The Complete Guide to Seasonal Depression (SAD). 7 types of light therapy

I have done a great job of researching the English language literature on the topic of recurrent depressive disorder ( F33 ) with a seasonal pattern . In this article I will systematically present all the information I found.



Why this article is important:

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4. Manufacturers of bright light bulbs use a clever manipulation to label weak bulbs as 10,000 lux, but achieve this brightness at a distance of about 10 centimeters from the bulb to the lens of the eye.

Introduction

Hello! In this article, I would like to tell you about such an unpleasant condition as seasonal affective disorder (SAD). The main task of this article is to create a central information hub for SAD, correctly configure and orient the reader, provide many, many links to resources, tie it all into one big picture and add a lot of unique information.



To begin with, I recommend reading you a quality introduction article from a psychiatrist on the depressia.info website. It contains general information and symptoms, I see no reason to retell them here.



Now, some information about myself. When I was 14 years old (2007), I met my first depressive winter. I was experiencing severe mood loss and unwillingness to do anything. It was difficult to wake up to school, and learning ability dropped many times in the classroom. But, the most terrible symptom for me is severe chronic pain throughout the body, which I had to endure every winter for 12 years. Back in school, I promised myself that someday I would study medicine in English and figure it out myself. When communicating with doctors, I felt their disinterest, but at that time I could not logically explain what they were doing wrong. Now I can, and there will be a whole paragraph about this in the article.



I have invested a lot in learning medical English and now I understand how good it was. Now I can dig into the problems that are important to me very deeply, and understand them many times better than specialist doctors, and also adapt to the characteristics of my body. After all, a specialist doctor has to study a very wide range of diseases and there is no motivation to study a specific area for a particular patient, even if it pays well.

I want to warn you right away that all the information in the article is given solely for informational purposes. Responsibility for use lies solely with you and you should first consult your doctor. At least with an ophthalmologist. If you are from St. Petersburg, I can recommend the doctor Marina Vasilievna Karpenko , she knows about light therapy. In general, light therapy is considered safe, but there are some rare eye conditions or photosensitive medications for which it may be contraindicated. Also, in severe cases and in the presence of suicidal thoughts, light therapy alone may not be enough.

Medical errors in St. Petersburg

After reading Rosenthal 's book and reading a large number of English-language articles and reference booksOn the subject, I got the impression that the effectiveness of light therapy is a well-known and generally accepted fact in the Western medical community. It also seemed to me that doctors in Russia have long followed Western standards, the Internet is open, and literature is available. Learning English at the level of reading medical literature does not require special investment. Surely, St. Petersburg doctors know about SAD, and the peculiarities of its treatment. I'll just come to the appointment, and the doctor will convince me that I wasted months studying English literature. And he will tell you about some rare store with powerful lamps of bright light, which are much more powerful than Beurer lamps and will solve my problem. Oh, how wrong I was!



I chose 2 psychiatrists, with 18 and 34 years of experience and good reviews, in one of the best paid clinics in St. Petersburg. After the receptions, I was in for a series of disappointments and even a small psychological trauma. It turns out that 2 out of 2 doctors don't know about light therapy.

1. The first doctor is a woman with 18 years of experience; in the work profile, “Depressive Disorders” are listed in the first place and she reads English literature in her specialty. Diagnoses me with recurrent depression with a seasonal pattern. When asked about light therapy, he equates it with a placebo and says that it is not used in clinical practice. When we opened the US Mental Disorders Handbook (DSM) downloaded from her together, it turned out that light therapy was still being used. After a 10-minute educational program, the doctor deftly added light therapy to the list of treatment recommendations. That's how it is!
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How so? But what about the statistics for Canada, in which from 2% to 6% of the country's inhabitants will be diagnosed with clinical SAD during their lifetime, and the percentage of the population with mild SAD can reach 15%? But what about the statistics for Alaska with its 9.9% ? Maybe the population of Russia has some genetic advantages? Or, after all, the problem lies in the not very good training of psychiatrists and the "schizophrenic" traditions of punitive medicine of the times of the USSR? True, I did not believe that doctors cannot know basic things. Classifying depression by subtype is the foundation!



If you type “seasonal depression” in Yandex, then a good article by a psychiatrist comes up in first place... In it, a whole paragraph is devoted to light therapy and tells about 2 of its types (sessions with lamps for 45 minutes + simulation of dawn). Also, if you open the Russian-language online version of Merk-manul (one of the oldest medical reference books, completely free) and go to the article "Depressive Disorders" , you can read the following:







It turns out that light therapy is used not only for patients with SAD, but also may be of limited help to patients with non-seasonal depression. That's how it is! Don't physicians specializing in affective disorders know such basic things? Or maybe we still have a look at the UpToDate, which is currently the most popular general reference for doctors? Suddenly, it points out that light therapy can be an excellent alternative to antidepressants for patients with mild to moderate depression.





And if you open the article on SAD in the English-language Wikipedia, then at the very beginning there will be a photo of an elderly man reading a book under a SAD lamp. At the moment, the article is not available in Russian. It seemed to me that in 2019 there was a weak translation of it, but for some reason it was deleted.

If you are a doctor and you have had a good experience with light therapy (or simply with mood disorders), please send me your resume and contacts at

jandorwizard@gmail.com . I am willing to pay for consultations above the market, provided that you can provide a lot of useful information that I do not know

Russian-speaking Internet - be careful!

To begin with, you need to be extremely careful and be persistent in order to find something meaningful in Russian. I am insanely shocked by the quality of the content in general. Absolute trash can appear in the TOP-5 articles when searching . This is one of the main reasons why I decided to write an article here. I sincerely hope that my article will be cited and that sooner or later it will reach the top of search engine results, compensating for the abundance of low-quality and confusing information. If you have a VK public or a website related to depression, then please repost my article as much as possible.



Let's analyze the results. I usually use Google, but the average citizen of Russia uses Yandex as a priority, so we will rely on it. Let's take a look at the search results for the queryseasonal depression .

Light therapy

Getting started with light therapy should start with classic fluorescent table lamps. They give 80% of the effect, and all other types of light therapy are in addition to them. It is fluorescent lamps that have been well researched and we are sure of their safety, because they began to be used back in 1980. And yet, they give a spectrum that is closest to the sun. The light is very soft and pleasant.



If you ask me what is the best light therapy table lamp, I will say that Sunray II . Together with delivery from the United States, it cost me about 40,000 rubles in 2019. Such a wonderful device is bought once and for life, except that the lamps need to be changed every 2 years, but you can order a set of replacement lamps for 10 years in advance. If you want to try alternatives - there is also CanadianNorth Star 10,000 . Both he and Sunray II give 10,000 lux at a distance of 58-63 cm. Pay special attention to this! You sit in a comfortable position at a distance of half a meter from the device, and receive a therapeutic dose of brightness. In Russia, light therapy lamps are NOT SOLD, which give such brightness even at a distance of half the size!

Be sure to install the luxometer app on your smartphone and take as many measurements as possible everywhere and everywhere. So you can numerically express the difference in illumination in different places of residence, and also check whether the manufacturers of light therapy lamps really give the declared brightness at the declared distance. The accuracy of the luxury meter in smartphones is more sufficient for your tasks; you do not need to buy a separate device.

You may be wondering - what can you do during a light therapy session? Anything, as long as the light therapy lamp is in your field of vision. I usually sit in my smartphone - I read Habr or correspond with friends. I also use a special palm rest (box) so that the smartphone is higher and more of the Sunray II comes into view.



It should also be added that depression in general has 3 components - psychological, biological and social. Light therapy works exclusively with a biological component. If in your case the psychological component plays a dominant role (many negative thoughts), then the effect of light therapy may seem insignificant to you as long as you do not focus on your thoughts. Ideally, you should combine light therapy and CBT exercises to correct distorted and negative thoughts. You can also do CBT exercises DURING light therapy for a double effect. In the summer of 2019, I spent a lot of time on CBT, and with the onset of darkness in the fall, I very clearly saw the appearance of depressive symptoms and negative thoughts completely from scratch. Also, I saw how the miraculous light therapy removes them in 20 minutes,and this is the most amazing phenomenon that I have observed in my entire life!

What lamps are available in Russia

At the time of this writing, weak lamps from the German company Beurer are very common in Russia . I started with a TL-50 lamp , and I recommend it to you as a trial version of light therapy, the price is about 8,000 rubles. I only had enough of it in September 2019, and in October I tried to combine it and the TL-90 at the same time, and I missed them. Because they are both very weak. 10,000 at a distance of 15 centimeters is VERY small. TL50 is 8 times weaker than Sunray II. You may also be tempted to get the TL90 , as Rosenthal recommends larger lamps. However, technically it gives the same 10,000 lux at a distance of 15 centimeters, and at a distance of half a meter is somehow weaker than the TL50. Overall, I regretted buying it.

Light alarm clocks

I highly recommend it. they are time-saving and work an hour before you wake up. Yes, this is the only type of light therapy that works with your eyes closed. Also, many studies have been carried out on them and proven to be effective in SAD. I use a Beurer light alarm (WL 75), which is powerful but very bulky. Perhaps a more compact alarm clock would be a better choice. There is a good assortment in Russian online stores , so choosing a good light alarm clock is not difficult. The main thing is that it starts up an hour before the target awakening and is powerful enough for you to slowly wake up thanks to the growing light before the beep.

Light therapy glasses

At the time of this writing, there are 2 eyeglass manufacturers represented in Russia, Luminette and Pegasi . On Habré there are 2 articles about Pegasi:

1. Smart glasses of vigor - impressions of Pegasi Dream Glasses
2. How to reprogram sleep patterns: 30 days every morning I shone a bright green light in my eyes

Actually, these articles (as well as official sites) explain well the essence of the work and technical features, so I see no reason to duplicate them here. On my own I will only add that they are significantly weaker than traditional lightboxes. For example, the Luminette has 3 modes , 500/1000 and 1500 lux blue light. If we make a rough estimate of the white light from the Sunray II and assume that the white light from the fluorescent source contains 1/3 of the cyan, we get 3300 lux of blue light from the Sunray II. This is 2 times more, but not 8 times, as with the TL50.



I myself am planning to buy light therapy glasses in order to take them to the dacha or on a trip. In theory, you can also use them at work when you cannot get a second dose at home.

About the safety of light therapy

In the medical community, light therapy is considered safe for the average patient and the side effects are mild and quick to respond.



There is a series of journalistic articles circulating on the Internet about the harm of blue light, and one of the points is the damage to the retina, even from weak light from displays. This conclusion is made on the basis of an experiment with mice, on which they shone with blue light for several weeks, and then opened and found damage to the retina in the experimental group. However, we know that rodents are nocturnal animals, and we cannot extrapolate the results to humans without additional experimentation. We know from the physics course that white daylight (100,000 lux) contains a large amount of blue at high brightness, and we do not observe retinal damage in southern countries (if screened with UV). If we open the UpToDate directory, there this point is clarified very well. We also know that there was a long-term study of 17 patients over six years regularly receiving light therapy. The patients visited the ophthalmologist several times a year and no damage to the eyes was found.

Walking on sunny days in winter

Even December can have sunny days! In 2019, there were only two of them, but they are good enough to lift your mood and leave it that way for a couple of days. You can also use mobile apps to receive push notifications in the morning when the weather is clear and to ask for a walk from work on these days. I used the Android application " Flexible Weather Alerts ". It can be easily configured for a convenient time interval and not visit the weather forecast sites after that.

Try sleeping with the curtains open.

By analogy with light alarms, you can also amplify the effects of natural dawn and not close the curtains at night in winter. Dr. Rosenthal mentioned this technique in passing in his book, but I immediately associated it with a childhood memory when my parents removed the curtains completely for washing in November and the next morning I was in a suspiciously good mood. Since then, I always sleep with the curtains open. Sometimes I closed them and watched the deterioration of health the next morning, although it was easier to fall asleep.



Here it should be noted about some contradiction with the classical approach for depression, when the patient is recommended to control the quality of sleep, and a darker environment makes it easier to fall asleep and deeper sleep. I have never had any problems sleeping, so I decided to neglect this factor in favor of light. But, in your case, the situation may be different!

Early light therapy and combo

In the book, Dr. Rosenthal mentioned that tabletop light therapy is most effective in the early morning hours, ideally around 7 a.m. You can experiment and get up 1-2 hours earlier than usual to feel the difference. And also, you can regularly get up once a week a couple of hours earlier than usual and go to the city center, drink coffee and walk there. So, you can get a combined effect (early light therapy + walk + caffeine + change of scenery) and recharge yourself with a very good mood for the whole day.

Antidepressants

Antidepressants are a controversial topic, even in Western countries. The reason for the controversy is that antidepressants work differently in different people. In Russia there is some stigmatization in relation to "magic pills". Do I support her? Yes and no. The fact is that the real world is complex and we have many special cases. Only you and your healthcare provider can decide if they are right for you.



In his book, Dr. Rosenthal mentioned that there are people out there who have NO side effects from antidepressants AT ALL. What if you are one of them? Also, the doctor mentioned a patient who was not comfortable spending a full hour every morning on light therapy, and antidepressants solved his problem perfectly. On the other hand, Rosenthal pointed out that for some, even small doses cause a large number of side effects. It's about people like me.

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A source

We also have an English-language forum survivingantidepressants.org , which is entirely devoted to the effect of withdrawal from antidepressants (withdrawal). There are links to more accurate tapering calculators to minimize peeling side effects after years of therapy.

Psychotherapy

Dr. Rosenthal recommends CBT as the primary psychotherapy method for SAD in his book. The medical guide UpToDate also recommends CBT . In these two sources there is not even a mention of psychoanalysis and gestalt therapy, which are so popular in Russia. I recently published an article Why psychoanalysis is so popular in Russia and how patients are deceived . I got the impression that psychoanalysts in the Russian Federation sell simple consulting services at the price of psychoanalysis services. Therefore, try to find a CBT center or just a good multidisciplinary clinic with CBT specialists.



It should also be noted that CBT can be studied on your own if you have the time, desire and are able to reflect on your thoughts. This approach can be especially effective if communicating with a therapist is causing you any difficulties, such as anxiety. I spent about two months thoughtfully reading Mood Therapy by David Björns (2019 high-quality translation) and incorporating over 20 CBT exercises into my android app. If you have development skills, I highly recommend this path, because existing applications are extremely limited and inconvenient, and CBT is amazingly effective and can make you happier than people you know and fundamentally reflash your brain without having any side effects. Well, you can also try the CBT Diary app(android) or similar for iOS.

SAD Online Community

At the moment, there is no Russian-speaking SAD community. But we have an international SAD community on Facebook , 7000 members. I recommend that you submit your application now and use the community wall to ask questions and get support. The community is very active, 3-4 posts every day and a large number of responses and comments for each of them. Don't be confused by the English language, because Facebook has a 1-click auto-translation function for posts. Also, the community has a large post-article in which approaches to the treatment of SAD are systematized, and I did not mention some of them in this Habra article, because I myself have not tried and adapted for the RF. To view the article, you must join the group and approve the application.

Vacation in a sunny country

Dr. Rosenthal recommended that northern latitude patients spend their holidays in southern latitudes or the tropics. For the average Russian, Thailand is the first to come to mind, and it can be great for this purpose, provided you can handle the heat well. I spent two months in Thailand (mid January to mid March) on Koh Samui and was full of energy the whole time. My productivity there was the highest and I did a lot in terms of working on my projects. It may sound fantastic, but January and February in Thailand can be sunnier than June and July in St. Petersburg. I rarely saw cloudy days, and even on these days the sun came out from behind clouds enough to get the necessary dose of bright light.

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Unfortunately, in Thailand, I encountered the other pole of seasonal depression - Summer SAD. It seemed like a trifle at the very beginning, but it began to cause serious damage to my mental health within a month, and at the end of the second month I dreamed of returning to St. Petersburg as soon as possible. At the same time, my productivity was still high, but I felt very bad inside because of the heat.



The fact is that on Koh Samui the temperature in January and February is kept at about 30 degrees during the day and 28 at night, and in Bangkok during the day it can reach 35 degrees . Perhaps you can find some mountain village or island where it will be both cool and sunny. If one of the readers researches this issue well, please write in the comments or email (jandorwizard@gmail.com ).



It seems that sunny cities in Russia like Sochi could be a good alternative to Thailand ( source ).

Relocation for permanent residence in a sunny country

Reading comments to English-language articles and posts in the Facebook group on SAD , I several times met the regrets of 40-year-old Americans that at one time they did not dare to relocate to Florida. Indeed, SAD can greatly affect the quality of life and is not curable, although it is possible to achieve long-term remission and not even fall under the criteria for mild depression (on the Beck Depression Scale ).



I would recommend that you try many, many methods against SAD while living in Russia and decide if you need relocation. It seems like moving to Silicon Valley seems like the perfect option for the tough IT professional with SAD. It is not too hot, but sunny, excellent choice of companies in terms of work and prospects. For me, SAD is an additional motivation to move to the USA. Every year I apply for a green card, and I advise you.

Light therapy rooms

1. Dr. Rosenthal described his experience of visiting light therapy rooms in Stockholm, Sweden (St. Gjöran's Hospital). Those. the clinic equipped such rooms specifically for patients with SAD 20 years ago! And you, Russian psychiatrists, continue to look for new ways to diagnose schizophrenia in patients, instead of mastering useful and effective techniques in the field of affective disorders!
2. There are also light cafes in Sweden . I really hope that sooner or later they will also be added to St. Petersburg. Perhaps my article will contribute to progress.
3. Museum in Toronto (Canada) has installed light therapy rooms

You may be wondering whether it is possible to design a light therapy room at home. On Habré there are at least 2 articles on how you can make a very powerful chandelier, though all this is experimental and I did not dare to do such feats:

1. Making a 100'000 lumen nuclear chandelier . By the way, I keep in touch with this author, and he promised a post on the new version of the LED-based nuclear chandelier.
2. Setting lighting at 30,000 lumens will help with winter depression (translation)

What else can you try

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3. Be sure to go to an appointment with an endocrinologist and get tested for Vitamin D in winter. If a deficiency is found, the doctor will first prescribe an intensive appointment for you to overcome the deficit, and then - life-long therapy once a week. In December, I had a deficiency, by March (the coronavirus pandemic in St. Petersburg), the concentration in the blood was significantly higher. And I was uplifted by the fact that I had reduced my chances of complications from the corona, because immuninet is highly dependent on vitamin D.

Plan

Dr. Rosenthal in his book very well outlined the general plan for lifestyle changes in SAD, from the winter solstice (shortest day, December 21) to summer (longest day, June 21).

Dating SAD

In my opinion, a man and a woman with SAD can be a great couple! And that's why:

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I propose to create a discussion "Dating SAD (seasonal depression)" in one of the VKontakte groups, for example in this one (Depressive Anonymous, 2000 participants), and drop your profiles there.



Taking this opportunity, I would like to advertise myself as a potential partner =) If you are a girl from St. Petersburg with SAD, then write me an email at jandorwizard@gmail.com with information about you (as much as possible) and your photos. To begin with, we can just be friends, and then maybe more.

Feedback with you

I would be very interested to hear your stories about SAD. Send emails to jandorwizard@gmail.com , and the more you write, the better!



We also know that the Russian people are very inventive and probably some of you have developed some of your own unique approaches and methods to combat SAD or ordinary depression. Be sure to tell us about them! It is possible that some of them may be more effective than placebo and add to the arsenal of approaches developed in the West. In the future, I may compile them into a separate article and try to find medical researchers who will recruit groups and study the effectiveness.