The Standard Explanation of Seasonal Affective Disorder (SAD)

SAD is a condition that can cause significant fatigue.  It is caused by a lack of sunlight or other bright light.  This can have a significant affect on the body.

The traditional definition of SAD is that it occurs in the winter when days are short and clears up in the summer.  One symptom is a craving for carbohydrate.  The treatment is to get extra sunlight or to use a lightbox for 30 to 60 minutes in the morning and possibly in the evening.

Someone who works indoors all day can also develop SAD.  (Some web-sites I've seen don't even consider this possibility.)  People who feel better on weekends or during vacations may want to consider that lack of bright light at work is the cause.

Sunlight on the skin causes the body to make vitamin D.  Bright light also influences the production of certain hormones.  The mechanism is not completely understood.

The Vitamin D Connection

Note that virtually all the conventional wisdom on Seasonal Affective Disorder emphasizes that patients should avoid ultraviolet light which is regarded as harmful.  The problem is that ultraviolet light striking the skin creates vitamin D.  People who avoid ultraviolet light should take vitamin D supplements!  See my new vitamin D page and see the changes in the rest of this page.

Long Term Light Deprivation

I have become utterly convinced that long term bright light deprivation over a period of months or years can lead to chronic fatigue and it might take many months of light therapy to recover.

For the last nine months, I have been using light therapy with very good results.  I have seen slow but steady improvement in my fatigue and other symptoms.  My back problems are finally gone and my TMJ is greatly improved.  My prostate problems are improved and I now sleep through the night without getting up.  For the first time in the years since I came down with chronic fatigue I feel optimistic that I may be on my way to a cure.  If you've read the rest of the site, you know that is a word that is used very sparingly.

On my Introduction page, I discuss the difference between root causes of chronic fatigue and secondary causes.  This site has many pages devoted to secondary causes, but fewer devoted to primary causes.  The primary cause of chronic fatigue is much more mysterious.  I am optimistic that I have finally found my primary cause, and that it can be treated.

Lack of bright sunlight can cause severe fatigue.  Seasonal Affective Disorder (SAD) is usually associated with the winter months when there is less sunlight, but the fact is it can happen any time of year.  Think of how many people work in office buildings where most of their light comes from fluorescent bulbs.  It can even happen to people who get an hour or more of bright sunlight per day.  Some people (like me) need more than that.

The amount of light outside can range from 5,000 lux on a rainy day to 100,000 lux on a sunny day.  The amount of light away from the windows under artificial light might well be less than 100 lux.  That's correct.  The amount of light in even a well lit office, can be 1,000 times dimmer than the light outside.

Many people with chronic fatigue become less active and leave the house less often.  This will only make the condition worse!

My History of Chronic Fatigue and Working Indoors

I have always thought I had a bit less energy than most people, but I did not truly develop chronic fatigue until I started working at a new company.  I slowly started going down hill.  I attributed it to the stress I felt at that company, but after starting work at another company with less stress, the fatigue did not improve.

I now know the answer.  Until that time, I had been working at home where I got some sunlight.  At the new company, I worked in an office under fluorescent lights.  At the company I later worked for, the lighting situation was no better.  Until recently, it never even occurred to me that this might be a factor.

At the new company, I did however have a forty minute commute.  The sun was often out in the morning and sometimes during my evening commute as well, and yet this was not enough sunlight for me.

Seasonal Affective Disorder and Traditional Sources of Light

Many people talk about "20th century disease".  They feel we are getting sick in ways that people simply didn't get sick before.  There is some evidence to support this.  We know that male sperm levels have dropped precipitously in the past 50 years.

So what causes "20th century disease"?  Is it pesticides, food additives, or pollution?  I believe that one possible cause is a lack of bright light.

The light bulb was invented in 1878.  Most people in this country did not have electricity until the 1920s.  Houses were designed with southern exposures to allow more sunlight in.  Before the electric light, during the day people got their light from windows!  It was absolutely inconceivable that people would not get a substantial amount of sunlight during the day.

I believe that one of the best ways to combat SAD is to get light the same way our ancestors did.  When possible, get your light from a window instead of an electric light.  I now keep my lights off during the day when I'm home.  I've moved my computer next to the window and do as much work as I can close to the window.  I use a lightbox at other times.  I use regular lights only after 8PM.

Diagnosing SAD

My body temperature was usually below 98.0f.  I noticed that my temperature was higher on the weekends.  There were a number of times when I went away for the weekend and I ran a fever of 99.5°f for the entire weekend.  It came back down as soon as I got home.  It finally occurred to me that I was getting a lot more sunlight on these trips and I started wondering if lack of bright light might be a factor in my fatigue.  It is important to note that I did not feel better during those weekend trips.  I was feverish!

It can take several weeks of bright sunlight or light therapy to see any improvement.  My experience is that it can take many months to see a major improvement.  It is a slow process.  Keep a journal so you can look back several weeks or months to see your improvement.  I suggest making a list of ALL your symptoms, no matter how big or small so you can look back later to see which ones have improved.

SAD is a fully recognized medical condition.  If you search the Internet, you will find articles at the Mayo Clinic web-site and other places on it.  It is treated with light therapy.

If you can't get sunlight daily or if you can't get as much as you want, you can buy a "light box".  The usual recommended treatment is to sit in front of the lightbox for 30 minutes to an hour everyday.  Start with this, but if you find it insufficient after several weeks, increase it.  I have small lightbox at work that looks like a desk lamp. I get as much exposure to sunlight as I can and use lightboxes the rest of the day.  The best light boxes are those that use full spectrum.  It is also helpful to do things to let more light into your home or workplace.  Some antidepressants have also been found to be useful.    (Note that even full spectrum usually do not put out ultraviolet light.  See the note above on vitamin D.)

Some direct sunlight is useful, especially mid-day.  Sitting in a place where you can see bright light is also helpful.  Direct sunlight contains ultraviolet light that produces vitamin D. Indirect sunlight will not produce vitamin D, but the bright light is still beneficial.

There are numerous web-sites listed on Yahoo about the condition.  Many insist on talking about it as if it was condition unique to winter-time.  It isn't!  Anyone who gets insufficient light can have it all year round and it can go on for many years.

My First Eight Weeks of Treatment

Over the first eight weeks I had some good results.  The treatment I used was a bit more than what which doctors usually recommend.

Doctors usually recommend that people with SAD get 30 to 60 minutes of bright light in the morning and another 30 to 60 minutes in the afternoon.  I believed that I needed much more than this.  For the past several years, I have had a 45 minute commute in the morning, but I realized this was not enough sun.

I started getting up an hour earlier.  I spent 45 minutes getting light in the morning by going for a walk or by sitting by the window and reading.  On rainy days, I used my light box.  I then left on my 45 minute commute.  I then went to my desk which is away from the windows.

At noon, I eat lunch in the cafeteria by the windows for 30 minutes.  About 2PM, I take a 30 minute walk outside.  At 5:30PM, I then drive home for 45 minutes.  In the beginning, during the summer, the drive home was in the sunlight.

I feel that the earlier light exposures are more useful than later ones.  The available literature also suggests this.  If you count the amount of light I was getting during the day, it works out to 3¼ hours.  Even without the evening commute which I find to be of debatable value, I was getting 2½ hours.

Each week after I started this I felt a little better.  I did have my ups and downs.  There were days when I felt more tired.  There were others when I ran a fever and had to stay home from work.  It took about six weeks before I truly started to feel better. 

The first thing I noticed was that I no longer was sensitive to light.  Before light therapy when I would walk outside in the morning, I would immediately feel pressure around my eyes.  It was uncomfortable.  Soon afterwards, this no longer happened.  I went away for the weekend to the same place I mentioned above and did not run a fever.  My back improved though it later got worse again.

At that point, I was still finding that I felt better on weekends than on weekdays.  On weekends, I made sure my drapes are always open and that I was always getting some sunlight in my home.  I believe that I truly need light all day and not just for a few hours.

Desktop Lightbox

Over the next three months I did not see a lot of improvement.  My back got worse again.  This time it was in the form of sciatica.  Sciatica is pain in the leg, but the origin is in the nerves in the back.  It became painful to walk.

I had reached a plateau.  I would get a great deal of sun in the morning as I noted above, but still noticed that about two hours after getting to work my energy would drop off.  I wondered if a desktop lightbox would help.  There are lightboxes for sale that look like ordinary desk lamps.  I purchased one for $200 and put it on my desk aimed down at the desk by my computer.  I was trying to simulate the effect of having sunlight coming in through a window and striking an area nearby.

At first, I did not want the lightbox aimed in my face all day.  I was afraid it would look funny to people. It seemed to work out well for a few weeks, but then I felt I was back on the plateau.  It was clear I would have to aim the light box at my face.

I put the lamp directly beside me and above me. When people come into my cubicle, I turn it off.  I don't discuss the fact that I have chronic fatigue at work, so I was concerned about what to say to people.

A few people have commented on the lamp and since I don't really want to discuss my health problems at work, I simply say, "I think it's too dark in here."  I've said to one or two that I do it because I'd heard that bright light has health benefits.

Since using the lightbox, I have seen a slow but steady improvement in symptoms.  I often have a cycle.  I would feel tired for a few days, better for a few days and then a day when I felt very good.  This was usually followed by 24 hours of feeling feverish, sometimes even nauseous.  After that, the cycle would begin again, but I'd feel a little better each time.

One of my symptoms is temporomandibular joint disease (TMJ).  This is a condition in which the jaw can be quite stiff.  For some people it is very painful, but for me it is not painful and just a minor inconvenience.  While on light therapy, I noticed that my jaw was becoming looser.  Often it would pop during the day.  This is a bit like popping your knuckles.  My jaw would feel looser after it did.  Now, my jaw usually pops early in the morning and stays loose the entire day.  Sometimes I wake up and find it never tightened up during the night at all.  The TMJ is not gone, but greatly improved.

I still had quite a bit of sciatic pain despite physical therapy.  Just before Thanksgiving, I had a day of feeling feverish. The next day I woke up and the sciatic pain was simply gone.

I did not have any more days of fever until a week before Christmas.  I was feverish and nauseous both Saturday and Sunday.  On Monday I woke up and my prostate problems were greatly improved.  I had not gotten up the entire night.  The prostate problems are not gone completely, but the improvement is huge.

Slowly my symptoms are going away.  When I get a feverish day, I wonder what symptom will improve or disappear the next day.

Symptoms of Seasonal Affective Disorder

SAD is usually diagnosed by determining if a patient's symptoms are seasonal.  If a patient feels depressed and fatigued in the winter, but not the summer, SAD is suspected.

I did not have the traditional symptoms.  I felt fatigued all year.  There were however three symptoms that made me suspect I had SAD.  The first is that my temperature was often a bit higher on weekends when I got more sun than on weekdays.  The second is that I felt quite feverish when I would go on long trips during which I was exposed to even more extensive sunlight.

I've often had pressure in my sinuses, ears, and under my eyes.  The third symptom was that whenever I would go out in the sun, the pressure would get worse.  It was very noticeable and uncomfortable.  It would encourage me to stay out of the sun.

All of these symptoms are now greatly improved or gone.

Acupuncture and Seasonal Affective Disorder:

I had gone for acupuncture for a while.  In the beginning, my acupuncturist told me I had "damp" energy.  I did not see much improvement until I started light therapy.  As the therapy went on, he saw distinct improvement.  It would be very interesting to know if an acupuncture diagnosis of "damp" energy corresponds to a western diagnosis of Seasonal Affective Disorder.

I do not believe that the acupuncture itself has helped much, but it was encouraging to have the acupuncturist confirm that I was improving.

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