Cover Story
“April is the cruelest month”? I guess T.S. Eliot wasn’t suffering from seasonal affective disorder when he wrote “The Waste Land,” and a good thing, living as he did in gray old England. April Schmapril—April is a fainting lily next to November.
November could tear April’s heart out through her throat. November is winter’s merciless siren, enticing us with her vivid early colors before hurling us into a cold and lifeless dungeon, taunting us like a death row prisoner’s lavish final meal. No month is more bittersweet—the breathtaking radiance of changing leaves in autumn’s peculiar late-afternoon sun, separated by only days from the wintry landscape’s lifeless pallor. I’ll stare at a glowing-orange sugar maple for several minutes without moving, hoping to store its vibrant hue in my neurons as some sort of insulation against the dreariness that will soon permeate my senses.
And the cruelest day? That’s easy—the last Sunday in October, when we turn the clocks back an hour. Sure, the time change doesn’t make the days any shorter—it just redistributes the sunlight. But it means that, before I know what hit me, the sky will pretty much be pitch-black by 5 p.m. I’ll start to feel sluggish, and in a couple weeks I’ll want to withdraw into my lair, like a hibernating bear. I’ll struggle at work, avoid social situations and won’t feel like answering the phone. (At least, that’s how things used to be....)
“Autumn enchants some with its grand colors, but for others it carries the menace of winter,” psychiatrist Norman Rosenthal writes in Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. Rosenthal, widely considered the world’s foremost authority on SAD, suffers from the syndrome himself, though it never manifested itself while he was growing up and training as a doctor in the temperate climate of his native South Africa. He had his first real experience with changing seasons upon moving to New York for his psychiatric residency.
“I left work that first Monday after the time change and found the world in darkness,” Rosenthal writes. “A cold wind blowing off the Hudson River filled me with foreboding. Winter came. My energy level declined, and I wondered how I could have undertaken so many tasks the previous summer. Had I been crazy? Now there seemed to be no alternative but to hang in and try to keep everything afloat. I understood for the first time the stoic temperaments of the northern nations. Finally, spring arrived. My energy level surged again, and I wondered why I had worried so over my workload.”
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So why is it that for Rosenthal, myself and countless other SAD sufferers, winter is so inordinately challenging?
Hmmm…can’t think. Maybe I’m coming down with something. Let’s shuffle these papers around my desk a little. There, that looks a little tidier. OK. Now, where was I? Oh yeah, that cover story on seasonal affective disorder. What day is it? Shit, it’s due next Thursday.
C’mon, just think of another paragraph, sentence, anything for Chrissakes! Focus!
“Seasonal affective disorder, or SAD, is a type of winter depression that affects an estimated…”
Perfect...if I was writing a sixth-grade term paper. Think, think…
“For as long as I can remember, I’ve suffered from seasonal…”
Yeah, that’ll draw ’em in. Not to mention that, these days, “as long as I can remember” is about three weeks.
Maybe I can bargain for time. “Liz, can I get another week or two? I can’t write my story on seasonal affective disorder because I’ve got seasonal affective disorder. It’s like when you misplace your glasses and can’t find ’em because you don’t have your glasses on.” How can she argue with that?
Maybe I’m protected under some sort of Americans With Disabilities Act clause. But what’ll that mean? I’ll just have to do it in December, when the days are even shorter and bleaker. Maybe I can wait till spring, when I’ll feel better. Nah, a story on the winter blues in April ain’t gonna fly. How about a story on springtime post-SAD hypomania?
I know, I’ll just quit and look for a new job—in a nicer place, where it’s sunny and warm year-round. There’s gotta be something on the Internet. Let’s see if this works...aruba.craigslist.com...come on…come to daddy... “Server not found.” Crap.
Damn, I’m getting drowsy. I hate mid-afternoon. Did someone drug my coffee? OK, close the door, put my feet up, close my eyes, a few minutes’ rest and I’ll feel refreshed. Seasonal… affective… tropical… Baywatch… zzzzzzzzzzz.
Huh? What time is it? It’s dark outside—I must’ve been asleep for hours. It’s only 5:15? Criminy! It’s only Nov. 3! Why did I ever move to Nashville? I figured the winters would be much milder than in Cleveland—but it never dawned on me that, being on the eastern end of the Central time zone, Nashville gets dark an hour earlier and is a tough place to live if you’re a SAD sufferer.
Ugggh.
No one can be sure why some people suffer from SAD, but the medical community now widely acknowledges the syndrome. It’s officially listed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the bible of the psychiatric community.
“It’s probably a vestigial sort of hibernation,” says Dr. Kirby Pate, a Nashville psychiatrist who works extensively with patients with SAD and sleep disorders. “If you think about it, if you lived in an agrarian society, it would really be pretty adaptive. You’d be less likely to want to get out in the cold where you’d freeze, you develop a preference for the foods that store better—a sack of potatoes will last all winter—and you’re less likely to conceive at a time when the mother’s vitamin stores would be at their lowest. So there are advantages.”
Light therapy seems to be the most effective, consequence-free treatment for SAD. Over the past 20-odd years, SAD researchers have concluded that lack of daylight is the key contributor to the annual malaise, which, according to Rosenthal’s book, affects about 6 percent of the U.S. population. (There are many more people who suffer from a milder winter blues that is not nearly as debilitating, but who also might benefit from light therapy.)
Colder and wetter weather can certainly affect moods, but light interacts with our bodies in specific ways that alter our biochemical processes. Basically, Pate says, people with SAD are running behind. “Their internal clock is two to four or more hours behind. These folks need much more light than normal.”
The obvious solution—get more light. But not just any light. Almost all of the doctors and researchers working with SAD agree that a light box is essential. There are several varieties—the one I use, which is a common style, is about a foot high, 2 feet long and 3 inches deep. When I have it on in my office, it looks a bit like a mini UFO has turned my desk into a landing pad.
To experience the greatest benefits, the light box should be 10,000 lux (a measure of brightness). The boxes use either regular white fluorescent bulbs or full-spectrum bulbs. Though research has shown both bulbs to be equally effective, many people (Rosenthal and myself included) prefer the full-spectrum bulbs, as they more closely approximate natural daylight. Light boxes must have a diffusing screen, which filters out potentially harmful ultraviolet rays.
They aren’t cheap—most models are in the range of $250 to $350—and it might be a challenge to get your insurance company to pay for it. “There’s no way to patent a light box,” Pate explains. “No one company is going to go to the trouble of getting FDA approval [so that insurance companies would more readily pay for the box] unless they have a patent on the process, and virtually anyone can make a light box. But I think everyone is in agreement. No one doubts that it works.”
Certain antidepressants are also effective—don’t tell Tom Cruise—and, Rosenthal says, some patients benefit most from a combination of drugs and light therapy. But Rosenthal and Pate agree that light therapy is the place to start. If the patient isn’t feeling better after a couple weeks, then medication should be considered.
“I encourage people to use light because it is the natural substance,” Pate says. “It’s what they lack. No one has ever accused me of not giving enough medicine. I think if it’s going to help, why not? But this is a case where you do really have a better alternative. You can buy a light box and use it the rest of your life. Think about what medicines are going to cost the rest of your life.”
There are other steps that can provide additional benefits to SAD sufferers. “Be very strict about your sleep schedule,” Pate advises. “Never sleep late. Get an adequate amount of exercise, and also an adequate amount of natural light.” Rosenthal’s book likewise emphasizes the importance of sticking to a regular sleep schedule, one that, most unfortunately, includes rising early in the morning.
I sit down to begin you a letter, not because I have received one since my last, but because it is one of the dankest, foggiest, and most dismal of November nights, and, as usual when the sun does not shine, I am as out of sorts as a man may haply be, and yet live through it…. This season of the year grinds the very soul out of me. My nerves lose their tone, my teeth ache, and my courage falls to the bottomless bottom of infinitude.... I would give up all my pleasures willingly if I could only be a mouse, and sleep three months at a time. Well! One can’t have life as one would, but if I ever take too much laudanum, the coroner’s jury may bring in a verdict of willful murder against the month of November.
—A letter from historian and author Henry Adams to Charles Milnes Gaskell, November 1869
Laudanum was never my drug of choice, but had it been readily available in the autumn of 1986, I probably would have stockpiled the stuff like a squirrel gathers acorns. It was the end of October, I was living in New York City’s Lower East Side, and the Mets, of whom I’d become a diehard fan, had just pulled off an amazing come-from-behind World Series conquest. It was my first experience rooting for a championship sports team, and I went whole-hog—running through the streets after Game 7, skipping work to go to the ticker-tape parade down Broadway.
Then came the post-championship blues. At least that’s what I suspected it was. Suddenly it was November, and it seemed there was nothing to live for. I felt myself sinking into a deep funk. Fortunately—or so I thought at the time—my neighborhood had no shortage of opiate-related laudanum alternatives, with which several of my friends had taken to experimenting. So began a debilitating drug habit that lasted several years after.
If only my friends had been experimenting with light boxes instead of heroin. Sure, light boxes didn’t have the same tragic mystique. You didn’t hear your bohemian cohorts whispering about how Miles Davis was deep into a light box habit when he recorded Bitches Brew, or how Lewis Carroll wrote Alice in Wonderland under a 10,000-lux haze. And make no mistake—my addiction problems had roots far deeper than a little seasonal affective disorder. But still, even though it’s been over a dozen years since I’ve even had a drink, I remember that my substance abuse would severely escalate as I headed into winter.
Though I first made the connection between the season and my annual funk while living in Cleveland in the early 1990s, I became much more aware of it when I moved to Nashville. Despite the milder winters, I found the earlier sunsets abominable. Sure, it got light much earlier than in Cleveland, but I was hardly an early riser, so those early daylight hours were lost on me.
I’ve been using a light box for the past few years, and the improvement in my mood has been dramatic. I’ve also made it a habit to wake up earlier and to get more exercise. I still feel a little slower, a little more sluggish and a tad less sociable this time of year. But now, instead of slipping into a black hole of despair, the worst that will happen is that I might skip a party to stay home and watch four continuous hours of Law & Order—even those Criminal Intent episodes featuring the painfully annoying Vincent D’Onofrio.
But it’s nothing compared to the way I used to feel. And, outside of the benefits of the light box, the simple matter of knowing that I have SAD is a huge relief. Before identifying the pattern, when November came around, I just thought there was something horribly wrong with my life, and I couldn’t put my finger on it.
Sure, my co-workers give me a good-natured teasing about the light box on my desk at work, but, come January, I’ll notice that they wander into my office more frequently—and for longer periods. I’m even more of a sarcastic bastard than usual this time of year, so I’m not sure what is responsible for these lingering visits. Must be the warm glow of the light box.