Tripod Home | New | TriTeca | Work/Money | Politics/Community | Living/Travel | Planet T | Daily ScoopLIVING & TRAVEL
Dr. Raymond Lam
interviewed by Anthony Qaiyum on December 8, 1995
"Over two thirds of people feel better in the summer than the winter."
Dr. Raymond Lam is an Associate Professor at the University of British Columbia and director of the Mood Disorders Clinic at Vancouver Hospital and Health Sciences Center. He spent time with Tripod to discuss Seasonal Affective Disorder (SAD).
Tripod: Can you give me a brief definition of Seasonal Affective Disorder (SAD)?
RL: Seasonal Affective Disorder is a form of clinical depression where people get their depressions only during the winter, so that in the spring and summer they actually feel perfectly normal. And the symptoms that they get, or the kinds of clinical depression that they get, usually involve, besides the low mood, feeling low energy and fatigued, oversleeping a lot during the winter, overeating, with weight gains, carbohydrate craving, and problems with concentration and memory, to the point where they really have difficulty functioning. They have impairment in either their work or their relationships because of these symptoms.
Tripod: Is it natural for most people to get down sometimes during the winter even if they don't have SAD?
RL: It is. And we distinguish that from "the winter blues," which affect a lot of people, you know, most people. Over two thirds of people feel better in the summer than the winter. But these people with SAD are kind of at the extreme end of the spectrum, so they have symptoms to the point where it really interferes with their functioning. But you're right. Everyone tends to sleep a little bit more, tends to eat a little bit more in winter compared to the summer.
Tripod: You always hear that there's a high suicide rate in Seattle because of the weather. Is this related to SAD?
RL: It's possible, although what we've found is that people with SAD usually are less suicidal compared to people with non-seasonal depression. And in part that's because they know that their depression's going to be over by the spring. There's a finite length of time. And so from that point of view, they don't get the same degree of hopelessness that people with non-seasonal depression have, because they never know how long their depression's going to last.
Tripod: The holidays also tend to depress many people. Does the winter holiday season make it difficult to diagnose SAD?
RL: Yes. That's what we always look for, are psychosocial stresses that might be a factor in the depression. But pretty clearly, for a lot of people, it starts in October-November, well before the season. Also we know from studies done in the Southern Hemisphere, during their winter, that they have SAD as well, which is obviously not during the Christmas holiday season.
Tripod: Study of SAD comes under psychobiology, right?
RL: Well, yes. I think all of us who research SAD are very interested in the biological factors. We all think there's a biological reason for people to have these winter depressions. And that's where all the research is right now.
Tripod: So, diagnosing SAD leans more toward the biological side than the psychological side?
RL: I think more and more we're recognizing how much biology has a role to play in most psychiatric illnesses. For sure, it's hard to divorce the biology from the "psychology."
Tripod: Is there a test for SAD?
RL: Unfortunately not. Like all depressions, we don't have a laboratory test for it. So the diagnosis is really made on a careful history, a careful interview of the person, and hopefully talking to other people who know them as well.
Tripod: Do you have SAD cases in sunny places, like Hawaii?
RL: No. Well, the studies have shown that there is that, even in sunny places, but it's much more common as you go farther north, where the days get shorter in the winter. Florida questionnaire studies have shown that less than one percent of the population has significant depressions, whereas in New Hampshire it was up to about ten percent.
Tripod: So, short of moving, what can someone with SAD do?
RL: Well, that's the neat thing about it, is that these cases seem to get better with exposure to bright light. That's usually given in the form of a light box. It's a fluorescent light box, and by sitting under a light box for as little as thirty minutes a day during the winter, they feel significantly better, almost as good as their summertime selves.
Tripod: Can you explain how this works in layman's terms?
RL: Well, we don't know. The research is trying to figure out why it is. The major theory behind it is that the bright light helps to reset the biological clock. We think there may be an abnormality in the biological clock, in the brain, that controls many of our daily seasonal rhythms, and that people with SAD aren't able to adjust their clocks to the changing levels of the day-night cycle in the winter. So what the bright light does is it helps to reset that clock. The other major theory is that the bright light affects a particular brain chemical called serotonin, and that people with SAD may have problems with the amount or the regulation of serotonin, and the bright light helps to increase that.
Tripod: So you wouldn't recommend someone who feels sad all the time in the winter to just go out and use it?
RL: We think it should be supervised by a qualified health professional. The reason is, people should be assessed anyway, never treat themselves, because many physical conditions, for example, thyroid problems, can present with very similar symptoms, so we need to make sure that that is indeed what they have. And there are some side effects with bright light exposure. People with certain eye problems, like retinal disorders, or who are on certain medications that can interact with the light, and perhaps have side effects or damage with the bright light. So it is something that should be done under professional supervision.
Tripod: What does the future of SAD look like? Is there a time when it will no longer be a problem?
RL: That's the interesting part of it. We're still trying to figure out what it is. But there are a lot of research centers very interested in this. Particularly in like Canada and Scandinavia countries, that sort of thing, where it's probably even more of a problem. But the other thing is trying to figure out how light can affect our mood states, and using that knowledge to treat other conditions, and as well using bright light to treat other conditions of the biological clock, like jet lag and shift work.
For more information, visit Dr. Lam's homepage at:
http://unixg.ubc.ca:780/~psychiat/ray/ray.html
Map | Search | Help | Send Us Comments
