Tag Archives: sad

Battling the Winter Blues

If the short, cold, dark winter days leave you feeling lethargic and energy-depleted, then you may be suffering from the winter blues, or its more severe form, seasonal affective disorder (SAD). Other symptoms include carbohydrate cravings, irritability, weight gain and the desire to avoid social situations.

The winter blues are triggered by a lack of sunlight – as the number of daylight hours decreases, levels of ‘feel-good’ hormones in our body begin to drop. The symptoms can appear in late autumn and don’t normally lift until the brighter days in early spring. Fortunately there are simple measures that can help to alleviate these troublesome symptoms.

There is certainly a link between low Vitamin D levels and seasonal affective disorder, although it is unclear whether there is a causal connection. A recent review of existing studies concluded that treating Vitamin D deficiency offers a simple way to improve mental health (1). It would seem sensible for those feeling the effects of the winter blues to test their Vitamin D levels, and to address any deficiency. Sunlight and supplementation are likely the fastest way to address deficiencies, although fatty fish, fortified milk and egg yolks will also help to boost levels.

Other studies have shown that omega-3s appear to help maintain healthy levels of the ‘feel-good’ brain chemicals dopamine and serotonin. Healthy cells membranes, which require good levels of omega-3 fats, are required for the brain to respond to serotonin and dopamine. A recent large double-blind trial of more than 400 adults supports its use in treating depression (2). Based on these results, ensuring adequate omega-3 intake is certainly a sensible approach for those affected by seasonal changes.

Studies investigating the effectiveness of supplements such as St John’s Wort and 5-HTP have had mixed results, though some studies have found that supplementation improves symptoms such as fatigue, sleep problems, anxiety and lethargy in those with SAD (3,4).

Dietary changes may also help to relieve symptoms. According to Judith Wurtman, Ph.D., co-author of The Serotonin Power Diet, a well-timed snack can help to relieve symptoms. Dr Wurtman led a study looking at the SAD-carb connection, concluding that a low-protein snack providing about 30 grams of carbohydrate was enough to provide a serotonin boost. A warm bowl of leek and potato soup in the evening might well provide that much-needed serotonin-boosting carbohydrate.

Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD
Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD

The most effective natural intervention, however, is probably light therapy. Light therapy is a non-invasive, natural, effective and well-researched treatment approach for those with SAD. Specially designed light therapy devices mimic the effects of sunlight to regulate levels of melatonin and serotonin. A recent meta-analysis concluded that light therapy works as an effective treatment for SAD no matter what time of day it is used, so long as it is used at least once daily (5). Dawn simulation is especially useful, and studies have found that this approach is more effective in alleviating SAD symptoms that standard bright light therapy or placebo, alongside additional benefits such as less morning drowsiness (6).

Those looking for a natural way to address the winter blues may benefit from the following approach:

1. Ensure that you are getting sufficient amounts of omega-3 and Vitamin D. You can have your levels checked by a nutritional therapist.

2. Exercise regularly. Try a 30-minute run or brisk walk in the daylight.

3. Start the day with a protein-rich breakfast, but try a carbohydrate-rich meal or snack in the evening. Good options are sweet potato, brown rice, lentils, rye bread and butternut squash.

4. Try a light therapy lamp or a dawn simulation device, making time to use the device at least once each day for the best results.

References

1. Anglin RES et al (2013) Samaan Z, Walter SD and McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br-J-Psych 2013, 202:100-107.

2. Lespérance F, Frasure-Smith N, St-André E, et al. (2011) The efficacy of Omega-3 supplementation for major depression: A randomized controlled trial. J Clin Psychiatry. 72:1054-1062.

3. Ghadirian AM et al (1998) Efficacy of light versus tryptophan therapy in seasonal affective disorder. J Affect Disord 50:23-7.

4. Wheatley D. (1999) Hypericum in seasonal affective disorder (SAD). Curr Med Red Opin 15:33-7.

5. Golden RN et al (2005) The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence. Am J Psychiatry 162(4):656-62.

6. Avery DH et al (2001) Dawn Simulation and Bright Light in the Treatment of SAD: A Controlled Study. Biol Psychiatry. 50:205-216.

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Beat the autumnal blues…

The nights are now well and truly drawing in and becoming colder and darker, so it’s common to feel low in mood.

Here are some helpful tips to keep you feeling upbeat:

Vitamin D
This sunshine vitamin has been getting more and more press coverage in recent months and it’s an important vitamin in supporting immunity amongst other things. Getting natural daylight is the best way to generate Vitamin D in your body; however in countries like the UK, the sun’s strength is not high enough between October and March to do this adequately. It’s important to eat foods containing vitamin D such as oily fish (mackerel, sardines etc), eggs, fortified breads and cereals. Supplementation is popular at this time of year with varying options of strengths (500iu – 5000iu) and types (tablets, capsules, sprays, sublingual) available. The UK Government now recommends that Vitamin D supplements should be taken by under 5′s, women who are pregnant or breast-feeding, everyone over 65 and anyone who has little sun exposure.

Omega 3
Continuing with the importance of fish and omega 3′s, it has been shown that those with diets high in fish and omega 3 fatty acids have been shown to have better moods. As well as other potential benefits such as improved skin quality, cardiovascular health and joint mobility.

Exercise is good for the mood
Exercise is good for helping to improve the mood during Autumn and Winter.

Natural Daylight
Balancing your circadian rhythm is important in balancing your mood and hormone levels. Try and get some natural daylight every day to avoid feeling low in energy and depressed – although it’s not easy if you work a in a 9-5 office environment. Go for a walk on your lunch break or offer to go to the shop for a colleague – any reason to get outside. Growing evidence also suggests sunshine can help protect against cancer, diabetes and heart disease. Having a SAD lightbox on your desk or at home can help beat the blues – opt for a lightbox with a 10,000 lux output from a respected manufacturer like Lumie or the Sad Lightbox Company.

Exercise
That lunch break walk suggested previously can have a double effect on your mood – gentle exercise can increase endorphins which are those “feel good factors” keeping your looking on the bright side of life. Green Exercise (i.e. not in a gym) has been found to have more significant improvements in mood.

5 HTP
This supplement is well known for its mood-boosting properties. If you feel you still need some support then this may be a good option. Speak to your GP or Health Practitioner first though, as it can interfere with other medications.

Written by Katie Guest

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Are you SAD or just Grumpy?

In the summer can you take on the world and work all day, with buckets of energy? But in autumn and winter do you feel lethargic and eat more, especially carbs, and feel irritable or overly anxious? It could be that you are just lacking in light. These are some of the symptoms of Seasonal Affective Disorder or SAD. Worse still, if your office has no windows or has tinted glass then you may be suffering all year round, as you are not getting the light that your body craves.

SAD Lightbox
Using a lightbox can be useful for SAD sufferers, but also those in need of more energy during the winter months.

The answer is simple – put a lightbox on your desk and then get on with your day. As you sit doing your tasks, your eye will automatically pick up the light. Within 7-10 days you will start to feel the benefits of using a lightbox, feeling more alert and having more energy.

So how does it work? The light goes into the eye, through the retinohypothalamic tract and into the brain. That’s the detail – what you need to know is that the light has a double effect. It ‘cuts off’ the body’s production of melatonin, the hormone which makes you sleepy and triggers hibernation in animals. It also increases levels of serotonin, ‘the feel good’ hormone.

So why are we seeing this problem now? When you think about it, it is only a little over a century ago that we got electric light. Before that about 75% of the population worked the land and kept to the rhythms of the seasons, getting up with the light and going to bed when it got dark – they weren’t trying to stretch the day the way we do now. So this is a man-made problem with a man-made solution – the lightbox.

Lightboxes are even VAT exempt, in recognition that SAD is a significant, debilitating condition. So if you feel tired all the time and can’t seem to pinpoint why, try using a lightbox to bring some light into your life.

Written by Carol Barksfield at the SAD Lightbox Co.

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An Introduction to Seasonal Affective Disorder and the Winter Blues

About SAD

Seasonal Affective Disorder, or S.A.D., is now officially recognised as a medical condition thought to affect over 2 million of the British population.

SAD can affect people of any age but most commonly it starts between the ages of 18-30. At one time it was thought that four times as many women as men suffered from SAD, but now increasingly men recognise the symptoms and seek treatment. SAD is also known as the Winter Blues, and about 10% of the population suffer to some degree with 2-3% suffering with clinical depression.

Typical symptoms include:

  • Depression, feelings of gloom and despondency for no apparent reason.
  • Lethargy, lacking in energy, unable to carry out a normal routine.
  • Anxiety, inability to cope.
  • Social problems, irritability not wanting to see people.
  • Sleep problems, finding it hard to stay awake during the day, but having disturbed nights.
  • Loss of libido, not interested in sex or physical contact.
  • Craving for carbohydrates and sweet foods, leading to weight gain.
  • Recurring symptoms year after year at about the same time of year (Autumn / Winter).

The Cause

SAD has a lot in common with the hibernation cycle of animals and research showed that this was triggered by a response to decreasing light levels. As the days grow shorter and the light becomes less intense, it increases the desire to ‘hibernate’.

Light intensity is measured in ‘lux’ the Latin word for light. On a summer’s day at our latitude we may have up to 16 hours of daylight at 100,000 lux. In winter an 8 hour dull day will give less than 5,000 lux and indoor lighting rarely exceeds 500 lux.

The Treatment

LitePod
Lights from trusted brands like the SAD Lightbox Co. have medical certifications and quality assurances.

Historically, treatment for depression involved the use of drugs, however, in recent years research in the USA and UK showed that SAD sufferers responded, often quite dramatically, to Bright Light Treatment. Fully proven lightboxes from trusted brands such as the SAD Lightbox Co. (carrying ISO 13485 / 9001 and Medical CE Mark 0120) have been specifically designed for and are a recognised method of alleviating S.A.D.

Lack of light causes an increase in the production of Melatonin (the hormone that makes us sleepy at night), and a reduction of Serotonin, a lack of which causes depression. The exposure to bright light therapy reverses the process, with the additional benefit of being drug free. You should start to feel the benefit within 4-10 days of using a lightbox.

By providing summertime levels of light during the winter you can successfully alleviate the symptoms of SAD with the result that former sufferers can lead a normal, happier life and beat the Winter Blues.

Studies have also shown that bright light therapy can prove beneficial with Pre-menstrual syndrome, Jet lag, shift work, insomnia and with some cases of MS and ME. The Light Therapy Institute have also been successful in treating children with dyslexia and specific learning difficulties; even children and students without these problems can benefit and work better by using the lightbox as a desk top working light.

 

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Trouble getting up in the mornings? A new symptom linked to SAD.

At this time of year, many people struggle to get up in the dark mornings. The lack of light on winter mornings affects sleep-related hormones, leaving many tired and unrefreshed.

Trouble getting up in the mornings?
Those with DPSP have difficulty getting to sleep at night, and struggle with rising in the morning. (4)

A new study, published in the October issue of the Journal of Affective Disorders, has assessed individuals with symptoms of delayed-phase sleep phenomenon (DPSP) and has found links with SAD (1). In DPSP, the bodyclock’s natural cycle of sleep and wakefulness is altered, and the effect is similar to jet lag. As a result, those with DPSP have difficulty getting to sleep at night, and struggle with rising in the morning.

In the study, researchers assessed a group of 327 individuals with DPSP, and compared them to a group of 331 controls (individuals without DPSP). They found that those with DPSP were much more likely to have seasonal affective disorder (SAD).

The research also found that those with DPSP were more likely to experience changes in appetite, body weight and fatigue during the darker months – symptoms that are common in SAD.

The study concluded that both DPSP and SAD may have the same underlying cause.

One treatment that has shown positive results with both DPSP and SAD is dawn simulation therapy. Dawn simulators, or sunrise alarm clocks, are alarm clocks that use gradually increasing light to simulate the sunrise each morning. Light receptors in the retina can detect the light, even through closed eyes. This type of light therapy can be used to help ‘reset’ the body clock, making winter mornings less of a struggle.

A recent controlled study found that both light boxes and dawn simulator alarm clocks were effective in treating symptoms of SAD (2), while a recent review recommends light therapy to address DPSP (3). While standard light boxes are indeed useful in this regard, dawn simulators can be more convenient for many. Using a dawn simulator alarm means that you don’t have to set aside time each day for your light therapy. And so for those with DPSP or SAD, using a dawn simulator that works while you sleep may make winter mornings less of a struggle.

Written by Nadia Mason

References

1. Lee et al (2011) Delayed sleep phase syndrome is related to seasonal affective disorder. Journal of Affective Disorders 133(3):573-579

2. Terman & Terman (2006) Controlled trial of naturalistic dawn simulation and negative air ionization for seasonal affective disorder. Am J Psychiatry 163(12):2126-33.

3. Martinez & Lanz (2011) Circadian rhythm sleep disorders. Indian J Med Res 131: 141-149.

4. Image courtesy of Stuart Miles.

 

 

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Beat the winter blues: Supplements and SAD

In Parts 1 and 2, I wrote about the impact of light therapy and diet on managing the symptoms of seasonal affective disorder (SAD) and its milder form, the ‘winter blues’. In Part 3 we’ll look at further nutritional support for this common disorder.

Doctor's Best Vitamin D3 2000iu
Evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Vitamin D

As there are fewer daylight hours in the winter months, levels of Vitamin D in the body can drop. While light boxes represent a promising treatment option for SAD, they do not provide UV light and so will not boost Vitamin D levels. Researchers have tested whether Vitamin D supplementation can improve mood during the winter months. A double-blind study found that mood improved in healthy people without SAD who received 400 or 800 IU per day of vitamin D for five days in late winter (1).

Another study tested the effects of supplementation with either 600 or 4000 IU of vitamin D every day for six months (2). Both dosages led to improved mood and general well-being in the participants, with those on the higher dose experiencing greater benefits.

Although additional research needs to be done before any conclusions can be made, the available evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Magnesium

The Western diet, high in animal produce and refined carbohydrates, leaves us vulnerable to deficiency in the mineral magnesium. This may affect mood, because conversion of tryptophan to mood-enhancing serotonin is dependent on sufficient levels of magnesium. Studies indicate that an insufficient level of magnesium can alter also levels of melatonin and upset the body’s biological clock, a pattern that is seen in SAD (3).

Supplementing with magnesium can be recommended to those with insufficient intake. I prefer the forms magnesium citrate or magnesium taurate, which are bioavailable, well-absorbed forms.

Omega-3

I wrote about the importance of omega 3 in optimising serotonin levels in Part 2. These oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied. While omega-3 can be supplied through oily fish in the diet, those who are concerned with levels of mercury in fish might want to try supplementing with a fish oil that has been screened for contaminants.

Omega 3
Omega 3 oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied.

St John’s Wort

St John’s Wort is widely recognised as an effective supplement for mood disorders, and one small randomised study has investigated its benefit for those with SAD (4). The blinded study tested the effects of a daily dose of 900mg of St John’s Wort over 4 weeks. It concluded that the supplement may be an efficient therapy for those with SAD, though further research is needed.

This herb is thought to increase serotonin levels by inhibiting serotonin reuptake, working in a similar way to conventional selective serotonin reuptake inhibitor (SSRI) antidepressants. If you are using a light box to relieve SAD or the ‘winter blues’, then you should check with your GP before taking St John’s Wort, as this herb can make your eyes more sensitive to light.

As winter approaches, the short days and long nights of the season can make life difficult for those with SAD. Even in its milder form, the ‘winter blues’, symptoms of low mood, fatigue and weight gain can make life miserable. The good news is that some fairly simply lifestyle adjustments can make a positive difference. Using a sunrise alarm clock in the mornings for instance can also help you get out of bed on the “right side”. The evidence for bright light therapy with an approved light box is compelling, and coupling this with nutritional support might just help you to banish those winter blues for good.

 

Written by Nadia Mason

References

1. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl) 1998.135:319–23.

2. Vieth R, et al. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal 2004. 3:8

3. Wester PO. Magnesium. Am. J. Clin. Nutr. 1987. 45 (5 Suppl): 1305–12. PMID 3578120

4. Durlach J, Pagès N, Bac P; Bara M, Guiet-Bara A, Agrapart C
Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock. Magnesium research : official organ of the International Society for the Development of Research on Magnesium 2002.15(3-4):263-8.

5. Kasper S. Treatment of seasonal affective disorder (SAD) with Hypericum extract. Pharmacopsychiatry 1997. 30:89-93.

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Beat the winter blues: diet and SAD

Previously I have written about the benefits of light therapy in treating seasonal affective disorder. Light therapy is a popular choice with those looking for a drug-free approach to dealing with SAD or the ‘winter blues’. An equally important consideration is how diet affects mood and symptoms in those with SAD – and in particular the importance of the macronutrients carbohydrate, protein and fat in the management of this condition.

Hormones and SAD

SAD is characterised by symptoms such as low mood, carbohydrate cravings, weight gain and fatigue (1, 2). These symptoms are linked to hormones that control our mood and energy levels.

Our body’s natural anti-depressant hormone, serotonin, is stimulated by light. The more light we have during the daytime, the more serotonin we produce. In the darker months of autumn and winter, serotonin levels can drop, resulting in feelings such as low mood, lack of energy and food cravings.

Likewise, darkness stimulates the hormone melatonin, which lowers body temperature and causes tiredness and feelings of fatigue.

How can diet help?

Those with SAD are thought to crave sugary and starchy foods because these types of carbohydrate temporarily boost levels of the body’s natural anti-depressant serotonin. These types of foods also boost energy levels and raise body temperature, countering the effects of melatonin.

Brown Rice
Whole grains such as brown rice and oats and proteins such as nuts help to keep blood sugar levels stable. (5)

Eating this type of diet can only be a temporary ‘fix’ however. In fact, a carbohydrate-rich diet based around sugary and starchy foods, leads to unstable blood sugar levels. This in turn can create a variety of symptoms that we might link to the ‘winter blues’ – moodiness, fatigue, foggy thinking and food cravings.

The solution is to eat a diet based around ‘low glycemic index’ carbohydrates that help to keep blood sugar levels stable. Whole grains such as brown rice and oats, as well as fresh fruits and vegetables are the wisest choices of carbohydrate.

Including a source of lean protein (such as chicken, turkey, eggs, beans or lentils) with each main meal is also a good idea. This helps the body in two ways. Firstly, including protein with each meal helps to control blood sugar levels, fighting off energy dips and cravings. Secondly, protein provides a source of the amino acid tryptophan, which the body can convert to serotonin. Including foods high in tryptophan – such as chicken, tuna, tofu, eggs, nuts, seeds and milk – in your daily diet can help to support your body in making serotonin.

Finally, healthy fats have been extensively studied in relation to depression and mood. Omega-3 fats also have a role in the production and utilisation of serotonin. Inflammatory chemicals in the body can cause serotonin deficiency in the brain. Omega-3 oils can reduce levels of these inflammatory chemicals, therefore helping to boost the brain’s serotonin levels.

The importance of omega-3 in dealing with SAD might explain the low incidence of SAD in Icelanders who have a diet high in oily fish (3). Ensuring a good level of omega-3 in your diet is essential. Including oily fish such as sardines, mackerel, herring or salmon in your diet can help to boost levels of omega-3, as can eating flaxseed oil, walnuts and omega-3 eggs.

Formal research in this area is limited, with many studies simply looking at the impact of a single meal on symptoms of SAD. This is an inadequate assessment of the role of diet. One study that looked at the longer term impact of diet on SAD showed promising results (4). I have certainly found in clinical practice that patients need to be consistent in their dietary choices in order to see an improvement in symptoms over time.

A well-managed diet, along with light therapy (such as a sunrise alarm clock or SAD light box), appears to be a safe approach to managing SAD. Of course carbohydrates, protein and fats are not the only nutrients of importance to those with the winter blues. Part 3 will examine the evidence behind other nutrients and dietary supplements in the support of SAD.

 

Written by Nadia Mason

References

1. Sher L. Genetic studies of seasonal affective disorder and seasonality. Comprehensive Psychiatry, 2001, Vol. 42, No. 2, pp. 105-110.

2. Magnusson A, Boivin D. Seasonal affective disorder: an overview. Chronobiology Int. 2003. 20(2):189-207.

3. Cott J, Hibbeln JR. Lack of seasonal mood change in Icelanders. American Journal of Psychiatry. 2001.

4. Wells, A, et al. (1998) Alterations in mood after changing to a low-fat diet. British Journal of Nutrition 79(1):23-30.

5. Image courtesy of Marcuso.

 

 

 

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Light therapy for SAD: Looking on the Bright Side

While many look forward to the crisp and clear autumn and winter months, others find that they struggle through these months feeling tired and low. Seasonal Affective Disorder, also known as SAD, is a form of depression that is brought on when levels of natural sunlight are reduced. Symptoms tend to begin as the days get shorter and winter draws in, only lifting completely during the summer months. A milder form of seasonal depression – often called sub-syndromal SAD (S-SAD) or simply ‘the winter blues’ – affects around 1 in 10 adults.

Bright Light Therapy
SAD is a form of depression that is brought on when levels of natural sunlight are reduced

I was interested to read a recent Swedish study that tested a treatment called ‘bright light therapy’ on individuals with SAD and with S-SAD (1). Bright light therapy is a treatment that involves exposure to a special light that mimics natural outdoor light.

The study tested the effects of the light therapy on 49 individuals who had been diagnosed with either SAD or S-SAD.

When the individuals began to experience winter depressive symptoms, some of the group were either given a 10-day course of bright light therapy, or were put onto a 3-week waiting list, after which they were given the 10-day treatment course. The group of people on the waiting list were used as the ‘control’ group for this study.

The study found that bright light therapy was linked to improvements in a number of symptoms. The researchers had conducted an earlier randomised clinical trial which found that bright light therapy did indeed have a positive effect on depressive mood in those with SAD and S-SAD (2). This new study, however, also measured the effects of bright light therapy on other symptoms, such as tiredness, fatigue, sleep problems and health-related quality of life. All of these symptoms had improved after the 10-day course of light therapy. Symptoms were then measured again, a month after the treatment had finished, and it was found that the symptom improvements had lasted.

The study suffers because, although a control group was used, strictly speaking there was no placebo group. If the second group had been exposed to a ‘placebo’ light rather than the therapeutic bright light, then this might have served as a better comparison group. The study is nevertheless very interesting because it indicates that light therapy can help not just depressive mood, but that it can bring about improvement in a number of symptoms including milder symptoms of depression and daytime sleepiness.

Despite the design flaw in the study, light therapy does appear to be a promising treatment for the ‘winter blues’. Systematic reviews have reported that light therapy represents an effective and well-tolerated treatment for SAD (3). A home light box may therefore be a wise investment for those who need a boost during these darker months. Using a light box for between 30 minutes to an hour in the morning is considered to be an effective approach, and the light should be at least 2500 lux to be beneficial. Some individuals also use a Sunrise Alarm Clock as well to help balance their circadian rhythm and ensure they wake naturally in the morning rather than to the sharp, shrill noise of a standard alarm clock. These Wake-Up Lights simulate the “sunrise” so the brain wakes gradually.

Seasonal affective disorder, or the milder ‘winter blues’ can mean months of misery for those affected. With an estimated 1 in 20 adults affected by SAD, and a further 1 in 10 suffering from its milder form S-SAD, it is certainly an approach worth considering.

Written by Nadia Mason

References
1. Rastad C, et al. Improvement in Fatigue, Sleepiness, and Health-Related Quality of Life with Bright Light Treatment in Persons with Seasonal Affective Disorder and Subsyndromal SAD. Depression Research and Treatment. 2011:543906
2. Rastad C, Ulfberg J, Lindberg P. Light room therapy effective in mild forms of seasonal affective disorder—a randomised controlled study. Journal of Affective Disorders. 2008. 108(3):291–296.
3. Lee T M, Chan C C. Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatrica Scandinavica 2000. 99(5): 315-323

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