The Healing Power of Touch

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By Mary O’Brien, M.D.

Seasoned politicians understand it.  Talented athletes get it.  Even newborn babies are “all in.”  Unfortunately, too many professionals in health care seem to need a reminder.  We’re slightly distracted by gadgets these days.  Actually, touching patients has become, well, “yucky.”

Savvy politicians realized long ago that patting another person’s shoulder as they shook hands elicited more support and cooperation.  Players in the National Basketball Association who engage in more high-fives, fist bumps, and “guy hugs,” are apt to play better as individuals and as a united team.  (Believe it or not, psychologists have actually studied this.)

The landmark research on positive touch dates back many decades, revealing that newborns deprived of caring, gentle, living touch resulted in failure to thrive despite adequate nutrition.

Research into the neurophysiology of touch demonstrates remarkable conditions between pleasant, soothing sensations and social connectedness.  In a nutshell, “A-beta” nerve fibers conduct impulses related to touch.  These touches are triggered by– displacement or movement of long hairs on the skin — by vibration, movement, indentation, and stretch.  “A-beta” fibers enable us to detect a wobbly table, a greasy dish slipping out of our hands, the weight of a puppy curled up against us, or the wind blowing through our hair.

Another type of fiber, “A-delta,” carries information about the movement of short hairs on our face or body.  These sensations are decidedly unpleasant like walking into a spider web or feeling a bug crawling up our arms or legs.  Assorted other fibers carry pain impulses at a very rapid rate so that we can react and hopefully survive.

However, the newest nerve fibers to be discovered are part of the emotional or affective touch system.  They are called CT or “C-tactile” afferents.  These fibers transmit impulses associated with gentle, pleasant, nurturing sensations — an affectionate pat, a warm hug, or a loving caress.  Compared to pain fibers, “C-tactile” fibers are slower to respond, perhaps encouraging the pleasant interaction to linger a little longer.

Gentle touch fosters human interactions, togetherness, and nurturing for survival.  It’s fascinating that touch is the first to develop in utero and the most highly developed one at birth.

Clinical research is underway to study the effects of gentle, pleasant touch on conditions including autism, neuropathic pain, depression, and spinal-cord damage.  Why wait?  Let’s put the gadgets aside for a minute and touch the patient.  You’ll both feel better.

References
— Denworth, L. The Social Power of Touch.  Scientific American Mind.  July-August 2015, pp. 30-39.
— Voos, A.C. Periphery, K.A., and Kaiser, M.D., Autistic Traits Are Associated with Diminished Neural Response to Affective Touch.  Social Cognitive and Affective Neuroscience, Vol. 8, No. 4, pp. 378-386, April 2013.

The Sounds of Silence

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By Mary O’Brien, M.D.

Paul Simon and Art Garfunkel had a huge hit with “The Sounds of Silence” about 50 years ago.  It resonated with millions of people.  Back in the late 60’s and early 70’s, excessive noise was considered a form of pollution, and that was long before anyone knew what a cell phone is.

Today, the scourge of excessive noise defies description.  Unfortunately, it has metastasized, with some devastating consequences, into every nook and cranny of health care.

People in medical and dental practices, hospitals, pharmacies, nursing homes, and every other patient-care area are bombarded by incessant noise.  Blaring TV’s, radios, “ patient-education” videos, cell-phone conversations, and shrill chatters continuously assault people who are sick and in pain.  Some are them are even patients.

What exactly are the consequences of noise pollution in healthcare?  For starters, staff members become increasingly edgy, irritable, and distracted.  Burnout is rarely far behind.  Patients and family members are often restless and annoyed.  Patients in hospitals and nursing homes cannot rest or sleep.  The resulting physiologic cascade can be staggering:  1) blood pressure and pulse increase; 2) glucose levels rise; 3) adrenaline, noradrenalin, insulin, and cortisol levels rise; 4) lymphocyte counts fall;  5) pain thresholds drop; and 6) tempers flare.  Rarely, however, does anyone make the connection.  What should we do?  Let’s take better care of ourselves in order to take better care of our patients.  Turn the sound down, or, better yet, turn it off (at least for a little while).  The sounds of silence are long overdue.

Diet and Alzheimer’s Disease

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What weighs a mere four pounds and has a workload that demands 20 percent of all the oxygen inhaled?  Answer:  the human brain.

As technology opens the door to the unique metabolic functions of the brain, scientists are investigating the nutrients required to keep mentally sharp over the decades.

With dementia rising at an alarming rate — along with obesity, diabetes, heart disease, and other ailments — let’s eat with purpose, using sound, nutrition-related science applicable to the brain and the rest of the body.

Starting with the belief that what we eat plays a significant role in determining who gets dementia, Martha Clare Morris, Ph.D. and colleagues developed the MIND Diet as an intervention against the most common cause of neurodegeneration:  Alzheimer’s disease.

The work of Morris and her colleagues is based on research completed at Rush Medical University in Chicago, Illinois.  The term “MIND” is an acronym for Mediterranean-DASH Intervention for Neurodegenerative Delay.

The DASH diet plan is based on research sponsored by the U.S. National Institutes of Health.  The plan was developed to lower blood pressure without the use of medication.

The Mediterranean and DASH diets are models of healthy eating for the body.  The Morris team chose foods that improve brain function significantly and also added to overall body wellness.

Adherence to the MIND diet may lower the risk of Alzheimer’s disease by as much as 53%, offering more protection for the brain than any other dietary regimen.

The MIND cuisine lists 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine).  The plan limits consumption of five brain-unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, and fried or fast food).

The plan suggests a minimum of three servings of whole grains, a salad, and one other vegetable every day — along with a glass of wine.  For snacks, add a variety of nuts.  Berries are the only fruits recommended.

Specifically, blueberries are noted as the powerful protectors of the brain.  Strawberries are a second choice for good cognitive function.

Use Google and enter the term “MIND Diet” for daily guidelines and recipes of a cuisine designed to maximize brain function while providing healthy foods for the rest of the body as well.

Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

 

Mood and Food

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What you eat can affect your risk of the most common mood disorder in the United States:  depression.

Mental health begins with lifestyle:  nutritious food; regular exercise; sufficient sleep; and coping skills.

The chemical components of food impact one’s state of mind throughout the day — that is, after every meal and snack.  A long period of time without nourishment (fasting) activates survival emotions throughout the brain.  Food, or the lack of it, thus alters both feelings and thoughts.

A significant part of the treatment program for patients with depression is a brain-healthy diet prescription designed by what may be termed a nutritional psychiatrist.  Clearly, changing one’s eating habits requires more time and energy than swallowing a pill.  However, research in mental health has appeared, showing the flaws of prescribing quick-fix medications — in the absence of healthy habits.

A recent study published in BioMed Central Medicine tested the effect of prescribing both a modified Mediterranean Diet and medication to treat patients with clinical depression.  Thirty-three percent of the patients given medication plus a modified Mediterranean Diet plan achieved remission in 12 weeks.  However, eight percent of the patients prescribed medication only reached remission in the same period of time. (Study by S. Reddy, January, 2017)  This mood-enhancing cuisine is highly concentrated in brain-protective foods:  fruits; vegetables; legumes; whole grains; raw, unsalted nuts; low-fat, unsweetened dairy foods; olive oil; and fish.

The positive effects of nutrition intervention reported in this study have encouraged psychiatrists to prioritize this diet prescription for all patients diagnosed with depression.  The modified Mediterranean food plan may help prevent the incidence of depression in persons at high risk, aid patients who reject medication, and may block the progression from mild depression to serious depression.

Regardless of one’s family history, the brain can slip into an imbalanced state that alters mood and mind-power. The wise statement, “You become what you eat,” applies to everyone.  The original Mediterranean cuisine has already scored high ratings against brain atrophy, pain, and all age-related diseases.  The Mind Diet, another modified format of the Mediterranean Diet, reduces the risk of Alzheimer’s disease.

Cook, eat, and share mood-enhancing meals.  It’s a challenge that delivers great rewards for the brain — sharper thinking and happier moments.
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Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

Finding Felicity in Food and Work

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“Life Is Good.” These three words have blossomed into a worldwide slogan.  Why?  You feel good just reading the words.

These days life elicits more worries than “happies.” Good times are short-lived and may be prone to addiction:  compulsive shopping with credit cards; eating comfort foods loaded with calories; drinking too much alcohol; or searching for drug dealers to soothe emotional or physical pain.  Sustainable happiness begins with the simple things:  the food you eat and the work you do.

Brain imaging has identified the pathway that produces good feelings.  Named the Reward Circuit, you experience an emotional response to foods consumed and work performed. Thus, the recommendation to “eat right and move more,” can improve both happiness and health.

Is eating right a happy experience?  It’s pretty obvious that foods high in fat, sugar, and salt light up the Reward Circuit, elevating feelings of joy.  Is it possible to eat foods that are healthy for the brain and add “happy” to your mood?

Researchers at the University of Warwick in Coventry UK say “yes!”  The staff followed 12,000 adults from Australian households for six years.  Participants kept food diaries and answered survey questions about their lives as well as their mental and emotional health.  By the end of the second year, participants who changed from eating no fruits and vegetables a day to eight portions a day reported feeling happier.  Participants who did not increase their intake of fruits and vegetables over the same period experienced a drop in happiness score.  The “happy” power of fruits and vegetables was equivalent to going from unemployment to a job. (American Journal of Public Health, August, 2016)

Consuming eight servings of fruits and vegetables each day (about four cups) provides thousands of antioxidants and anti-inflammatory nutrients that improve brain function in measurable, mood-altering ways.

What about work?  Regardless of the wording (labor, exercise, work, or toil), the brain activates, controls, and evaluates movement.  Both psychologists and neuroscientists have independently addressed the theory that work ignites positive emotions.

Psychologists investigated a unique consumer issue called “The Ikea Effect,” that is, the consequences of buyers’ assembling items purchased.  The study concluded that assembling an item boosted feelings of pride, confidence, and competence even when the end product was poorly assembled.  It appeared that work, especially with the hands, activated the Reward Circuit.

Real-time imaging of the brain, conducted by Kelly Lambert, a neuroscientist, confirmed the conclusions of the Ikea study.  Dr. Lambert recruited persons with untreated depression and set up work projects, such as pottery-making, wood carving, or knitting.  She demonstrated that labor with the hands and arms activated the Reward Circuit, elevating positive emotions sufficiently to eliminate the symptoms of depression in her patients.  Dr. Lambert labeled the process as “effort-driven reward.”  Yes, work can be a happy experience.  And, when the effort is purposeful and helps others, the happiness rating is even higher. (“Lifting Depression” by Kelly Lambert, 2010)

“The groundwork for all happiness is good health.” –Leigh Hunt, English poet

Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

What is a Mild Brain Injury?

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By Michael Howard, Ph.D.

The Mild Traumatic Brain Injury (MTBI) Working Group of the CDC (Center for Disease Control) in Atlanta has defined MTBI as an injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions:

  • transient confusion, disorientation, or impaired consciousness.
  • dysfunction of memory around the time of injury.
  • loss of consciousness lasting less than 30 minutes.

Mild traumatic brain injury is also called concussion.  Traumatic brain injury results when the neurons inside the brain are damaged from acceleration-deceleration forces during impact.  When the head is struck or moved violently, the gel-like brain is rapidly displaced or concussed back and forth within the skull.  The brain is distorted in shape and the fragile, thread-like neuron cells inside the brain can be stretched, torn, or traumatized by the mechanical forces.

Typically, the long axon of the neuron is most susceptible to injury.  The phenomenon is called axonal shearing.  This type of traumatic injury can result in the neuron’s death or temporary loss of function.  When, by head trauma, a number of neurons is disabled in such a manner, disruption or alteration of brain functions can occur.  This is the major mechanism behind MTBI.

Traumatic brain injury can result in the skull being broken or fractured (penetrating head injury) or the skull remaining intact (closed head injury).  In MTBI, closed-head injuries are by far the most common.  It is not necessary for the head to be physically struck to result in mild traumatic brain injury.  Violent back-and-forth movement of the head, called whiplash, can also result in neuronal damage.  The MTBI that is due to proximity to a blast explosion that many soldiers and others in Iraq have sustained is another example of an MTBI occurring without the head being physically struck.

WHAT ARE THE SYMPTOMS OF A MILD BRAIN INJURY?

It is common for individuals to have immediate symptoms of brain impairment after a mild traumatic brain injury.  These symptoms can be physical, cognitive, and behavioral in nature and can occur in any combination. They typically last up to a few weeks.  Although there is no “typical” MTBI patient, headaches, dizziness, insomnia, and intermittent confusion are commonly seen in the first days or weeks after the injury.  These symptoms are most severe immediately after the injury.

Over the few days or weeks following the injury, the symptoms should diminish in number and intensity.  Whether or not an individual will have symptoms persisting beyond the first few weeks or months is very difficult to predict and may depend on a number of factors, including the presence of co-existing conditions like depression, anxiety, chronic pain, prior head traumas, or involvement in personal-injury litigation.

Celebrate the Brain

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fondue-709713_640Thanksgiving and the many holidays that follow are joyful times to be with family and friends.  Holiday cheer, a positive emotion, can also provide the brain with healthful hormones and neurochemicals that improve brain function.

Family traditions boost enjoyment of holiday gatherings.  In a recent series of studies in the Journal of the Association for Consumer Research, subjects described the customs they followed — along with those of their families — during holidays.  These activities were rated as enjoyable, personal experiences that enhanced bondings with family members.  In fact, simply recalling past traditions can put a warm glow on holiday gatherings and support creative thinking.

Memories of childhood or lost loved ones often surface at celebrations.  The bittersweet feeling of nostalgia can elevate mood and mental outlook.  A recent study published in the journal, Emotion, reported that nostalgia boosts a sense of connection to the past, creating a social web that extends across people and time.  This “self-continuity” energizes the brain.  So, pull out an old photo album and spend some time revisiting your past this season.

When listing New Year’s resolutions, resolve to keep friendships alive throughout the year.  The benefits of supportive relationships are numerous.  Research published online in the Journal of Epidemiology and Community Health (2016), stated that individuals who have greater levels of social support enjoy better psychological health and mental functioning.  The reduction of chronic stress and the stimulation associated with meaningful social interaction are strongly linked to improved resilience and reduced risk of anxiety and depression.  There is also a lower likelihood of cognitive decline.

The highlight of any holiday is food, often deeply entwined with tradition, but possibly devoid of brain-healthy choices.  Compromises that allow both brain-healthy and traditionally-happy fare, including desserts, can solve this dilemma.  First, shift the spotlight from rich food to lighter fare by serving salad as the first course.  Go heavy on the greens, colored veggies, and crunchy bits of apples or pears.  Second, make a healthy vegetable side dish the co-star of the main course.  Third, regarding the turkey, think outside the bread box with offerings such as wild-rice stuffing, augmented with vegetables and dried cranberries.  Lastly, the first bite of dessert, thoughtfully consumed, always gets rated as the best.

Enjoy the fabulous taste of that bite!  Then, empower your mind with oxygen — by taking a mindful walk — to complete the celebration of your brain.


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

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Binge Eating Disorder

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binge-eatingBinge eating disorder is an illness that resembles bulimia nervosa. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5 (“Diagnostic and Statistical Manual, ” version 5).  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders, when they do eat, they eat rapidly, consuming large quantities of food.  They do not stop until they are uncomfortably full. When binging, they typically do so alone because of feeling embarrassed by how much they are eating.  They tend to feel disgusted with themselves, depressed, or very guilty afterward. Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men. Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically-supervised, weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  These therapies result in improvements in specific eating disorder psychopathology and associated psychiatric problems, such as depression and psychosocial functioning (Wilson, 2011).

Epidemiology of Eating Disorders

 Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • An estimated five million Americans suffer from eating disorders at any given time, including approximately five percent of women and less than one percent of men.  The disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:1 (although 19 to 30 percent of younger patient populations with anorexia nervosa are male).
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined cases to four percent for more broadly defined cases of anorexia nervosa.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Approximately 5 to 1.0 percent of adolescents suffer from anorexia nervosa and one to five percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • While eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries, in recent years, data are steadily accumulating to document that:
  1. eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries.
  2. ethnic and racial minority groups in these countries are vulnerable to eating disorders.
  3. there is nothing uniquely “Western” about eating disorders, which are a global health problem (Pike et al, 2013).

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History of Meditation

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The earliest roots of meditation go back too far to trace with full confidence. We do know, however, that the practice of meditation was refined in the temples, caves, and monasteries of the East and Near East.  Meditation has found its way to the West in the past century. In slightly different form, meditation also appears in the Judeo-Christian tradition.

Meditation dates back to our earliest ancestors, who stared in wonder at the sky as they waited for hours to hunt for prey.  Perhaps these ancestors waited while communal fires burned. Our ancestors had plenty of time on their hands.  Because meditation entails a shift from thinking and doing to just “being,” these ancestors were probably able to meditate during the course of many of their days.

Long before the arrival of Buddha in the East, or the great Indian yogis, shamans — people with alleged access to what is good and evil — living in hunter-gatherer cultures all over the world used meditative techniques to enter altered states of consciousness known as trances. Focusing their minds using simple rhythms and chants, and sometimes employing hallucinogenic substances, these shamans traveled to the “spirit world” and returned with wisdom, healing abilities, magic abilities, and spirit blessings to bestow on their people.

Cave paintings dating back at least 15,000 years show figures lying on the ground in poses of meditative absorption. Scholars have determined that these were shamans in a trance state asking the spirits for a successful hunt. Other cave pictures showed shamans transformed into animals and taking on the animals’ magical powers.

Although shamanism has declined considerably, there are still world cultures that utilize shamans as healers, guides for the dead, and intermediaries between humans and spirits. Recent years have shown an upsurge of interest in shamanism, due in some part to the writings of Carlos Castaneda, Michael Harner, and Joseph Campbell.

But perhaps meditation’s deepest roots can be traced to India, where sadhus (traveling holy men and women) and yogis have practiced meditation in one form or another for more than 5,000 years. It was in India that meditation first flourished, and it is from India that meditation later traveled and spread to distant parts of the globe.

The earliest Indian scriptures, the Vedas, don’t have a word for meditation but described what are now known to be meditative rituals requiring great concentration. Over time, these practices evolved into a type of prayerful meditation that entailed the use of breath control with devotional focus on the Divine. From these earliest roots, three of India’s best-known meditative traditions blossomed:  yoga; Buddhism; and tantra (a range of religious traditions).

By Barbara Sternberg, Ph.D.

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Seasonal Affective Disorder

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Seasonal affective disorder (SAD), also known as winter depression and winter blues, is a type of mood disorder that is typically caused by low light levels. SAD generally begins in the fall and worsens during the winter months.  The rarer, reverse seasonal affective disorder (summer blues, summer depression) begins in the spring and worsens in the in the summer.

SAD is generally found more frequently in people who live in latitudes far north or south of the equator (for example, one percent in Florida; four percent in Washington, D.C.; 10 percent in Alaska).  Some patients experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Although symptoms may be severe, they generally resolve over several months.

SAD can be a serious disorder that may require hospitalization. There is a potential risk of suicide among some individuals experiencing SAD. The symptoms of SAD mimic those of clinical depression or dysthymia. The prevalence of SAD in the adult American population has been estimated at between 1.5 percent in Florida and about nine percent in the northern US.  Overall, 6.1 percent of the US population is affected by SAD. Subsyndromal seasonal affective disorder is a milder form of SAD estimated to affect 14.3 percent of the American population.

Seasonal affective disorder is more common in women than men and in people between the ages of 15 and 55 years. The risk of developing SAD for the first time decreases with age. People who have a close relative with SAD are also at greater risk.

CAUSES

There is strong evidence that SAD is caused by a lack of available sunlight. Decreased exposure to sunlight may have an effect on the body’s biological clock, which regulates mood, sleep, and hormone production. Exposure to light may reset the biological clock. Melatonin and serotonin synthesis may be altered in individuals with SAD. Exposure to light appears to correct both neurotransmitter deficits and changes in the biological clock.

SYMPTOMS

Symptoms of SAD include difficulty waking up in the morning, a tendency to oversleep, to overeat, and to crave carbohydrate-rich foods, often leading to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. Individuals with SAD are characterized by depression, pessimism, and a lack of pleasure in usual activities. Symptoms of SAD can include heightened anxiety as well as depression. For most people with SAD, symptoms start in September or October and end in April or May  and tend to occur at the same time every year.

TREATMENT

There are several treatment options for classic SAD. Bright-light treatment uses a specially designed lamp (or light box) — with an intense “full spectrum” or blue light at doses of 2,500 to 10,000 lux. The patient sits at a prescribed distance, usually 30 to 60 cm, in front of the box with eyes open but not staring at the light source for 30 to 60 minutes. Many individuals use the light box in the morning, and there is evidence that morning light is superior to evening light  although people may respond to evening light as well. One study found that up to 69 percent of patients find the treatment inconvenient, and as many as 19 percent stop use because of this.

There is evidence that dawn simulation is effective as well. In some studies, this has been found to be 83 percent more effective than other bright-light therapies. Most studies have found light therapies to work well — for several weeks — as seasonal treatment until greater amounts of natural light are available.

By Nikita Katz, MD, PhD

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