Lead, kindly light, amid the encircling gloom…

By James Bradshaw, Assistant Editor
November 1, 2003



–from “The Pillar of the Cloud” by John Henry Newman

Paul A. Arbisi, Ph.D., had received a few calls already even before the autumn end of Daylight Savings Time. The gloom of another Minnesota winter was approaching, and there would be more calls soon.

Arbisi is an assistant clinical professor at the University of Minnesota and staff psychologist at the Minneapolis Veteran’s Administration Medical Center. He is also a recognized expert on SAD — seasonal affective disorder — and knows that for many the dwindling hours of daylight will mark the onset of depression.

“I’m a clinician,” Arbisi said, explaining that he doesn’t get direct calls from patients, but he said practicing psychologists sometimes call to confirm their diagnosis when they suspect a client is suffering from SAD.

“The diagnosis is critical,” Arbisi said. “Most people in the northern hemisphere feel some of the symptoms — less energy, finding it harder to get up in the morning, eating more — the difference is the degree. Seasonal Affective Disorder refers to the fact that these people become depressed only in the winter.”

Arbisi noted that Daniel F. Kripke, M.D., and fellow researchers at the University of California, San Diego, have conducted studies showing that bright light therapy — exposing subjects to the illumination of special light boxes for 30 minutes each morning — can be helpful in treating even those with Major Depressive Disorders when used in conjunction with “wake treatment,” the currently preferred term for sleep deprivation.

The difference, Arbisi said, is that light therapy is a possible adjunct to treatment for other forms of depression, which may require medication as well. For SAD cases, light boxes provide the primary treatment and often the only treatment needed.

“The light therapy is more effective than medication, and it’s swifter and has fewer side effects — none, in fact,” Arbisi explained. “Anecdotally, most people report improvement within a few days.”

The regimen is simple once a SAD diagnosis is confirmed. The sufferer is instructed to buy a special light box that provide light of 10,000 lux intensity at a specified distance, then spends a half hour each morning, usually sometime between 7 a.m. and 9 a.m., within the recommended proximity.

“The person can read a book or watch television or the like. You can eat your Cheerios or whatever, but you shouldn’t walk away,” Arbisi said. A light box will have accompanying instructions on the distance to be maintained for optimum results, he said. “They must stay close. As distance increases the effect decreases exponentially — it drops off like a cliff.”

Arbisi said most light box manufacturers have sites on the Worldwide Web describing their products and clients should seek advice from their psychologist on which model best suits their needs. Important considerations include a full spectrum light source with diffusers to filter out ultraviolet rays and the absence of flickering, Arbisi said.

He said he has used models manufactured by Apollo Health and SunBox Inc. in his studies but many other manufacturers have entered the market since the SAD diagnosis emerged in the 1980s.

The primary sign that a depression stems from Seasonal Affective Disorder is its predictable onset each winter, Arbisi said. “People with Non-Seasonal Affective Disorder do not show that regular correlation,” he said.

The instructions accompanying a particular light box model should be followed, but the “rule of thumb” is to begin with 30-minute sessions, Arbisi said. “That’s what I usually start out with. When they begin to show remission, I may have them back down to 15 minutes.”

Once relief is achieved, the client can use the light box as necessary while awaiting the ultimate cure — the return of spring and longer hours of daylight.

Arbisi said most clients also will benefit from a better understanding of SAD. “I think the best book for the lay person is Rosenthal’s (Norman E. Rosenthal, M.D.) Winter Blues.”

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