prevalence rate there of severe depressions in the winter time, I don't know numbers but it's extraordinarily high. And there are some who believe it accounts for some of the high alcohol rates in that part of the world, to try to deal with a day with no sunlight.

CURWOOD: It does seem, though, that even in the North, even here in Boston or in Alaska or in Minnesota there are people that are apparently unaffected by SAD. Why do you suppose that is?

LINDSLEY: I believe the difference is probably genetic. People with blue eyes tend to get it more than people with brown eyes. It may affect how much light they're actually able to take in. And people with SAD tend to have family members with SAD as well.

CURWOOD: I'm wondering if SAD is related to the fact that we used to follow the natural rhythms, you know, being, getting up when it's light and going to bed when it was dark. And in the winter time that would mean we would sleep longer. But in today's world, you know, there's a clock. We get up, we go to work, we're there at 8 o'clock or 9 o'clock every day, whether it's the summer when it's bright or it's the winter and it's barely getting light. Do you think that has anything to do with it?

LINDSLEY: Yeah, I do. Because of course, in the winter in the old days, when we didn't have all that pressure and pushing and electrical lights so we could extend our days, it was a time when farms were fallow, and it was probably a time where people just rested. And I think what probably happens now with SAD, I think, is really is just excessive sleepiness from the shortening of the days. But if we're trying to push against that, then we're not functioning very well and our self esteem can drop and we can feel dysfunctional, and for those who are vulnerable that may be the key to why it becomes a depression rather than just sleepiness.

CURWOOD: Now in health food stores these days, you'll see displays of what's being touted as the natural wonder drug. It's called Melatonin. It's a pill. I guess you take it once a day and it's being taken by many people to treat SAD, Seasonal Affective Disorder, and a number of disorders as well. So can you tell us just what is Melatonin, and what role it might play in SAD?

LINDSLEY: It comes from a gland that's in the brain, and the gland is called the pineal gland. There's a lot of evidence now that Melatonin is probably the key hormone in our entire body that organizes all of our different biological clocks.

CURWOOD: Really. Now if you have Seasonal Affective Disorder, if you're SAD, can you take Melatonin to somehow make you feel better?

LINDSLEY: I think that's a terrible idea. If you think about it, Seasonal Affective Disorder, one of the most important symptoms of it are people who want to squirrel up in bed and not get out until spring. If you think of Melatonin as a sleep inducer, it's about the last thing that you want to do. In fact, what you really want to do is to suppress Melatonin and kind of fool the body into thinking there's more daylight. Now it may be that if you take Melatonin exactly timed right, that you can up the amount of Melatonin at night, maybe, but I've not seen it work and really the treatment seems to be anything that can make Melatonin be out of the body for about the same length of time you'd normally expect in the spring. That's the normal strategy for treating SAD.

CURWOOD: The best treatment for SAD?

LINDSLEY: Bright light therapy.

CURWOOD: Uh huh.

LINDSLEY: Basically what you're trying to do is to convince your body that it's really spring. You just think you see darkness outside. Now, the bright lights that are used, that are called broad spectrum bright lights, and what that means is that as opposed to these little 60- or 100-watt dealies that we have, that they're simulating broad sunlight midday during the spring time. Now these tricky lights were eventually the ones that began to be used for Seasonal Affective Disorder, and those are still the treatment of choice.

CURWOOD: Now, besides bright light therapy, are there simpler remedies to ward off SAD? I mean, should I get out of the office every day at noon if there's sun to go around the block for a walk? Or is the only solution to pack my bags for the Pond, the Caribbean or something?

LINDSLEY: I think the best solution is to pack your bags for the Caribbean, frankly. But before you start packing your bags and uprooting your life, the common sense things to do are number one, be aware it's a seasonal pattern. Number two, anticipate it in advance of the winter so that part of the depression, part of it is feeling alone and isolated, so build your life so that you're going to have a lot of contact with people during the winter months. Of course it's absolutely critical to get a lot of light, and before it even really starts, resist the impulse to stay in bed a little longer because it's not going to help you.

CURWOOD: Gila Lindsley is a clinical psychologist and sleep disorder specialist who practices in Lexington, Massachusetts. Thanks for joining us.

LINDSLEY: Thanks for having me.