DR. KEVIN'S COLUMN
January 8, 2001
A Blue Christmas in London
you're going overseas for work, London is said to be a plum assignment.
Joseph Kennedy brought his family to London in 1938, when he was
named ambassador to England by President Franklin D. Roosevelt.
The Kennedys are said to have had a wonderful time here despite
World War II. I suppose I should consider myself and my family
lucky; I was called to London six months ago to help launch another
health-related Internet company and brought my wife and three
children with me. We all thought it would be a great adventure
-- the kids would be exposed to a new culture, and my wife and
I could enjoy the sophisticated city of London as residents, not
tourists. Certain aspects of being overseas do make London seem
like the choice assignment it is purported to be. But those positive
aspects do not include the famously bad English weather.
Since my arrival six months ago, it has rained nearly every day.
The standing joke in my office is, If you don't like the weather
in London, just wait 15 minutes. On a typical day, the sky is
overcast, it rains, and it's sunny for brief periods. On the evening
weather report, the forecaster measures the amount of sunshine
in hours per day: "We had 1.2 hours of sunshine today" or "We've
experienced a cumulative total of 0.8 hours of sunshine since
Don't get me wrong, London is a fantastic city. But coming here
from Austin, Texas, where the sun bakes the entire state nearly
every day, I am convinced this dark English weather is getting
me down. This summer it rained for weeks at a time and was cloudy
with intermittent sunshine, and according to the British, Mother
Nature was being rather generous. They kept warning me, "Wait
till the winter, when it doesn't get light till 8 a.m. and gets
dark by 3 p.m."
My family and I aren't exactly strangers to depressing weather.
Before moving to Texas, we lived in New England, where the winters
are normally dark and long. With the short days and the icy cold
of Connecticut, we all felt pretty down for a few months -- especially
when all three of our children had colds at the same time.
Clearly, where you live is a key factor in determining
whether or not you get SAD. Those living in New England
are more likely to suffer from SAD than people living
in Texas, simply due to the decreased amount of light.
To pick our spirits up during those dark days, my wife and invested
in specially designed light boxes for our kitchen, where we spent
the majority of our time. After just a few short days of morning
light therapy, the entire family seemed happier. We're not the
only ones who benefited from increased light in our day; several
medical studies show that daily exposure to the brilliant light
generated by specialized phototherapy units provides marked relief
from winter depression. Doctors call this form of depression or
moodiness seasonal affective disorder. The cause is very simple:
lack of natural light.
Seasonal affective disorder, or SAD, is an extreme form of the
winter blues that actually results in clinical depression. It
is estimated that 11 million Americans suffer from the condition
in the winter and that 25 million others have a milder form of
the winter blues. Women are more likely to develop SAD than men
are. The condition typically starts in September or October and
can last until April. People who have this type of winter depression
actually experience a shift in their circadian rhythm (i.e., their
"biological clock") because waking up in darkness causes negative
shifts in people's sleep/wake cycle. Decreased daylight causes
people to feel sleepy and withdrawn. SAD results when the brain's
pineal gland increases production of the sleep-inducing hormone
melatonin in the darker winter months, resulting in sleepiness,
apathy, fatigue, and depression.
of Seasonal Affective Disorder
all of these symptoms may appear during the winter
months, generally between September and April. The
treatment for SAD could include the following: specialized
light therapy, exercise, stress management, antidepressants,
sleepiness, difficulty getting out of bed in the
of sexual desire
of concentration and focus
in junk-food cravings
Studies show that people with mild SAD benefit from using household
fluorescent or incandescent bulbs for 30 minutes to 2 hours of
"light therapy" every morning in the winter. By reducing melatonin
production, light therapy alleviates symptoms of depression. But
research also shows that most extreme sufferers of SAD require
exposure to much brighter light. Therapeutic levels are at least
five times higher (as measured in lux, the unit that measures
light intensity) than that provided by ordinary lamps and ceiling
fixtures in the home or office. Average domestic or office lighting
emits an intensity of 200-500 lux; the minimum dose necessary
to treat severe SAD is 2,500 lux. To put this in perspective,
on a bright summer day the sun can emit a whopping 100,000 lux.
Special light boxes are commercially available that can provide
a high intensity of light -- between 2,500 and 10,000 lux -- and
filter out ultraviolet waves.
Clearly, where you live is a key factor in determining whether
or not you get SAD. Those living in New England are more likely
to suffer from SAD than people living in Texas, simply due to
the decreased amount of light.
Unfortunately, we didn't bring our special light boxes to England,
and I already regret it. Julie keeps saying she is trying to "hibernate
the winter away" by staying in bed longer in the mornings and
going to bed earlier. She says she thinks she must have been a
bear in a previous life. Trudging through the bleak and rainy
London weather, she is often uncharacteristically blue and withdrawn.
But if the sun shines through the clouds even for even a brief
moment, it brings an instant smile to her face. My response to
winter darkness has been to eat more, particularly potato chips,
and to stay indoors. Our kids are often moody and throw more temper
tantrums than usual in the winter. We try every day to be more
British in our approach to the weather -- stiff upper lip and
all. Until we master that, we're importing some light boxes from
the United States.
Send feedback on this article.
Kevin Shushtari, M.D., is Rx.com's Chief Medical Officer and a co-founder
of the company. He is also a board-certified internist with a medical
degree from Dartmouth College. In Dr. Kevin's Column he will share
his own experiences as a physician, a family member, and a patient.