How Seasonal Affective Disorder came to be recognized as a problem

A 1981 Washington Post story began: "I should have been a bear."

The subject, quoted under a pseudo-name, was a young professional woman in New York suffering from depression that only emerged in the fall as the days got shorter, cooler and gloomier.

A researcher at the National Institutes of Mental Health, Norman Rosenthal, was studying the impact of light on mental health and theorized that in rare cases the human brain may respond negatively to the diminishing exposure to sun.

At the end of the Post article, the reporter gave Rosenthal an assist, asking readers to contact him if they too experienced seasonal mood changes.

"I thought I was dealing with a very rare syndrome," he said. "I thought we'd get maybe half a dozen and we could do something. We got 3,000 responses from all over the country."

Rosenthal, who in 1984 was the first to identity and later label Seasonal Affective Disorder, or SAD, has spent the last 30 years of his career studying and refining the causes, symptoms and cures for depression induced by lack of light.

Today, though estimates vary, more than 10 million Americans are believed to struggle with SAD. And many more experience a milder version, commonly referred to as the winter blues.

SAD was added in 1987 to the American Psychiatric Association's official manual as a descriptor for major depression. It's so ubiquitous now that a restaurant in Manhattan recently began serving a cocktail infused with drops of vitamin D to combat the winter blues.

Pizza Beach opened in the dead of winter earlier this year with the promise of transporting patrons out of the cold and onto the beach. "I can't stand it," owner Anthony Martignetti said of the winter months. "I know that (SAD) is more real than people give credit."

The drink, a mixture of rum, orange and pineapple juice and nutmeg, spiked with vitamin D, is his small part to try and help.

Vitamin D supplements have helped Ben Kubaryk, a 31-year-old living in Washington, D.C., cope with his cyclical depression. But they weren't enough.

Kubaryk spent most of his childhood in Puerto Rico, but his family relocated to Atlanta when he was 15 years old. Georgian winters are fairly mild, but living at the higher latitude impacted him almost immediately.

That first winter, he said he felt like he was sitting in a cold, dark hole. Each year after, he'd feel himself begin to dig the hole in the early fall and by December he'd be immersed in it. He could see a spot of warmth above him, he said, but it was out of reach.

It wasn't until college, when he learned about SAD in a psychology class, that he recognized his symptoms in the description. Come winter he'd lose energy. It was hard for him to get out of bed. In group settings, he wouldn't speak up and later wonder why he'd been so quiet.

From the middle of December through April he'd go about his day like a zombie, slogging through, not initiating conversation. After another bleak winter this year, Kubaryk bought himself a light box that mimics sunlight. He started sitting in front of it in September every morning before work. So far, the cold, dark hole has stayed closed.

"I promised myself I'm not doing this again," he said. "There has to be a better way to do winter."

In the early 1980s, Rosenthal discovered that "lengthening" the shorter winter days with artificial light could boost mood and energy. It's believed that for people with SAD, the lack of light slows their release of serotonin - a brain chemical that affects mood.

Eating sugary, carbohydrate-rich foods also increases serotonin, which is why cravings may increase in the winter leading to weight gain, a common side effect of SAD.

Rosenthal laid out this example: The seasonal depression has made you lethargic and you miss a deadline at work. Your boss is angry and gives you a poor review. Now you feel worse. Desperate for comfort you eat three doughnuts. You put on a few pounds. Your clothes are tight.

"It's a spiral," he said.

Light therapy has helped Sue F. (she asked that we not use her last name), a 55-year-old artist in Gaithersburg, Maryland, manage her SAD. Like Kubaryk, she had spent her early childhood on the Marshall Islands in the Pacific Ocean, but moved to Boston when she was 10 years old.

Even then, she noticed that she wasn't as happy in the winter. But it wasn't until she moved to Chicago in her early 20s that she noticed how, come fall, small chores like going to the grocery store or doing laundry felt strenuous.

"It feels like moving through honey, like you're in a big bathtub of honey," she said. "You have the right intentions, you remember how it is to go for a jog, but you're slowed down despite yourself."

She uses a light box every day. It gets her to about 50 percent, she said. And though she's been dealing with cyclical depression her entire life, every year around this time it still catches her a bit off guard.

"All of a sudden it's not August anymore, social interactions that are normally very easy, oh my goodness, they become more difficult for a now obvious reason," she said. "Every year I kind of forget when the summer is going that fall is coming. Maybe it's a quirk of nature."

It's common for sufferers of SAD to feel like the winter has crept up on them, especially if they are feeling jubilant and active during the summer months. Rosenthal recommends pre-emptive action to get ahead of it.

As the days become shorter, many of us wake in the dark, go into an office, and return home in the dark, perhaps never seeing actual sunlight. From his book, "Winter Blues," here are five ways Rosenthal suggests getting ahead of SAD by starting these treatments as soon as possible. He says they can all be used together for a holistic approach.

Light therapy

Purchase a light box and sit in front of it, with your eyes open but not looking directly at it, for about 20 to 90 minutes every day, preferably early in the morning.

Rosenthal has found that 2,500 to 10,000 lux (the measurement for light intensity) is appropriate for SAD therapy. Most recommended boxes run between $100 to $250.

Sometimes insurance companies will reimburse you with a note from your doctor.

Also, even when it's freezing, get outside into real sunlight if you can.

Exercise

Aerobic exercise that elevates the heart rate is known to improve mood and energy.

If feeling unmotivated, Rosenthal suggests incorporating light therapy with exercise, whether it's bundling up and going for a brisk walk during the daylight hours or exercising at home in front of the light box.

Since SAD often leads to overeating, working out can also help stave off weight gain.

Diet

Eating healthy during the winter months is another way to keep energy up.

While challenging during the holidays, limit carbohydrates, which provide only a quick jolt of good feelings. They wear off, blood sugar drops and lethargy kicks in.

Rosenthal says SAD suffers should be mindful of eating more protein-rich and nutrient-dense foods like lean meats and vegetables and less sugary, processed items like candy or white flour-based products.

Meditation

Rosenthal recently updated his book to include this treatment for SAD.

By bringing your mind to the present, people often feel calmer, less anxious and can concentrate more. People find these practices help them regulate their emotions.

Take a vacation

While not always easy for some, going to a sunny climate in the middle of the winter can provide a much-needed energy boost and mood elevator.

Just a few days in, the strong sun can lift people out of their deep sadness. Rosenthal warns, however, that when returning home the SAD symptoms could feel worse, so it's crucial to continue the above regimens.