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The waning days of October signal certain rites of fall: turning back clocks to standard time, raking mounds of leaves and picking out bright orange pumpkins to carve for Halloween.
For thousands, it also has involved revving up a bulky light box to ward off the effects of seasonal affective disorder, or SAD, leaving many sufferers to feel like a freak with a voodoo-style treatment.
But SAD, a mood disorder related specifically to a change in season that causes sleepiness, fatigue and depression, has gone from fringe disorder to mainstream malady in recent years. Its light treatment is now so convincingly documented that researchers are studying light therapy for other mood disorders like premenstrual syndrome, major depressive disorder and bulimia nervosa. Doctors also are beginning to be convinced of the benefits of light therapy for people with certain sleep disorders and jet lag and those who work night shifts.
Nearly half of the nation's insurers pay for light therapy when prescribed by a psychiatrist or psychologist to treat SAD, according to an article published in the Journal of the American Medical Association.
"We do know that light therapy works, definitely, for people with seasonal affective disorder," said Dr. Margarita Dubocovich, professor of molecular pharmacology and biological chemistry at Northwestern University School of Medicine.
Perhaps one of the biggest gains in the treatment of SAD, however, is the advent of much smaller, portable, lighter-weight appliances, minimizing the freak factor for many sufferers of the syndrome.
"This is just fabulous," said Tim Byrne, a comptroller from Atlanta, of his new light box that weighs half a pound. "I love the technology, and I can use it in the morning just as I'm making my coffee."
Therapeutic doses of light for SAD sufferers like Byrne need to be bright enough to mimic dawn or twilight --- somewhere between 2,500 and 10,000 units of light measurement called a lux. Household lighting such as that in incandescent bulbs cannot come close to creating the level of light needed to relieve SAD symptoms.
For years, only bulky fluorescent tube lighting in a metal box, covered with a plexiglass screen to filter out dangerous ultraviolet light, was effective in providing very bright indoor light.
As the science progressed, however, a new light source became available. Scientists in Japan about five years ago were able to create white light from a light-emitting diode, an electronic device with two electrodes that may one day push the light bulb to extinction. A distinct illness
Larry Pederson of Alberta is one of several who have responded to the market. His Litebook company has developed the lamp that Byrne uses.
Instead of the fluorescent tube of traditional light boxes, it has 60 light-emitting diodes, pencil eraser-sized discs of white light that produce 5,000 lux.
While SAD has some of the symptoms of depression, such as lethargy, blues, overeating and sleeping, it is a distinct illness. First documented in the late 1800s, SAD became evident as people moved away from farms and into factories, thus lowering the amount of time they spent outdoors each day. In the winter months, as people ended their workdays in darkness, their exposure to daylight was negligible. Cafe light boxes
The extra darkness appears to stimulate the pineal gland, which secretes melatonin. The higher level of melatonin makes a person sleepier and lethargic.
Experts estimate that about one in 20 people in the United States have a pronounced form of SAD, and another three in 20 have a milder version of the syndrome.
In Canada, where winter days can be only a few hours long, every university hospital has a SAD treatment clinic. And in Scandinavia, some coffee shops have light boxes so that patrons can get a dosage of light along with their morning coffee on winter days.
"We have four lamps that people use," said Tanka Sipila of Cafe Engel in Helsinki, Finland. "They are pretty popular."
While people in higher latitudes, such as Pederson's Alberta, are most vulnerable, Atlanta and the rest of the sunny South have their share of sufferers, too.
"I go into what I call hibernation mode," said Byrne. "I start craving certain foods, like pasta and starches. It's like a bear wanting to hibernate . . . but I can ill afford to stock up."
Byrne, who grew up in New York and has lived in Nebraska and Minnesota, said his symptoms were more pronounced when he lived farther north. But a job keeping him in front of a computer inside all day keeps him out of the sunlight --- and increases his symptoms of SAD.
While local psychologists cannot say how many people in Georgia have SAD, they have seen more casees in recent years. They are unsure whether the increase comes from better awareness of the disorder or perhaps from Atlantans spending more time in darkness during morning and evening commutes, thus seeing the light of day less frequently.
'It is absolutely a legitimate syndrome here," said Buckhead psychologist Robert Simmermon. "It can be dismissed as a fad, but that's a mistake."
Karla Schell, a case manager for a health care company who lives in Atlanta, has suffered from SAD for years. She has a panoply of fluorescent lamps and lights, she said, including one that is timed to turn on before dawn so that she awakens to a gentle daylight glow.
"I couldn't survive without them," Schell said.
Clinical trials are under way at several sites to determine whether light therapy can help depression by raising levels of serotonin and dopamine, chemicals in the body that also affect mood.
Dubocovich and others noted that studies also show that treatment with the hormone melatonin are effective for many who suffer from SAD.
But all researchers interviewed cautioned strongly against using melatonin, available in many health food stores, without physician oversight.
"Melatonin is not controlled," explained Dr. Beth Malow, director of the Sleep Disorder Clinic at Vanderbilt University. Thus, it is hard for consumers to know the purity of what they buy and also effective and safe dosage regimens.
Malow also noted that even though light boxes have been proved safe and effective, it is still best to use them only under a doctor's care.
In some cases, the light dosage leads to mania, or excessive excitability and hyperactivity, Malow said.
Also, those who suspect they may have SAD should not self-diagnose and self-treat with a light box.
"You have to be sure you have the right diagnosis," said Dr. William McKinney of the Asher Center for the Study and Treatment of Depressive Disorder at Northwestern.
"It's a very specialized diagnosis. There are a lot of reasons people can get sad during the winter months. It needs to be looked at. We're not talking about the blues here and there."
Copyright 2003 The Atlanta Journal-Constitution