Daydreams of the beach float through her mind as she huddles under covers in her dark dorm room. After 16 hours of sleep, she awakes, wondering where her day has gone. Since early October, her ambitions of doing homework and going to the gym have been replaced with long hours of crying and feasting on Ben and Jerry's ice cream. Seasonal affective disorder (SAD) has consumed her life, but she's not alone.
When the days grow shorter and the temperature drops, some students in Happy Valley can get SAD quickly.
Taking into consideration the duration of winter, decreased light intensity and national SAD statistics, it can be estimated that 4 to 5 percent of Penn State students fall victim to this kind of depression each winter, said Mary Anne Knapp, clinical social worker and therapist at Penn State's Center for Counseling and Psychological Services.
As the depression sets in, these students often find themselves hibernating in their dorm rooms because of a decreased interest in socializing and a lack of desire to engage in activities they usually find pleasurable. Unlike other types of depression, SAD symptoms include an increase in sleep, appetite and interpersonal conflict.
This disorder does not just plague those in the Northeast. SAD affects 10 million Americans, many of whom are unaware of their condition.
But according to Yvonne Patterson, University Health Services physician, only 1.4 percent of Florida residents suffer from it, compared to 9.7 percent in New Hampshire, because of decreased exposure to sunlight in northern latitudes.
Knapp added that 75 percent of those affected are women.
Critical chemical reactions occur when sunlight hits the retina, said Dr. Michael M. Jacobs, M.D., the team physician for varsity football and baseball at the United States Naval Academy in Annapolis, Md.
"The eyes are literally connected to the brain. So this process is responsible for a cascade of biochemical reactions resulting in the formation of mood-elevating neurotransmitters," he said.
When the brain is not stimulated by sunlight, neurotransmitters, such as serotonin, dopamine and norepinephrine, which stabilize mood, are released in decreased amounts. These alterations impair the normal 24-hour wake-and-sleep cycle called circadian rhythm. However, bright light therapy can help to avoid this delay in the sleep cycle.
Light-box therapy, a non-pharmacological intervention, is a common approach to easing the symptoms. SAD patients can read, eat or engage in other activities while sitting under a light box, which is usually set up on their tables or countertops, for 30 minutes to two hours.
The boxes have a type of fluorescent light with a diffusing filter, which makes it five times brighter than sunlight, Jacobs said.
Light boxes generally range from 2,500 to 10,000 lux, a light intensity measurement, and beginning costs are around $200, Knapp said.
Some students find that the light boxes work well for them, while others said that exercising and being outside work just as well.
In fact, Jacobs advises that a one-hour walk in the sunlight is the equivalent of two to three hours of light-box therapy.
Pharmacological treatments include the use of drugs such as Zoloft, Prozac and Paxil, which all increase serotonin levels in the body. Wellbutrin is another renowned drug that increases dopamine and norepinephrine levels. However, hypertension, insomnia, psychosis and sexual side effects can accompany usage.
S-Adenosyl-Methionine (SAM-e, pronounced "Sammy"), a more recent approach to treating SAD, positively affects the targeted neurotransmitters with trivial or minimal side effects. SAM-e was first used to treat discomfort and pain, which is amplified by depression.
"Fifty percent of reported abdominal pains have no organic causes, likewise of back and neck pain. Depression exacerbates pain," Jacobs said.
This drug is still relatively new, and Knapp said she has had little experience with Penn State students consistently using SAM-e successfully or even having it recommended. She also said she thinks SAM-e will turn out to be less effective than predicted because other medicines for depression of the same origin have failed.
"There are issues of less standardization of herbal medication, and SAM-e has been used more recently with less history of studies," said Knapp.
It is important to note that combining SAM-e with any other anti-depressants should be avoided.
Tanning beds are a less popular approach to combating SAD. Typically, users go once a week, but they must be careful, because it could be addictive. This isn't surprising, as the dropped levels of dopamine have caused habits such as alcoholism, addictive gambling and the cravings for carbohydrates associated with SAD.
Tanning beds are not for everyone. For those who have a history of cancer in their family, tanning can be dangerous.
Genetics also play a big role in determining whether someone would have any affective disorder or what type of treatment to use.
Many patients said they have found that their relatives are not aware of potential suffering from SAD because of where they live. For instance, SAD is not as common in some regions like Europe. This suggests that genetics, climate and culture impact the prevalence.
However, in Greenland, where SAD affects a larger percentage of the population, all of the lighting in business buildings is full spectrum, similar to the lights used in phototherapy. This constant exposure to bright light helps residents to carry on with their lives.
"A person cannot be physiologically well if they are not mentally, emotionally and spiritually well," Jacobs said.
