When winter first makes its appearance, there’s usually a honeymoon phase. The first snowfall, thoughts of warm winter meals that aren’t as appealing in the warmer months, and visions of cozy nights in with a fire and the people you hold most dear. Maybe you’re not into all the cozy aesthetics that colder temps can bring (give me an oversized sweater and constant flow of hot coffee and I’m happy for at least a month) but you jump at the chance to get out and play in the snow: snow shoeing, skiing, ice fishing, snowmobiling and the list goes on.
No matter how you make it through the winter: with a grin or a grimace, it eventually gets long for everyone. Did you know that the difference in daylight hours between the Summer Solstice in June and the Winter Solstice in December is an incredible 6 hours and 20 minutes in Wisconsin? We lose almost a half a day’s worth of sunlight in the winter. My brother, who made the bold life choice to relocate to Alaska several years ago sees an even greater disparity between light and dark. Right now he’s getting about 6 hours of daylight every day and even that’s not direct sunlight.
That lack of sunlight might just leave you feeling a little low or it may mean you’re experiencing something called Seasonal Affective Disorder, or S.A.D. which is a form of depression that surfaces at the beginning of the colder months and then usually resolves or improves drastically when the weather turns warmer and days become brighter (Seasonal affective disorder (SAD) 2017).
So it’s dark, why does that matter?
We all know that too much sun is never a good thing (although I am guilty of getting a bit too sun kissed in the summer now and then). But what happens to our bodies as we hit the deep, dark days of winter and our faces don’t see the light of day for what feels like an eternity? It turns out there are actual physiologic and psychological effects. In simple terms, a lack of sunlight, which happens commonly in the winter, can lead to lower levels of vitamin D, decreased serotonin (the hormone classically thought of as the “good mood hormone”), and can affect both your physical function as well as mental health and cognition.
Phototherapy
Like I said, there are a number of things that can aid in reducing the degree of symptoms when the winter blues arise. Perhaps the most fascinating concept I’ve come across is that of phototherapy, otherwise known as light therapy. Simply put, we lack natural light in the winter months and over the course of time, scientists have figured out how to manufacture that. There are several different options when it comes to light therapy, all of which can be helpful when it comes to the winter blues (tanning beds aren’t one of those options). Light therapy may not cure your seasonal depression but it has been shown to decrease symptoms and improve overall mood and energy, sometimes producing noticeable change in a little as a few days. On average, results show up in 2-4 weeks (Light therapy 2017). Light therapy can be used in combination with medication and other behavioral interventions to help treat seasonal depression.
How does it work?
A common misconception about light therapy is that the task is accomplished simply via direct exposure to the sun. In reality, the work is accomplished through ambient exposure to the eyes. You certainly don’t want to be staring directly at the light but the light needs to be able to enter your eyes. Bright light, whether via natural sun or light therapy, works through activation of cells within the eye that connect to the hypothalamus (a gland that regulates A LOT of things in the body). Activating the hypothalamus at the typical “dawn” time of the day can help your body return to a normal circadian rhythm, thus improving S.A.D. symptoms. While learning about light therapy, I was so intrigued to find that it had more to do with the eyes than the skin.
How do I “do” light therapy?
The beautiful thing about phototherapy is that there are a number of ways to incorporate it into your life. In its simplest form involves a small, table top light box like this one and when a quality light is used, it only takes 20-30 minutes per day. Many people place these on their desks or next to their beds and work on other tasks while simultaneously practicing light therapy. Here are some basics to consider when initiating light therapy:
| Light intensity | Mayo Clinic recommends using a 10,000-lux (100x brighter than typical indoor lighting) light box at a distance of about 16 to 24 inches from the face. A bright sunny day is rated at about 50,000 lux for comparison. |
| Duration | With a 10,000 lux light box, 20-30 minutes a day is recommended. Lights with lower intensity may require sessions up to 60 minutes/day. |
| Timing | Light therapy is typically done in the early morning as this mimics sunrise and stimulates serotonin release that naturally occurs with daylight. |
| Consistency | Consistency is key. Aiming for daily light therapy sessions are the best way to maximize results. |
| Track it | It can be helpful to keep a journal of symptoms and light sessions to know if symptoms are improving over time. |
| UV filter | Find a light that filters out UV rays. These are the harmful light rays that can cause damage to your body. You may have to spend a little bit more but finding a light that fully filters UV is worth it. |
Photo by Joseph Redfield on Pexels.com
Time is Precious
You might not have the time to sit and stare at a light box for a half hour a day. Life is busy, we only get so many minutes in the day, and multitasking is almost a requirement for function these days. If time isn’t on your side, another viable choice for using light therapy is the dawn simulator. This is essentially a light that is situated over the user’s bed that comes on near dawn and slowly increases in intensity over 30-60 minutes. Its function is in its name: it simulates natural dawn. Treatment in this mode is actually accomplished through your eyes: light is able to pass through your eyelids and reach your retina that way. By the time you’re awake, your light therapy session is already done and you won’t have missed a beat (Phelps, 2016). The dawn simulator also works in conjunction with the natural circadian rhythm (your sleep-wake cycle) because of the gradual onset of light whereas the bright light therapy jumps right to full brightness, bypassing that benefit.
The work of choosing a good dawn simulator can be challenging. There are a lot of options but fortunately you can check out this link for a list of the best dawn simulators broken down by lux intensity, additional features, the ability to filter UV rays, and price point, among others.
Timing
It’s recommended that light therapy is utilized in the early morning hours to most closely mimic natural sunrise and your circadian rhythm. If you can’t get in an early morning light session, doing it later in the day still proves beneficial as long as you’re not doing it within about 2 hours of bedtime.
Most people who experience the winter blues or who are diagnosed with Seasonal Affective Disorder notice that symptoms start mid-fall when days are shorter and typically cloudier and persist through until spring when the days become brighter and longer. Most patients utilize light therapy during symptomatic times, starting a few weeks before symptoms typically set in and continuing until they begin to taper off as natural exposure to outdoor light increases and can take over for supplemental light therapy. Some people use light therapy for non-seasonal depression and this is something you can pursue with your doctor to see if it’s right for your circumstances.
Does light therapy actually work?
One study of 95 participants comparing bright light therapy, dawn simulation, and placebo groups found that dawn simulation resulted in greater remission of depression symptoms than bright light therapy and placebo (Avery et al., 2001). Another study utilizing both bright light therapy and dawn simulation showed a 43.8% and 42.2% reduction in depressive symptoms over a week long course of treatment based on a subjective depression rating (Danilenko & Ivanova, 2015). In some cases, light therapy is at least as effective as antidepressant medications for treating seasonal affective disorder (Miller, 2020)
Are there any risks or side effects?
There are certainly groups of people who may want to avoid initiating light therapy. If you have skin conditions that make you more sensitive to light, if you take medications that affect your skin’s response to light, or if you have any eye condition, especially one that may be aggravated by exposure to light, you should have a chat with your personal provider to make the decision regarding light therapy in your treatment of S.A.D. or winter blues. You should also know that the Food and Drug Administration does not approve or regulate light therapy despite the number of studies showing efficacy. There are a lot of light boxes on the market. If you’re curious about light therapy, ask your doctor because chances are, he or she perhaps has a recommendation for a reputable light box and can provide helpful tips for making the most of your light therapy experience.
Additionally, if you suffer from bipolar disorder, light therapy may trigger mania. You should hold off on starting any kind of light therapy program until you’ve discussed with your doctor.
Side effects of light therapy are typically fairly mild and can include things like eyestrain, headaches, mild nausea, irritability, or mania/hyperactivity. These things usually resolve on their own within days of starting therapy but can be somewhat lessened by decreasing the length of light therapy, increasing distance between you and your light box, and changing the time of day that you use light therapy (Light Therapy, 2017).
No treatment is an island
Just like no man is an island, no treatment for S.A.D. is 100% effective on its own. Light therapy may be used in conjunction with medications prescribed by your doctor to help manage depressive symptoms. In addition, counseling, behavioral therapy, adequate sleep hygiene, and ensuring good dietary intake of vitamins and minerals may also help improve depressive symptoms. Hopefully you’ll give light therapy a try and if you do, I’d love to hear about how it went and if it was helpful.
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References
Avery, D. H., Eder, D. N., Bolte, M. A., Hellekson, C. J., Dunner, D. L., Vitiello, M. V., & Prinz, P. N. (2001). Dawn simulation and bright light in the treatment of SAD: a controlled study. Biological psychiatry, 50(3), 205–216. https://doi.org/10.1016/s0006-3223(01)01200-8
Danilenko, K. V., & Ivanova, I. A. (2015). Dawn simulation vs. bright light in seasonal affective disorder: Treatment effects and subjective preference. Journal of affective disorders, 180, 87–89. https://doi.org/10.1016/j.jad.2015.03.055
Light therapy. (2017, February 08). Retrieved January 10, 2021, from https://www.mayoclinic.org/tests-procedures/light-therapy/about/pac-20384604
Mead, M. N. (2008). Benefits of Sunlight: A Bright Spot for Human Health. Environmental Health Perspectives, 116(4). doi:10.1289/ehp.116-a160
Miller, M. C., MD. (2020, June 05). Seasonal affective disorder: Bring on the light. Retrieved January 10, 2021, from https://www.health.harvard.edu/blog/seasonal-affective-disorder-bring-on-the-light-201212215663
Phelps, J., MD. (2016, December 8). The Lowly Dawn Simulator. Retrieved January 10, 2021, from https://www.psychiatrictimes.com/view/lowly-dawn-simulator
Seasonal affective disorder (SAD). (2017, October 25). Retrieved January 10, 2021, from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
Team, T. (2020, April 07). 3 Surprising Benefits of Vitamin D. Retrieved January 09, 2021, from https://www.healthline.com/health/food-nutrition/benefits-vitamin-d#_noHeaderPrefixedContent
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