Saturday, October 28, 2006

Daylight saving-time and Seasonal Affective Disorder

Well, it's that time of year again, time to turn the clocks back an hour tonight. I dread this change every year because it signals to me the beginning of the end of my natural cheerful and upbeat disposition, agreeable temperament, and boundless energy. Okay, I never had those traits, not even in my twenties or at any time in my life. I have always been a bit of a contrarian, had a foul temper (verbally, at least) that I have managed to control through years of utter hard work, and been on the verge of exhaustion on most days of my life. But once the time change sets in, the exhaustion deepens. I know, I know, I should try to follow the advice of the health and fitness experts who give all kinds of tips such as "go outside, exercise and go for a twenty minute walk a day, and take vitamins."

My results? The outdoors gives me allergies and makes me even more fatigued, walking makes me dizzy combined with all the heart meds I take and those vitamins hurt my stomach. So after this advice, my mood turns even darker. Is it Seasonal Affective Disorder (SAD)? Who knows? Many colleagues and others suggest light therapy devices.

Does SAD really exist? Most psychologists and experts say "yes," but other studies such as this one found that the Icelandic population did not suffer from seasonal mood changes like other populations. Could SAD be culturally induced, caused by the media or companies who want to sell light therapy devices? Or is it real?

What do you think?

147 Comments:

Blogger Baronger said...

Could they have been enough genetic drift in the icelandic population, so that todays population is better adapted to low sunlight conditions. I would like to see if similar studies have been done among the Inuit. SAD would have to exert some evolutionary pressure on a population, as those that don't suffer or have a milder case would be able to do better in those environments.

4:38 PM, October 28, 2006  
Blogger Helen said...

Baronger,

Genetics and adaptability probably do play a part. I think there are also more SAD symptoms in places where the seasons change more distinctly.

4:48 PM, October 28, 2006  
Blogger Eric said...

It's real, it's here, and it doesn't seem I'll ever get used to it. Best thing to do is move to a better climate with more light.

Or move to Iceland and spend half the year drinking?

But consider the following odd factoid:

**quote**Alcoholics Anonymous World Headquarters has compiled AA group membership data in countries around the world. In 1991 (the last year for which data were kept), the western country with the fewest AA groups per capita was Portugal, with 0.6 groups per million population. The highest was Iceland, with almost 800 groups per million. This is a strong indicator of greater perceived alcohol problems in Iceland--even though Portugal consumes 2 1/2 times as much alcohol per capita as Iceland!**quote**

http://www.peele.net/lib/sociocul.html

Maybe the Portugese just don't realize how messed up they are.

Is it worth trying to figure out a way to make denial work?

4:49 PM, October 28, 2006  
Blogger Sissy Willis said...

Architects have been experimenting with "the art of daylighting" for a number of years, and "the use of daylight as both an energy-efficient lighting source and an agent of increased occupant happiness and productivity has been documented in numerous case studies around the country."

Let there be light

5:01 PM, October 28, 2006  
Anonymous Anonymous said...

I look forward all summer to this day. Why must government force us to get up an hour earlier all summer?

You people who like to get up early, why don't you just get yourselves up and enjoy the extra hour in the morning, instead of forcing all of society to change its clocks?

5:11 PM, October 28, 2006  
Blogger RebeccaH said...

I believe SAD is real, having suffered from it all my adult life. Getting outside in the light helps a lot, especially after the first freeze (freeze, not frosts) when outdoor allergens have been largely put down. I'd also recommend vitamins in liquid form such as fortified juices (for instance, Goji juice).

Genetics probably does play a part, but Icelanders are also a very active people who spend a lot of time outdoors even in winter. If outdoors isn't an option (which it is for me), perhaps a light box would be helpful.

Some people swear by yoga, but I figure just cutting back on stressors is a plus.

5:15 PM, October 28, 2006  
Anonymous triticale said...

This time of year there simply isn't enough natural daylight to do the job. Large amounts of artificial light does not solve the problem; spectrum is important. "Daylight" flourescents are expensive, but there is a cheaper solution anywhere non-compact flourescents are used, one developed by small-scale indoor marijuana growers. Mix equal numbers of warm and cool spectrum flourescents. We had a kitchen with the old concentric ring fixture. A warm tube for the outer ring made the room much more comfortable.

5:17 PM, October 28, 2006  
Blogger Mr. Snitch said...

FWIW, I also find it rather depressing when darkness arrives earlier.

5:21 PM, October 28, 2006  
Blogger Alcibiades said...

You could always try that whipping therapy that Glenn mentioned yesterday.

5:26 PM, October 28, 2006  
Anonymous zhombre said...

Move to Florida.

5:29 PM, October 28, 2006  
Anonymous Gina said...

Dr. Helen,
There have been some studies linking vitamin D deficiency with SAD and other forms of depression...

5:32 PM, October 28, 2006  
Blogger Doug Wade said...

I've always had mood issues in the winter, especially after moving to San Francisco from LA. I find it really helps to make sure I get outdoors when I can.

Not sure if it's a chemical thing with the light, or if it's a lack of exercise, or if I just get a bit stir crazy if I'm home all the time but getting out and about in the winter does make a big difference for me.

5:36 PM, October 28, 2006  
Anonymous Anonymous said...

I'm a lot that way as well, but figure that it was sort of the Pavlov's dog type effect as the holiday season starts ramping up.

5:36 PM, October 28, 2006  
Blogger Gordon R. Durand said...

We really get SAD here in drizzly old Oregon. I landed a contract in San Diego winter before last. That cured it for me.

5:39 PM, October 28, 2006  
Anonymous Debbie said...

Dr. Helen,

I think SAD is real - I actually have reverse seasonal affective disorder. I get lethargic, depressed and grumpy during the summer months. I used to think I was really crazy until I read, sure enough, there are a few of us who need less sun and light. I absolutely come alive during the winter months. Go figure. I feel for you - having just left my RSAD season. I have a friend who had good luck with a fake sun lamp for her SAD. And, my husband, who I think has a mild version of SAD, bought a tanning bed that he uses during the winter to cheer him up (and give him skin cancer I like to point out - and he's a doctor!).

Debbie

5:39 PM, October 28, 2006  
Anonymous Old Guy said...

Gina is right. I also have cardiomyopathy and have to be careful with meds. I live much farther north than you, and the lack of sunlight during winter is even worse. I had been on anti-depressants during the winter, and decided to drop them for many reasons. My wife, a strong believer in naturopathic remedies, dragged me to a practitioner, who told me to take big handfuls of Vitamin D during the shortest days. They work.

By the way, shifting from daylight savings to standard just means that an hour of light at the end of the day has been transferred to the beginning. Makes it easier to bounce out earlier.

Good luck.

5:40 PM, October 28, 2006  
Anonymous Anonymous said...

I usually wake up at 7:50, so tomorrow it'll be 6:50 -- most likely.

I'm prepared for that extra time though! I've got fresh eggs, a pound of bacon, a package of brown'n'serve sausages, a bag of pancake mix, butter and Grade B maple syrup.

Can't go too far wrong with that plan!, then by Tuesday I'll be back to 7:50 again.

5:46 PM, October 28, 2006  
Blogger Maddad said...

I'm another natural grouch and it's the rain that gets me. If it rains for more than a day or two it's all over for me.

I work out and that seems to help a bit, but if I can't go outside for at least a few minutes a day...watch out.

My younger two kids are just like me, have to have sunlight.

5:49 PM, October 28, 2006  
Anonymous Anonymous said...

I'm told I have a case of SADs but since I have fibro myalgia, fall/winter with its cold temperatures and seasonal changes adds another dimension of misery that makes SAD look like nothing.

My suggestion: Cat naps. Not as in "Just a brief lil nap". It means drag a futon, coach, or other comfy piece of furniture near a south or east sunny window. Open up the drapes and take a 30-45 minute or so nap in the afternoon sunshine.

It takes a while to get used to it but a Mexican Siesta really helps manage stress and energy levels.

You don't have to deal with the outdoors, finding the right lightbulbs, and it should be within the range of the right amount of sunshine.

-E.W., Southern New Mexico

5:50 PM, October 28, 2006  
Blogger DRJ said...

I think it's liver disease.

6:00 PM, October 28, 2006  
Anonymous Chuck Pelto said...

TO: Dr. Helen
RE: SAD[ness]

Personally....

....I'd recommend taking a close look at homeopathy.

I've no personal experience with SAD, however I have found homeopathic techniques effective against nerve problems, e.g., burning feet in the Summer time when going to bed [sulfur], and burns themselves [cantharis].

With the latter, there is little, if any, scar tissue. [Note: Explain THAT away with the 'placebo effect'.]

Good luck....

Regards,

Chuck(le)
P.S. For this sort of thingie, I'd recommend Boericke's tome on Materia Medica.

6:06 PM, October 28, 2006  
Anonymous Roland Hecht said...

My wife became lethargic and quite depressed every winter in our last house. Always one to try the simple before the expensive I replaced the incandescent ceiling fixture in the kitchen/dining room (her favorite daytime area) with a two-bulb 4-foot fluorescent fixture and put daylight bulbs in it. Honestly it seemed as if we had a skylight in the kitchen ceiling. She credits it with improving her mood substantially. I called a commercial lighting supply for advice on the bulbs, and got a quick lesson on the proper Kelvin temperature to mimic sunlight. Home Depot carries "Daylight" bulbs now, but I'd still call a commercial supply house to make sure I got an appropriate bulb.

6:10 PM, October 28, 2006  
Blogger Ken Arneson said...

SAD is real. I have it. I've spent three winters in Sweden, and by the time February came around each year, I was the most miserable person on the planet. (The symptoms always hit me worst in February, for some reason.) It was horrible.

I live in California now, and the weather/extra daylight helps, but getting older hasn't. A few years ago, my February irritability progressed into February full-blown panic attacks, and so I've had to move up from just "dealing with it" to actively managing the problem.

The keys for me are two things:

1. A light therapy lamp. This is easy; you can just have it on next to your computer as you work, and it doesn't intrude with what you're doing.

2. Get enough sleep. When I was in my 20s, I could stay up all night if I wanted to. Now I'm in my 40s, and if I go one night without my 7-8 hours of sleep, I'm a mess for two days. I can't emphasize this enough. Don't skimp on sleep.

Good luck.

6:15 PM, October 28, 2006  
Anonymous Tom Bridge said...

I've had a full spectrum light the last few winters, and whie it makes a difference, it's not a cure. I know it sounds tacky, but tanning salons help the most.

While this is just my personal theory, I lived much of my youth in a more southerly location than I live now, and I think the decrease in daylight is part of my problem...

6:18 PM, October 28, 2006  
Anonymous Dave Hardy said...

1. My wife gets irritable and depressive in the summers. Of course, this is the Arizona desert, where in winter you walk around in a pullover shirt and still don sunscreen, and in summer highs go over 110 and you stay indoors as much as you can.

2. I noticed when working in DC that people could take about 4-5 days of complete and continual overcast. Beyond that point, everyone seemed to lose energy, sadden, and in short become depressive. A day or two of sunshine would restore things.

6:18 PM, October 28, 2006  
Anonymous Michael Anderson said...

Try getting as much natural--instead of artificial--light as you can. I have dread fluorescent lights in my office, but great windows, and the sunshine, even indirect, is a great picker-upper.

You don't have to power walk to take advantage of the outdoors, either. I occasionally walk to a nearby building just to dodge the phone and see the sun. My mother knew best: "Go outside and play, dangit!"

6:19 PM, October 28, 2006  
Anonymous Joel said...

Dr. Helen:

For me, SAD used to set in just after the leaves hit their peak because of the looming tunnel of winter. (Insert death analogies here)

I've been able to push it back recently by planning a low key Caribbean trip (Bequia) with my wife over the Thanksgiving holiday. The sun stays up longer because its closer to the equator and it actually feels like its Summer. When we return to the frozen North, it's the Christmas season and, being refreshed, we are ready to celebrate the remaining holidays with our friends and family. It also gives us something to talk about that isn't work related.

We then plan a second trip to a different warm weather destination for February. By the time the glow from that trip fades, Spring is at hand and with the longer days, SAD is successfully sidestepped.

Repeat as necessary.

Joel Beach, Delaware County, PA

6:25 PM, October 28, 2006  
Blogger Maetenloch said...

I probably have a touch of SAD myself. I find that I lose some energy and have a tendency towards depression during the dark winter months. For me having the window blinds open in the morning along with a bright light on a timer coming on 30 minutes before my alarm goes off makes a difference. Also exercise helps a lot and not just in the SAD area. I've tried various supplements, but haven't noticed much of an effect. Melatonin can help get your bodyclock back in sync with the daytime/nighttime cycle, but it doesn't provide the wakeup signal that bright light does. Some people's biological clocks are more sensitive than others and need a strong synchronization signal everyday to stay in phase.

6:26 PM, October 28, 2006  
Blogger Ric Locke said...

The form of light therapy that does best for me is to use it as an alarm clock. It's getting up in the dark that gets me down.

Put a full-spectrum lamp on a timer. You can use one of those that's like a wall wart, plugs into the wall and has a 24-hour dial on it. Set it to come on a few minutes (less than 5) before your alarm goes off.

If you're a computer geek, you can get one of the X-10 gadgets and program the computer to turn it on gradually. That's even better. I wish somebody would build a lamp with LEDs in it that you could program for color temperature. Programming it to simulate a June dawn would have me chipper and ready to get up. I wouldn't be able to afford it though.

Try it. It won't cost much (the timers are cheap, and a 100W bright-white incandescent will do for the experiment.) It makes a big difference to me. Perhaps it will help you.

Regards,
Ric Locke

6:28 PM, October 28, 2006  
Anonymous Anonymous said...

I have the same problem. I just hate the short, dark, gloomy winter days, the lack of color, the rain, rain, rain (or snow snow snow when I lived up North). I drag myself through the days and I'm ready for bed by 7 pm. By springtime I'm ready to kill myself, or at least kill my family. Nothing works for me - not exercise, not special lights, nothing. What I must have is warm sunshine and the colors of summer. Consider a wintertime getaway to a sunny beach location a necessity, not a luxury. It's a temporary fix, but it does wonders for my psyche, and I'll take what I can get!

good luck!

6:30 PM, October 28, 2006  
Blogger Maetenloch said...

Roland Hecht is right about using 'daylight' fluorescent bulbs. A few years ago I worked in an interior office that got almost no natural light. The existing bulbs were pretty dim, so finally I went out and bought some full spectrum bulbs with my own money from Home Depot - they're only about $5 each. They made an amazing difference in how I felt in the office - not only were they brighter, but their color made it feel like I had skylights. It made the office seem much less claustrophobic and tiring. It's amazing how much a simple light change can affect your psyche.

6:34 PM, October 28, 2006  
Anonymous BN said...

I've had good luck with Artic Cod Liver OIl. (It comes in gel caps so you don't actually taste it!) It's not a total fix but it helps with PMS, has lots of Vitamin D and is good for your heart. If you get some, make sure that it is 'Molecularly Distilled' this means no impurities like mercury etc.

Best of luck.

6:34 PM, October 28, 2006  
Blogger Cogitatus Incognito said...

You might consider apple juice. It apparently boosts production of acetylcholine. I'm not a foodie or health-food person by any stretch of the imagination, but I began drinking two to three glasses of apple juice a day after reading it helps with memory. Acetylcholine is also implicated in depressive disorders, as you know doubt know. I've noticed a definite impact on my unmedicated clinical depression since starting the apple juice, especially the dsythymia and low motivation. And if it helps reduce my risk of developing Alzehimer's and I love apples, what's to complain about.

http://psychcentral.com/news/2006/08/02/apple-juice-for-memory/

http://www.sciencedaily.com/releases/2006/08/060801225922.htm

6:36 PM, October 28, 2006  
Anonymous Anonymous said...

I have a related problem. I can't stand summer. I'm indoors for work and school and desperately want to be outside but never find the time during the day. Winter is soothing and makes me want to stay inside. I am therefor much more productive and happier in the winter.

6:42 PM, October 28, 2006  
Anonymous Jay said...

SAD is absolutely real! I kind of had some idea there might be something like it going on with me before the notion of SAD was announced. My reaction was a cross between "well, duh" and "yes! vindicated" when I first saw the news it had been discovered or posited or however you might put it.

I felt even more vindicated when my doctor recently suggested I probably have it, entirely unprompted by me.

6:43 PM, October 28, 2006  
Anonymous MathMom said...

When I lived in Alaska I had to learn a bit about this. In Anchorage on the shortest day, it is pitch dark still at 9 or 9:30 in the morning, and the sun doesn't get above the mountains until about noon. It drops back below the mountains about 3:30, and is dark again by 5 or so. I was advised to go outside every day and get into the sun if it ever appeared. Since it's so difficult to get real sunlight, doctors there advise using full-spectrum fluorescent light to supplement the tiny amount of daylight available.

These fluorescents used to be $25-35 per tube, but now you can get full spectrum fluorescent tubes at Home Depot for about $7 each. You need to get tubes with a light temperature of at least 5000K, which is supposed to be equivalent to high noon on a summer day. They also have lights with a temperature of 6500K, which used to be called Arctic White. I prefer these. Home Depot has these extremely white lights in compact fluorescent screw-base styles, as well.

When in Alaska, I had a draftsman's table lamp which had two fluorescents. I changed them for full spectrum, and spent time each day looking directly at that light. I also had a bare full-spectrum fluorescent over the kitchen sink which I looked at and worked under when working in the kitchen. Making an effort to look directly at the light helped a lot.

I live in Texas now, but still have the 6500K fluorescent tubes in my kitchen, because it feels like I have a skylight when I have them on. They really wake me up in the morning when I snap on the light at 5:30 a.m. I also have the 6500K compact fluorescents in my computer room, which has a ceiling fan with 4 lights. I feel less eye strain and general fatigue when working in there since I started using those lights.

The 6500K lights are not the best choice in a reading lamp - they give a very odd color through the shade, and they are rather jarring when used in the parts of the house where you hope to have a restful ambiance. Ordinary incandescent bulbs are better there. If fluorescent overhead lighting isn't possible in your house, try the draftsman lamp idea, and move it to where you are sitting or working to get your daily dose of sunshine.

6:44 PM, October 28, 2006  
Blogger tomcal said...

I like it better with the clocks set to standard time. lets just keep them that way all year round.

Daylight Savings time was established so that kids would have time to work the farm after school during the harvest season. I don't see many kids working the farm these days...

6:45 PM, October 28, 2006  
Anonymous Anonymous said...

June 12: Sunrise 5:08am Sunset 8:39pm
Oct. 29: Sunrise 7:26am Sunset 5:48pm

Last year, in the month of November, 25 days were overcast skies with an average temperature of 42.5 degrees.

Yes, I want to hibernate! I gain weight, I crave sleep, and I feel perpetually pressed for time. With the loss of sunlight your inner clock, your circadian rhythm, resets.

I do know some friends who take St. John's Wort during the winter months. I just soldier through and deal with the mopiness as best I can, I indulge my need for sleep, drink red wine, binge on chocolate and on sunny days when I am home, I fight the cats for a spot by the windowsill.

6:46 PM, October 28, 2006  
Anonymous Danny said...

SAD, wintertime blues, or whatever you call it...it's not caused by the end of DST. The day is no shorter than before...your clocks just moved back an hour. Anyway, if I suffered from it, which I don't I guess I'd watch a lot of summery movies in my spare time.

6:47 PM, October 28, 2006  
Blogger Ben said...

I'm pretty sure that I have SAD.

When I went to college in Pennsylvania, and I definitely noticed a difference in the winter time, and it seemed to hit hardest after Daylight Savings Time weekend.

Then something interesting happened when I moved to South Carolina after college, and I've just been able to put my finger on it in the past few years: in Dixieland, during the Summer I'm very distractable and flighty, and then when it starts to cool off and darken a little bit in the Autumn, I calm down and find it easier to concentrate. Living in the South, I find that it's my most productive and creative time of the year.

So I have SAD, but it seems to manifest itself differently at different latitudes. Go figure.

6:49 PM, October 28, 2006  
Anonymous Cover Me, Porkins said...

Helen: think Thanksgiving. After Thanksgiving, think Christmas. By New Year's, days will have been lengthening for over a week.

6:51 PM, October 28, 2006  
Blogger steve poling said...

This ain't pretty, but sometime in late December when I haven't seen the sun for a few weeks, I pull my 800watt halogen drywall lights out of my basement. I set them up in a corner of my office and work with the light burning there in the corner. I googled up a picture of it here. My wife puts up with this for a week or two, then I have to put it away.

6:53 PM, October 28, 2006  
Blogger Steve Bartin said...

Helen:

If you can, go to the gym.Get your Ipod on and lift weights.I suggest at least an hour a day work out.I suggest,if this doesn't work,go back to the gym a second time a day.The endorfens rush should make you feel really good.As you feel and look better(because you will with all that activity) you mind will get off the darkness.

7:08 PM, October 28, 2006  
Blogger TMink said...

Hey Helen,
My father had SAD, he made his own light box with lots of daylight tubes and would read email and play solitaire for around an hour a day in the winter. He missed the lost hour, but you could tell the difference in his mood. Give it a try. Hubbie will get to play with some power tools to build it!

Trey

7:10 PM, October 28, 2006  
Blogger Californian said...

Flourescent tubes should have a CRI value on the tube -- that's for color reproduction index. For photography, you want the highest number to reflect all the color of your subject.

I'd guess the same applies for mood boosting, too. You'll quickly notice that many so-called "full spectrum" lights have CRIs in the 80s. Not good.

Home Depot sells bulbs with high CRI values for a decent price.

I grew up in the gloomy suburbs of Washington DC. First thing out of college I moved to Colorado. Then to Florida. Now SoCal.

See the pattern?

7:44 PM, October 28, 2006  
Anonymous John Cz said...

My work requires me to be in windowless offices all year long. I have found "sun light" bulbs in either flourescent or incandescent fixtures to be a big help. Facilities people can be problematical. In one facility the facility people kept trying to remove the bulbs I supplied at my expense so be alert to this.

7:45 PM, October 28, 2006  
Blogger Helen said...

To all:

Thanks so much for the great advice so far!

7:49 PM, October 28, 2006  
Anonymous Anonymous said...

I used to pooh-pooh Seasonal Affective Disorder, but some experience convinced me it is the real thing.

When the legislature in my state is in session, me and some other folks work in a room without windows and semi-dim light. When we come to work, it's dark, and when we leave, it's dark.

A co-worker saw a doctor for depression-like symptoms. He told my friend to sit in front of a "light box" for an hour or so each day. He did, and his mood improved noticeably.

I deal with it by taking short breaks in an area of the building that has abundant natural light. It's more convenient than going outdoors -- too cold.

7:51 PM, October 28, 2006  
Blogger OhioAnne said...

For me the next few weeks - between tommorrow and December 23rd - are the worse. You go to work in the dark and pretty much come home in the dark as well.

A couple of years ago, I read that, in addition to light therapy, keeping cooler is helpful. Instead of grabbing a parka on the first cold day, use a lighter jacket instead. Don't bundle up until you really have not choice at all but to do so.

Whether being cooler really helps or if it is simply a form of mental rebellion against the inevitable winter that's coming, I'm not sure, but it does work for me.

Once the shortest day of the year passes, I can usually handle it.

7:52 PM, October 28, 2006  
Anonymous Anonymous said...

Helen--
I have treated more than a few patients with SAD, and have no doubt that it's real. There are several treatments that have well documented efficacy, but not every treatment works equally well for everyone. Wellbutrin XL (bupropion) is an antidepressant that has recently received FDA approval for prevention of episodes of SAD, and is often but not always effective. It's nice because it's associated with neither weight gain nor sexual side effects, as are the SSRI's. The SSRI's are often effective in SAD as well, although none has received FDA approval. (To my knowledge, none of the SSRI makers have sought such approval.) Fall/Winter depressions are frequently atypical symptomatically--that is, sufferers often have increased sleep, appetite and weight, whereas in the more standard variety of depression people experience reductions in sleep, appetite and weight. Also, Fall/Winter depression, the most common form of SAD, is usually associated with very prominent fatigue.

The most simple and elegant treatment, although it does not always work as used, is phototherapy, which others here have mentioned. Much more important than the frequency of light (e.g., "full spectrum" lights, aka "grow" lights) is the intensity of the light. Most devices that are now standard do not use full spectrum lights, but rather high intensity fluorescent bulbs. The standard now is to utilize 10,000 lux lights, with lux being a unit of intensity. These devices produce 10,000 lux at a given distance--usually 18-24 inches from the source. This is about 10-20 times the intensity of ambient light in an average room. It's so bright that it borders on aversive, which is the root cause of many therapeutic failures of phototherapy: many patients unconsciously move away from, or turn away from the source. To be effective the light must be shining directly into the face (eyes), although one shouldn't stare at the light. I often counsel people to read a book or magazine held immediately below the source so it can shine in the eyes, for 20-30 minutes per day, preferably in the AM. Again note: since light intensity decreases by the square of the distance from the source (e.g., doubling the distance from the source reduces the received intensity by 75%) , it is crucial to be within the distance range suggested by the manufacturer.

Most of the nerve cell fibers from the retina go to a visual processing center in an area of the brain called the thalamus, but a small number form the retinohypothalamic tract and terminate in the hypothalamus. The hypothalamus is involved in mediating drives, such as appetite, sleep, sex, and makes up part of the limbic system which is known to be important for the experience of emotion. Presumably, it is via this tract that light helps to entrain all sorts of normal behaviors (e.g., migration, hibernation)to a yearly cycle, and to ultimately betray those with SAD.

Exercise helps, but I suspect that the magnitude of benefit of exercise for many sufferers is likely less than that associated with phototherapy and antidepressants. Getting outdoors is similarly of some benefit, but is nto likely to be curative alone. After all, the reduction in light intensity in Fall and Winter has as much, or more, to do with the low angle of incidence of the light on Earth as it does with the length of the day.

As others have said about the low prevalence among Icelanders, I believe this relates to genetic adaptation in this population, which is well known for its genetic isolation. There are good data that examine the effect of latitude on the prevalence of SAD. As one would expect, the incidence rises dramatically with latitude.

Hope this helps.

Joe B.

8:03 PM, October 28, 2006  
Anonymous Anonymous said...

Oh, I think light has a lot to do with it (and, given the chemistry, vitamin D). Caveat -- genetics for me makes depression a part of nature.

As a contractor, my job has me outside spring, summer, and fall. Winter (i.e. cold weather) brings inside work and slower business.

The slowdown in business isn't much of a factor, given unexpectedly busy work schedules during a few random winters. Last winter was perhaps my busiest but I was in a real funk through February, whereas the funk usually lasts into January.

I'm keeping track of the comments made -- it's been my suspicion for a few years that the natural light/vitamin D thing is key.

8:19 PM, October 28, 2006  
Anonymous Anonymous said...

I've been using one of those light therapy devices appoximately October through April, expecially when I wake up to a pitch black "morning" in Michigan. Its possible its a placebo, but I think it does help.

Richard.

8:20 PM, October 28, 2006  
Blogger Bret said...

SAMe helps me.

8:38 PM, October 28, 2006  
Blogger 74 said...

Dear Dr. Helen, I offer my condolences. Although the rest of our family doesn't seem to have that problem, my oldest daughter developed the symptoms during her last two years in Winters college. It got so bad that she dropped out of school with just two quarters to go and moved from our home town in Oregon to Texas. After moving to Texas, her symptoms disappeared. Five years after her move, she came back to finish her degree and started suffering the symptoms again during the Winter term. She has now graduated and moved back to Texas. Interestingly, she didn't seem to have any problems during the two winters we lived in Iceland when she was quite young. Perhaps there is an age component to SADS as well.

8:47 PM, October 28, 2006  
Anonymous Anonymous said...

I use full spectrum lights (Verilux, mainly) to good effect, but not as an intensive therapy. Instead they are in my study, my kitchen, my office at work and anywhere I try to read.

I find that having the more extended exposure makes a huge difference over the course of weeks and months.

8:48 PM, October 28, 2006  
Blogger Scoobie said...

Move to San Diego. It worked for me.

8:53 PM, October 28, 2006  
Anonymous Anonymous said...

I have had SAD most of my life and was a patient in one of the first studies done at NIH in the early '80s.

At that time, production of the hormone melatonin was tracked to determine the presence of SAD. Melatonin is produced when there is little or no light and shut down by the presence of light of the right intensity and color. Melatonin is the hormone that makes you sleepy at night. In most people it rises and falls very predictably. With SAD, production is all over the map.

Studies were done to determine the effectiveness of light therapy in controlling the problem. It was found (at that time) that the light levels had to be very high and that the orange part of the spectrum was most important. This has probably changed by now because the studies had difficulty in that area.

What works and does not work (for me, your mileage may vary).

Frequent world travel. No kidding, it works like a charm. The last 5 years of my job before I retired required this. It seems that a semi-permanent case of mild jet-lag completely negates the cause of SAD.

Move to the equater. Works as well as world travel. I spent several months in Rio and never felt better.

Move to the Southern U.S. Second only to the equater.

Lights. When used in the early morning they have some affect. Evening lights did not help at all.

Antidepressants. Did not help at all and they can wreck your sex life.

Carbohydrate loading. Helps for a few hours but has other side effects, like increasing waist size.

SAD is a recognized disorder and you may be able to find references at the National Library of Medicine. www.nlm.nih.gov


Hope this is some help..

Jerry H.

8:59 PM, October 28, 2006  
Anonymous Anonymous said...

1. Find a motorcycle of agile automobile.
2. Head out from Knoxville, through Marysville, and over the Foothills Parkway.
3. Head up US129 and over Deal's Gap.

Repeat step 3 as needed.

Works for me every time.

9:06 PM, October 28, 2006  
Anonymous Anonymous said...

I am from a sub tropical country, and moved to Seattle a few years ago, and definitely found Winter bad. The ratio of day to night length really seems to throw me.

My solution is a little different to the others above. I reasoned that I wanted to replicate a subtropical day/night length, and I work from home, so this is easier to achieve.

I bought several very bright Halogen upright lamps, and also some daylight bulbs. I then went to smarthome.com and bought myself some X10 compatible controllers. I set things up so that one halogen in my bedroom and some other lights were smoothly ramped up in the morning, so I had an artificial dawn that woke me. I also set up the lights to be ramped down 12 hours later.

I use a mix of normal and daylight bulbs around the house - the lights closest to windows have the brightest daylight bulbs I can get. I use normal (yellowish) bulbs internally to the house. The effect is that you feel like it is bright outside, if you are not looking directly at the window.

I also take vitamin D supplements.

The bright light during the day is nice, but I think it is the artificial dawn that keeps me sane.

BTW, I have used BuyLighting.com, and am quite pleased with their service.

Good luck!
Ray

9:13 PM, October 28, 2006  
Blogger Éowyn said...

I hope this link will be helpful http://www.vitamindcouncil.com/depression.shtml#content

Vitamin D3 deficiency can be a big factor in SAD and conditions such as chronic muscle pain and Multiple Sclerosis. An earlier comment mentioned no problems or less in Iceland (sorry quick scan thru). It could be because of a greater intake of fish oil (rich in D) that could be responsible.

Good luck! Let me know if it helps!

9:34 PM, October 28, 2006  
Blogger Man in the Middle said...

To get added real daylight into our home, we added three Solatubes. (www.solatube.com) In my opinion they work even better than high color temperature bulbs at improving my mode as days shorten.

I also make a point of spending time outdoors in daylight every day, and whenever possible leave the office before sundown even in late Fall. That helps too.

As mentioned by another, my mood brightens immediately on December 22, as days start to lengthen again.

9:58 PM, October 28, 2006  
Anonymous Phoenix said...

Easy. Becom an Arizona snowbird. Zonians love our winter (more than our summer). But please remember to switch off your turn signal and please drive faster than the speed limit.

10:11 PM, October 28, 2006  
Blogger John said...

For heaven's sake, lady; don't you live in *Tennessee*?!?!?!

Try Vermont. You'll be gardening at Easter, I'll be digging out from the last Nor'Easter.

SKS

10:21 PM, October 28, 2006  
Blogger Chris said...

Could SAD simply be a manifestation of the fact that our diets tend to change in Fall and Winter? Most people eat less fresh fruit and vegetables during the darker months. My totally non-professional advice would be to increase fresh greens and veggies, and supplement with daily vitamin D. Try it for six weeks and see if there's any improvement. It's always worked for me.

10:34 PM, October 28, 2006  
Blogger ed said...

Hmmm.

I get very irritable during the wintertime as well. Ok. More irritable than normal.

Morning:
10 minutes on a treadmill.
5-10 minute very hot shower to open the pores.
15-20 minutes in a sauna.
warm shower afterwards to cool and clean the skin.

At night:
one small glass of brandy

*shrug* it works for me.

10:53 PM, October 28, 2006  
Anonymous Anonymous said...

Ask Rush Limbaugh. He seems to be an expert this week.

My vote: Try light therapy

11:05 PM, October 28, 2006  
Anonymous Anonymous said...

I have starting taking St John's wort from November thru February. It works actually pretty well. The importance of exercise cannot be understated too.

11:07 PM, October 28, 2006  
Anonymous Venomous Kate said...

Wow, there are so many comments, I have no idea whether someone's already suggested this or not.

As a fellow allergy sufferer who's also recently started taking some serious meds, I wholly understand the frustration of not being able to go outside to counteract the "blahs." I try to exercise regularly (although probably not enough) but after being diagnosed with RA recently it's just getting far too painful.

What has helped was forcing myself to adhere to a strict early wake/early to sleep schedule (which is hard, considering I'm a night owl) and, most of all, increasing the amount of Omega-3 in my diet.

(QUOTE) Omega-3 fatty acids have a role in the synthesis of serotonin, and there are encouraging data about their use in depressive disorders. Also, because the incidence of SAD is associated with higher latitudes, it seems logical that people who live in the Arctic would suffer from very high rates of a winter depressive disorder. Researchers, however, have found to their surprise that SAD is very rare among Icelandic peoples, who eat a lot of omega-3 fatty acids in coldwater fish. Interestingly, when fish consumption goes down, the incidence of SAD begins to increase (McGrath-Hanna NK et al 2003; Cott J et al 2001; Magnusson A et al 2000). (END QUOTE)

This is easily done by eating more salmon, ahi tuna, sardines, brazil nuts, walnuts. If you like sushi, this is a great excuse to eat more!

I do hope you feel more like yourself soon. It's miserable spending such a large chunk of the year out of sorts!

11:22 PM, October 28, 2006  
Anonymous Suzie Nolen said...

I have friends who swear by the light therapy thing.

Why can't we dispose of Daylight Savings Time, period?

11:26 PM, October 28, 2006  
Anonymous michael said...

The lux and duration therof doesn't seem like much in terms of what is needed to entrain ciracadian rhythms disruption of which is seen as biologically relevant. I have patients in Dallas who claim SAD; doubtful. I find the seasonal, dietary hypothesis novel, possible. Some people respond to stormy, gray weather with excitement and tranquility. It seems to give an externalization to their mood, be a relief. I think for others it may be an unwelcome 'return of the repressed.' The weather as artwork may be relevant.

11:40 PM, October 28, 2006  
Blogger Mark Sicignano said...

I think we've got "lighting" pretty well covered in these comments.

On to some of the other senses now... What about maintaining spring and summer sounds in your house when you're "shut in" during the cold months, when the birds have flown south.

I downloaded a bunch of sound clips from the internet, if various birds, ocean sounds, streams, and played them in a loop while doing some reading last winter. It seemed to make me feel better and put me "in another place" mentally.

How about scents? Does having having more plants in your home make a difference? I know that my mood is lifted with the smell of a Christmas tree... Can you buy the smell of fresh cut grass in a bottle? :-)

11:42 PM, October 28, 2006  
Anonymous Anonymous said...

My fathet and sister have SAD and a 20 mins a day of a natural light lamp seem to help. Apparently there is a high suicide rate in Northern Europe, allegedly related to SAD, All I know is that my wife and I get depressed during Pittsburgh winters.

11:43 PM, October 28, 2006  
Anonymous Paul in Kona said...

I first experienced SAD when the Army sent me from Colorado to Alaska. I had no idea what was happening to me. I was sad, lacked energy and actually considered suicide. When the long summer days came, I recovered, with no idea of the cause.
Going on to college in Fairbanks, I still had no clue. From an honor student I all but failed; cutting classes for days at a time, hiding in my bed, overuse of alcohol, etc. Of course summers were glorious, but I did not put the two things together.
Some years later I read about this syndrome, and realized belatedly, what had happened to me. I started using the natural light bulbs, and most of all, moved here to Hawaii, where it only appears on overcast, rainy days (and to think I spent years suffering in Juneau also, wet, dark, rainy). I recommend the lights and if possible, moving farther south.

12:00 AM, October 29, 2006  
Blogger eclectic said...

I think it is real > I have always had to have all of my major projects complete prior to thr comming of the winter season. I worked as an environmental inspector in mining and reclamation ubtill I retired.

12:01 AM, October 29, 2006  
Anonymous Anonymous said...

On the intolerance of vitamins, let me suggest trying those bound with kelp, such as GNC's Women's Ultra Mega. Those are the only ones I've ever been able to tolerate without indigestion.

12:16 AM, October 29, 2006  
Blogger Dr. Melissa said...

Hi Dr. Helen,

S.A.D. is definitely real. I grew up in Michigan and spent the months of February and March in a consuming funk. When I moved to California for college, I remember being awed by the non-stop sun. Even still, the first year, I experienced a "downer" two weeks. The years after that, I had a few days of lingering, body-memory depression during February.

All this made me to decide to move down South. I've never regretted it--humidity be damned.

I think the difference is partly psychological. Down here, I know that a dreary day will turn around tomorrow. In Michigan, the dreary lasted months. I couldn't take it.

Nothing, save vacations to sunny destinations breaks the cycle.

12:29 AM, October 29, 2006  
Anonymous Anonymous said...

I would concur with what "Joe B." said above. As a psychiatrist in Michigan I've had a good deal of experience with SAD. One of the significant findings is people saying that a trip to Florida where the days are longer quickly improves their mood (though the vacation itself isn't a bad experience of course). Light therapy can be very helpful. The most effective effort is to increase the length of the day with the light by a couple of hours. The original research on this used 10,000 lux of full spectrum lights. Eight florescent bulbs produce that amount when you are sitting next to them. The amount of light is comparable to sitting next to a window in the morning (out of the direct sun). It is easy to make such a light box using shop lights which are inexpensive but the full spectrum light bulbs cost about $10 a piece. I don't think anyone ever compared the results using standard florescent lights. Since it is the amount of light getting into the eyes that is thought to be theraputic, attempts have been made to use lights of less intensity placed closer to the eyes. In my experience these don't work all that well.
Several of the writers above have commented on the Icelanders but none have mentioned other Scandinavians who in addition to a generally dour manner do have higher suicide rates in the winter that have been related to SAD.
van

12:34 AM, October 29, 2006  
Blogger Carl said...

I had severe SAD for years, and dealt with all the depression-related, very dehibilitating symptoms, and was very close to taking the "easy way out" with SSRIs until I gave Cod Liver Oil a try last year, the liquid stuff that doesn't taste very good, but has made a world of difference, for both me, my family, and my coworkers. (FYI: Tried light therapy, fish oil capsuls, etc. and nothing worked until this)

12:35 AM, October 29, 2006  
Blogger tcobb said...

I know that what I have to say here might seem (and be) unrelated, but I wonder if it might be the key. Years ago I worked in a semi-conductor fab on a rather brutal shift that began at midnight and lasted until 12:30 in the afternoon. There were no windows in the factory at all. Most people began to exhibit signs of fatigue after about six hours of this, and it all just began to go downhill after this. What always amazed me was how I could go outside once the sun had come up and somehow this would seem to "reset" my brain and attitude, if the sun was indeed shining (this was in Texas by the way). It's just speculation on my part, but I suspect that it is the intensity of the light that is the key here, and that if the light (and perhaps the ultra-violet) is intense enough it doesn't have to be of that great a duration to be effective.

12:36 AM, October 29, 2006  
Blogger Resident Genius said...

I believe that a whole host of problems are caused by too much leisure time with no idea how to fill it. Before WWII this kind of stuff was unheard of. People didn't have time to sit around and obsess over every little thing and turn minor annoyances into major problems. They were too busy working like mad to stay alive.

12:44 AM, October 29, 2006  
Anonymous SWLiP said...

I'm a Florida native, and when I lived in Eastern Europe SAD hit me hard every year from mid-October until springtime. It is very real.

Ironically, then only time it hits me in Miami is during the summer, when we sometimes have several days of rain and overcast skies in a row.

12:48 AM, October 29, 2006  
Blogger Paddy O. said...

I realized when I moved to Chicago for college that I was a California boy. It wasn't the cold. It was the fact the sun would disappear for months at a time. I'd get increasingly depressed -- seriously so.

I never noticed this in myself before college, but ever since I graduated any sustained overcast day causes me to get increasingly down. I think the Chicago winters snapped something.

So, it's real. To respond I've learned a few things -- mostly to counteract other contributing factors as much as possible. I drink a lot of water. I exercise regularly. Both do a great deal to overcome the seasonal blues. I try to get outside, no matter the weather, just to get some nature in my soul. Not as good as 15 minutes in the sun but it generally helps a lot more than staying indoors.

I also have a lot of light on my work desk. One is just a cheap, but really bright desk lamp. The other is a more expensive light therapy lamp made by NatureBright. It also functions as a great alarm clock that turns gradually brighter starting about a half hour before the alarm, so as to simulate dawn.

With these lights on while I'm working, I've noticed my moods swing quite a bit less. But, even with these I've learned that the best thing is to be very intentional about getting direct sunlight if it makes an appearance. Even 15 minutes or so does wonders.

I also give myself a lot of grace during the darker times. If it's cloudy out, I don't beat myself up over why I just don't have my usual zeal.

Doing all these things has meant a lot better winters for me the last couple of years.

12:48 AM, October 29, 2006  
Blogger Paddy O. said...

Resident genius, of course this stuff was around. Have you read any personal journals or biographies about people who lived before WWII? They didn't have a name for it, but moods were definitely no different than they are today. Not having time to face down their moods doesn't mean they didn't have them or such moods didn't affect them.

Robert Burton, writing a definitive volume on Melancholy in the early 1600s (which was before WWII), noted : "A troublesome tempestuous air is as bad as impure, rough, and foul weather, impetuous winds, cloudy dark days, as it is commonly with us, coelum visu foedum, Polydore calls it, a filthy sky, et in quo facile generantur nubes [where the clouds rapidly collect]; as Tully's brother Quintus wrote to him in Rom being then Quaestor in Britain: "In a thick and cloudy air" (saith Lemnius) "men are tetric, sad, and peevish: and if the western winds blow, and that there be a calm, or a fair sunshine day, there is a kind of alacrity in mens' minds; it cheers up men and beasts: but if it be a turbulent, rough, cloudy, stormy weather, men are sad, lumpish, and much dejected, angry, waspish, dull, and melancholy."

The era you note tended to be more dismissive and repressed about psychological health, which didn't exactly lead to happy societies.

But, you're likely a little right about the work bit. Many great monastic writings in talking about the symptoms of being depressed or moody suggested manual labor as a great tool for overcoming.

1:04 AM, October 29, 2006  
Blogger Ardsgaine said...

Move to the sunshine state. I hibernate all summer, and don't come out of my airconditioned cave until it starts to cool down. I live for those days where the temperature doesn't go above 75.

1:26 AM, October 29, 2006  
Anonymous Anonymous said...

I work third shift, and in the winter the only sun I see during the week is the rising sun I squint into as I drive home. I've worked second or third shift most of my adult life, and SAD is real.

Maybe I just don't suffer from it as badly as some, but I find that I don't need the high-dollar light therapy boxes. I simply use desk lamps at home and at the office that accept a standard light bulb, then use a full spectrum bulb in the desk lamps. The ones I use (made by SunWave) last for years, and use much less power- A 20 watt spiral flourescent gives as much light as a 75 watt standard bulb, or (for the main lights in my home office) 26 watt equals a 120 watt bulb.

I COULD sit and stare at a 10,000 lumen light box for half an hour each day, but providing myself with fake sunlight through most of the day seems to work for me. No fake sunlight in the bedroom. If you have a dressing room where you get dressed for the day, that's a good place for one. (I'm a barbarian, if the pants and shirt are roughly the same color, and the shoes are both from the same pair, I'm good. For those with more refined habits using the same light to dress in as you'll spend most of the day in probably makes sense.) (I didn't mention socks because they're all black, and all of the same style from the same maker.)

Ott Lites(tm) also have full spectrum bulbs, folks who sew and bead swear by them. However, you have to hunt a lot to find out what the CRI and Kelvin Temperature are for a particular Ott Lite.

Which brings us to the part where folks often run off into the weeds arguing about what matters...
Kelvin Temperature, Color Reflectivity Index, Lumens, amount of time exposed all are argued about with religious fervor, especially by the marketroids. The most interesting paper I've found on the subject is at
http://www.lrc.rpi.edu/programs/NLPIP/lightingAnswers/fullSpectrum/lightSources.asp
The short form: 10,000 lumens of white light for half an hour works. No measurable results from full spectrum lights (which they spend a bit of time defining)but there appear to be some psychological benefits.

That's all above my pay grade. All I can say for sure is that it seems to work for me, and works best with a light that has a Kelvin Temperature of at least 5000 degrees, and a CRI of at least 90.

1:31 AM, October 29, 2006  
Blogger AST said...

In my case, it's not so much the light as the change in temperature. I get sinus and eye problems whenever the furnace starts running.

As for depression, I've been clinically depressed all my life and no longer have any faith in medicine or therapy.

Maybe it's similar to jet lag, having your circadian clock being reset.

1:31 AM, October 29, 2006  
Anonymous Smokejumper42 said...

The best answer, by far, is move to Hawaii. I did, from Seattle, and no more SAD. We have lots of sunshine, stable temperatures and sun almost every day.

Aloha

1:35 AM, October 29, 2006  
Anonymous Anonymous said...

When I lived in the Midwest I dreaded winter because the short days and, especially, the dark, overcast skies knocked the energy out of me. Now I live in Florida, winter is fine and summer is great -- all that wonderful light! However, more than a day or two of rainy weather and I start to get that Midwest winter feeling again. For me, BRIGHT sunlight is key.

One thing that I have found very helpful, wherever I have lived, is to spend as much of the indoor day as possible in rooms that have lots of glass and face South. Northern exposure in the winter can be a soul killer, even in sunny Florida, and particularly if one's windows are shaded by trees. If possible, spend time in high floors looking South.

1:11 AM, October 29, 2006  
Blogger tomcal said...

I just can't believe the number of posts on this subject. I have never experienced any problem, except during the unusually dreary winter of 1977-78 when I was a freshman at UC San Diego. And I alway attributed that to culture shock since I grew up in South America.

But maybe there is something to it. Whenever I get depressed here, I go to my home in Nicaragua, where there is always withering sunshine and I feel just fine. But then again I always attributed that effect to seeing the grinding poverty there; which reminds me just how lucky I am to be a citizen of the U.S.

Who knows? I guess I will just continue with my philosophy of using each day the make the world a better place for someone. When I think of that, it always elevates my mood :)

1:39 AM, October 29, 2006  
Blogger mango said...

Lots of mood disorders have been linked to a dietary deficiency of omega-3 fatty acids. Adding omega-3s to the diet has been shown to dramatically decrease violence and impulsiveness, depression, and a host of other things. Plus, they're good for you in general. As one of the best sources of omega-3s is fish, it makes sense to me that Iceland, an island nation which eats a lot of fish, doesn't suffer as much from SAD as one might expect. I agree with the suggestion above to take fish oil capsules, not only to help with SAD but also for heart health. In the UK, not prescribing fish oil after a heart attack is almost malpractice, the results are that dramatic.

1:46 AM, October 29, 2006  
Anonymous Dallas said...

SAD is definitely real. As the other posters have noted, it's related to depression and alcoholism. Light therapy is one way to go. I moved to Boston in 2000 and bought a couple sun-spectrum light bulbs. I think they've helped.

And yes - take those omega-3 fatty acids, eat fish, etc. That's also very real. It does amazing things for cardiac and mood problems.

2:18 AM, October 29, 2006  
Blogger Editor Theorist said...

Tennessee is probably too far south for SAD

Light-curable-SAD occurs due to extreme latitude causing extreme seasonal diurnal variation in day-night cycles, interacting with the fact that humans evolved in Africa at low latitudes where winter summer day lengths are similar. Almost all animals are sensitive to daynight cycles: humans are no exception.

But Tennessee is only 35 degrees north - the same as North Africa - check on a globe.

SAD has only been a significant problem above about 45-50 degrees latitude, especially above about 55 degrees (eg. where I live, in Northern England). It seems very unlikely that the slight summer-winter difference in Tennessee would be enough to cause SAD. But if it was then two or three days with a light visor should be enough to lift the gloom (ie. this could be a diagnostic test - however light visors cost about 250 dollars).

The lower-than-expected SAD in Iceland actually demonstrates what a serious problem SAD is for some people - since it implies that the Icelandic population who were NOT resistant to SAD failed to reproduce at the normal rate, and these non-SAD-resistant genes were (mostly) eliminated from the Icelandic gene pool. This was confirmed a study in Winnipeg, Canada, (published in Canadian Journal of Psychiatry, 2002) which demonstrated lower prevalence of SAD in the Icelandic-descended population than in the non-Icelanders.

My guess would be that winter seasonality of low mood in Tennessee is due to something else than lack of light: maybe the increased winter prevalence of illnesses such as upper respiratory tract infections, combined with the sleep disurbance which these cause.

4:06 AM, October 29, 2006  
Anonymous Nick Good (South Africa) said...

Helen wrote Does SAD really exist?

I think so. One of the reasons I moved from the UK to South Africa. The UK Winters are just so long and depressing. Why put up with it when there are other options....and I'm pleased to say that the Jacarandas are in full blossom and it's a balmy 33°c at the start of our Southern Hemisphere Summer.

If you can't move, I'd certainly try light therapy.

4:26 AM, October 29, 2006  
Blogger jw said...

I'm phototoxic, light makes me sick. Well, not quite .... too much of the blue end of light makes me sick.

We keep the house MUCH darker than is considered normal and use incandescent lightbulbs 'cause flourescent bulbs use a chemical inspired blue spike to balance color.

To the best of my knowledge I see no SAD's. Mind you, my light is fairly constant and I take fish oil pills every day for the Vit D.

My wife on the other hand may well have some SAD's. She gets a lot more light than do I, at least in the summer as she doesn't much like cold weather. In the winter she does tend to feel the blah's.

So, the best I can say about SAD's is ... maybe.

Might not the reason for the Iclander's low level of SAD's be that they spend more time outdoors during the winter?

4:40 AM, October 29, 2006  
Blogger Peggy Snow Cahill said...

I'm gonna get on the cod liver oil bandwagon here. But be sure to get one that isn't so overprocessed that they had to add back in synthetic vitamins A and D. The only one I know that is good at the health food stores is Garden of Life, but there are several available online. Check out the Weston Price Foundation online for a truly eye-opening view of what good nutrition should be and always was until the last fifty to a hundred years. (http://www.westonaprice.org/splash_2.htm)
And they have more info on cod liver oil than I could've imagined!
Good luck, and God bless.

6:38 AM, October 29, 2006  
Blogger Cham said...

Is SAD real?

I am one person who wouldn't have a clue. ;)

7:00 AM, October 29, 2006  
Blogger Rowena Hullfire said...

I go sculling after work, so I notice the days getting shorter starting in September! In October, I have to start taking vacation time at the end of the work day to get out and row and beat the darkness.

Last year and this year, it turns out my rowing season is being cut short for medical reasons. Bummer.

I have a rowing machine at the house, which is for winter training. I get up an hour early and row, to upbeat music, all the lights in the house blaring, and it peps me up.

The rowing machine company sponsors seasonal challenges during the winter "foodie" seasons, so it's motivating to keep exercising to earn and then burn off my holiday goodies.

I find that work is busy and holiday travels home to see my family keep me peppy and optimistic through New Year's, then we have registration at the college, then mid-January through the beginning of March...slumpsville. I get my boat back and start rowing at the beginning of April, after the danger of freezing temps is gone.

I found my winter SAD was worse moving from Iowa to Kentucky! It may be further south, but Iowa winters are extremely sunny and snowy and there's good outdoor winter activities to do. Kentucky is foggy and muddy and brown and overcast and depressing! Even if it isn't as snot-freezingly bitterly cold.

Go camping on a mild weekend in February. Bike a long bike trail like the Virginia Creeper. Take a day hike or a long hike. Those help too.

9:01 AM, October 29, 2006  
Blogger SarahW said...

My advice? Hit up Tim Blair for use of his guest room, and get on a plane to Australia.

9:44 AM, October 29, 2006  
Blogger TMink said...

I wonder if daylight savings time is involved at all. I think it is the seasonal variation of the photoperiod. The loss of daylight merely concurs with the shift in our clocks.

Trey

10:08 AM, October 29, 2006  
Anonymous Auld Pharte said...

I had a very good therapist once, in Dallas, who altered his practice during the "holiday season" and actually shut it doen from about mid-December until after the New Year. His (extensive) experience was that many people become depressed during this period of time, and it had all to do with the season and negative residue from early years. They showed up in droves, uninterested in serious therapy but hoping to get temporary relief, then disappeared after the threatening time had passed. And his regular patients learned that, in fact, they could function in his absence.

I don't suggest you fall into this category, Dr. Helen, but I do suggest that a look outside the bounds of SAD might be worthwhile.

10:15 AM, October 29, 2006  
Blogger Dr. StrangeGun said...

Cod liver oil.

Seriously... not only to you get a lot of omega-3 and vitamin D intake, but if you only take one a day and in the morning, well, you're so happy that the "morning ordeal" is over with that you cast a bright shine on the rest of the day :)

10:46 AM, October 29, 2006  
Blogger Gregg said...

I get SAD and I have heart issues that I believe are roughly similar to yours, if not as severe.

A few days last year I jiggered my workday around so I'd have at least a little time between the end of the workday and sunset. That helped some.

Binge drinking also helps take my mind off it. Really.

11:01 AM, October 29, 2006  
Anonymous Anonymous said...

Dr. Helen:

I've been a fellow sufferer of SAD for a number of years. The combination of pharmaco- and photo-therapy seem to work very well for me. There a number of sources for lights specifically designed for SAD therapy. These lamps are VERY bright, enough to make reading a monitor difficult. They are also pricey - but they work.

11:51 AM, October 29, 2006  
Anonymous Brad Rubenstein said...

Helen,


Science News
has an interesting article on spectrum sensitivity in SAD, and the discovery of a new class of 430nm sensitive receptors (not cones or rods) in human eyes. Upshot: treat yourself to light that is rich in 430 - 477 nm blue light.

Oh - stay warm. I recommend Rio.

11:58 AM, October 29, 2006  
Blogger Helen said...

Gregg,

How do I go about binge drinking with all the heart meds I take? Doesn't it make you sick?

11:58 AM, October 29, 2006  
Blogger Helen said...

Hi Brad,

Thanks for the article.

12:00 PM, October 29, 2006  
Blogger Norman Yarvin said...

Vitamin D, and not in small amounts. There is a medical urban legend about that vitamin, which states that eating more than 2000 IU/day can be toxic. But Reinhold Vieth, a leading researcher in the field, did an exhaustive study of the literature, and found no credible reports of toxicity below 40,000 IU/day -- and most reports of toxicity were at far greater levels.

There was a randomized study done recently which compared full-spectrum light against Vitamin D pills, for treatment of seasonal affective disorder. The pills (actually a single 100,000 IU pill) were far more effective.

As Vieth points out, human biochemistry evolved running around naked in Africa. We are built to have lots of this vitamin; white skin is only a quick hack to allow us to exist in northern latitudes, and even it we defeat by wearing clothing and living indoors.

1:53 PM, October 29, 2006  
Blogger TMink said...

Binge drinking? Seriously? I must recommend nice quick walks with the ipod instead.

Trey

7:03 PM, October 29, 2006  
Anonymous linda seebach said...

Nobody seems to have mentioned that the earliest sunset (which is what depresses me) comes about three weeks earlier than the shortest day, so I've only about five weeks to get through before I can see daily improvement.
That said, sunny Colorado is easier to take than dreary Minnesota.

7:15 PM, October 29, 2006  
Blogger Gregg said...

Re: binges

I take 20 mg Lipitor, 25 mg Atenolol, 20 mg Lisinopril and 325 mg ASA daily. A bout of 14-20 "standard drinks" (a beer, glass of wine or shot of liquor) causes no problems for me. I'm 42 y/o, 240 lbs and quite physically active. My heart issues surfaced at age 32. I wouldn't have tried this for a few years after the stents came in, but now it works pretty darn well. YMMV.

7:22 PM, October 29, 2006  
Blogger chsw10605 said...

The best defense against SAD might be a tenured position at UCSD, UJacksonville, or UMiami. Perhaps the law schools will find something for husband.

8:14 PM, October 29, 2006  
Blogger rammer said...

SAD is common enough that there must be something to it. Having lived in cloudy Michigan and now living in relatively sunny St Louis, I can attest to the affect of simple sunshine on attitude. A couple years back I wrote up a formula published by Dr David Wheatley on the likelihood of SAD being a problem for someone based on his research at http://216.69.151.141/blog/?p=816, but for some reason the javascript only works in Firefox now. Best wishes to you and yours.

9:29 PM, October 29, 2006  
Anonymous M. G. said...

I'm sure the light boxes work well. What has worked for a couple of women in my life has been a fireplace.

Wood burning seems to work better than the fake gas types. Build a fire in the evening and just be there near it. You can watch television or read (or blog, I guess).


Both women suffer from depression which gets worse in winter; both report that having a fire a few times a week really, really helps.

9:37 PM, October 29, 2006  
Blogger Gregg said...

I live in Denver and had SAD much worse in SoCal due to the cloudy weather in winter. Here there's at least sunshine a few hours nearly every day rather than gray for days on end. Maybe moving from the Northern Hemisphere to the Southern every year . . .

9:42 PM, October 29, 2006  
Anonymous JKB said...

I had good luck with a sunrise simulator. It slowly brings a light up to simulate sunrise which brings you out of deep sleep. I had mine run a halogen floor lamp to have a bright awakening. I don't know if it was SAD but it got rid of the homicidal tendencies when I had to get up be for the sun. Not to mention my general mood in overcast weather.

I've also had some luck with green light. The USCG in crew endurance management research found green light to had the same waking affect as full spectrum white light but at one third the intensity. They were looking for wakefulness without the loss of nightvision. The USCG used a specific wave length of green in their research but I've had luck with a green LED known as nightvision green (turquoise). Indirect shining of the green LED has relieve eye fatigue and improved my wakefulness.

For those unaware, next year they are expanding DST. "Starting in March 2007, daylight time in the United States will begin on the second Sunday in March and end on the first Sunday in November."

USCG CEMS website: http://www.uscg.mil/hq/g-m/cems/index.htm
LED keychain lights in "nightvision green": http://www.photonlight.com
DST: http://aa.usno.navy.mil/faq/docs/daylight_time.html

10:26 PM, October 29, 2006  
Blogger tomcal said...

Just how many ounces of alcohol constutes a "binge" anyway? I weigh 215, have just had half a bottle, or 375ml of 12.5% alcohol wine, and feel just fine.

11:02 PM, October 29, 2006  
Blogger tomcal said...

That's 215 pounds, not kilgragrams, and I am 6'3".

11:05 PM, October 29, 2006  
Blogger Ken said...

I would be happy if it was standard time all year. I wouldbe happy if itm were daylight time all year. I'd even settle for calling it midnight when the sun was at zenith, if we always did it. Changing time twice a year is a fantasic waste of time and resources. It is truly one of the most idiotic inventions of man.

4:56 AM, October 30, 2006  
Blogger Stephen M. St. Onge said...

        Yes, SAD exists, and light therapy helps a lot.  I speak from experience.

        As for Icelanders not getting it, after a thousand years of living there, I think you can consider that evolution in action.

10:10 AM, October 30, 2006  
Anonymous Bugs said...

I hit rock bottom about this time of year. I attribute this mood swing to a pattern of extreme parental abuse I suffered as a child. Every year, just Fall began, my folks forced me to go BACK TO SCHOOL! Even though I'm now 46 years old, I still feel as if the world will end every September.

So does Christmas, for that matter, with its memories of endless car trips to Grandma's house and feigning the joy of the season while suffering from colds, flu, allergies, aspirin overdoses, botulism, ennui, teen angst, and a host of other uncomfortable conditions.

So sunlight or no sunlight, I think Winter just plain sucks.

11:18 AM, October 30, 2006  
Anonymous Anonymous said...

The light therapy box works fine for me. I use it in the morning for about 20 minutes while I drink coffee and read the paper.

I seem to need it only between Thanksgiving and Groundhog's day.

11:54 AM, October 30, 2006  
Anonymous Anonymous said...

Try L5 HTP Tryptophan supplement. Ditto onthe Omega 3's.

12:36 PM, October 30, 2006  
Anonymous INC said...

Let me add my voice to the choruses of yes, SAD is real. The hardest week was the week we went off of daylight savings time. Not because there was less sun, but because of the change of schedule. There's an upheaval to eating and sleeping patterns and you know winter is coming. It was also hard to look at the time in late afternoon and feel like the world was plunged into darkness way too early. I used to cherish every extra minute of sunshine as the days became longer and longer. The end of March was like being set free from prison.

I was born and grew up in Florida. We lived in NJ for two years and then NH for about ten years before moving back to Florida. As I grew older the effect of winter became more noticeable. I was tired, listless, craving food, depressed, etc. A doctor told me he thought that I had SAD. I was on meds but this didn't hold back the gloom completely. I tried getting out in the sun, exercising, etc. However, when the weather would sometimes run two weeks without sun this really didn't help very much.

One thing that was hard emotionally was coming home after dark. If you can manage your schedule so that you come home in the daylight I found that to be helpful.

I bought a SAD lamp that was desk size. I think the therapeutic length of time was about 30 minutes, but I used it all day. It did help, but nothing beats sunshine.

This was one of several reasons we decided to move back to Florida. The first few months we were back it was as if my body just craved sunshine. I could not get enough of it. One great bonus was that the food craving went away without even trying. This I wouldn't have believed this if it had not happened to me.

My advice would be to buy a lamp and use it. (I also put in full spectrum tubes in the laundry area and light bulbs anywhere else possible). I like the idea of the commenter above who mentioned the fireplace. Candles and fire give a really nice bright glow.

Plan a vacation for late January. Since you're in Tennessee, you could easily take some spontaneous long weekend trips to Florida. Visits we made back to Florida in the winter were like a shot in the arm for me.

I hope this winter goes better for you.

4:34 PM, October 30, 2006  
Anonymous Anonymous said...

No, depression is just how whiney people get attention, and is mostly a "disease" made up by the pharmaceutical industry. People just need to get up and do good deeds, paint a smile on their face, and get to work. Think positive! You could live in Iraq!

Joking. I'm bipolar. Sunshine is to you what Lamictal is to me. Besides, if light works, who cares if SAD "exists" or not? Call it Jane instead if you want, and do what makes you feel better.

6:10 PM, October 30, 2006  
Blogger tomcal said...

"Ken said...
I would be happy if it was standard time all year. I wouldbe happy if itm were daylight time all year."

Yes, let's just keep it the same. Why intentionally subject ourselves to jet-lag twice a year?

1:36 AM, October 31, 2006  
Blogger TMink said...

Anon 6:10 made me laugh. You really had me going, I was thinking up the post to refute your Scientology/Szaz nonsense. I was getting hot! You got me!

Trey

10:05 AM, October 31, 2006  
Anonymous Anonymous said...

One thought I had is that there could be a biological/evolutionary reason for this. When we are depressed, we just want to be inside and get warm. There's not at much consequence to not doing so these days, but a thousand years ago, not heeding this urge could possibly result in death. So, it would seem the solution would have to involve something that would counteract this natural urge.

Light could do it, as could vitamin D (which is really more of a hormone than a vitamin). Vitamin D levels are very easy to test as well.

One of the most important recommendations I can think of is to be out in the natural light as soon after you wake up as possible, as this stops (or at least slows to daytime levels) melatonin production, which could help you feel much less drowsy and sad during the day. It's much easier not to feel sad if you're not exhausted!

Alternatively, another option could be to not fight the biological urge to be inside and warm, and to have activities planned for the winter inside that you wouldn't do other times of the year. It's kind of counter-intuitive, but if you can accept that the depression will be there, then any positive bump you get beyond it will be very welcome!

12:51 PM, October 31, 2006  
Anonymous owlish said...

I have a friend who did a year at the NIMH, looking at SAD. He wasn't very impressed with the effect size of using a light box, and thought that there might be a placebo effect from forcing the person to wake up a little earlier in the day, at the same time each day. Good luck.

2:40 PM, October 31, 2006  
Anonymous Anonymous said...

I've lived in both Fairbanks and now Anchorage for many years, am active outdoors year round, and have never taken meds for moods. Since light therapy has been around for awhile and seems to be beyond the fad phase, a month ago I rented (nice option from a local pharmacy!) a serious light therapy box for the breakfast table. Two weeks ago I paid the balance on the purchase. I've been impressed with my mood and energy level. I wake up craving my time in front of it (20 minutes). No other variable in my life has changed. I'm a believer.

8:23 PM, October 31, 2006  
Anonymous Anonymous said...

If it's something that normal people experience, why is it called a disorder?

7:45 AM, November 01, 2006  
Anonymous JimMay said...

I have DSPS, delayed sleep-phase syndrome, where my circadian rhythm doesn't get "reset" by sunlight the way normal people do. As a result, my body clock is perpetually "free-running", as that of normal people do when subjected to a complete lack of day/night "reset" signals. I've been able to verify this during a few extended periods of having no schedule to adhere to, by letting myself sleep as I want; over time my body clock slid out of sync with no sign of any daylight reset, al the way around the clock until it caught up on the other side.

Today I compensate by taking melatonin at the same time each night to simulate the "reset".

I speculated in an earlier email to Glenn that I might be immune to SAD because of this. I'd have to be, else I'd be permanently depressed.

4:58 PM, November 02, 2006  
Anonymous dweeb said...

Does SAD really exist? Most psychologists and experts say "yes," but other studies such as this one found that the Icelandic population did not suffer from seasonal mood changes like other populations. Could SAD be culturally induced, caused by the media

Ask yourself, why do old movies look different? A lot of people, upon seeing the Mel Gibson movie "Payback," came out remarking that they thought it was in black and white, but it was actually color, shot in the lighting style of the 30's and 40's. Modern TV and movies are shot in a style where shadows are not allowed. Notice how, on a sitcom, there are no apparent light sources on a set, yet it looks like the surface of the sun. Now, consider that most people these days spend 3-5 hours a day looking at a screen that is essentially a window into a world of all pervasive light, a world without shadows, except when the director wants to convey a sense of dark forboding. We have a population conditioned to respond with fear and pessimism to the light level of the real world, and then we wonder why so many people are on anti-depressants. Go figure.

4:46 PM, November 06, 2006  
Anonymous RDoc said...

The mood is always brighther on a sunny day

11:05 AM, November 09, 2006  
Blogger DRJ said...

New health news for the seasonally afflicted:

"In their study, Dr. Michael Terman and Dr. Jiuan Su Terman of Columbia University in New York randomly assigned 99 adults with SAD to one of five treatments: dawn simulation equivalent to that May in northern temperate latitudes; a brief dawn "pulse"; bright light after waking; high flow rate negative air ionization; or low flow rate ionization.
***
Summing up, Michael Terman said while morning bright light therapy "remains the first-line intervention for SAD, with thousands of successes and satisfied patients," dawn simulation and negative air ionization may also be considered as options.

If you think you may suffer from winter depression, Terman suggests, as a first step, completing the Personalized Inventory for Depression and SAD survey, a free and confidential online self-assessment questionnaire posted on the nonprofit website of the Center for Environmental Therapeutics, www.cet.org. The site also includes more detailed description of light and ion therapy."

12:36 AM, January 04, 2007  
Blogger Heather said...

I have SAD. I notice myself feeling more tired during the winter months. My feeling is that it's a sleep disorder, before a mood disorder.

How many folks with sleep disorders also suffer with depression? I'd like to know.

When you're tired, it's harder to get tasks done, you make mistakes, you don't feel up to social interaction, you feel physically run-down... Why wouldn't all that *CAUSE* depression?

5:56 AM, September 19, 2007  
Blogger B said...

Is it important to use the light box at a specific time each morning or just sometime in the morning? I found some good advice here too: http://www.howtodothings.com/health-fitness/how-to-deal-with-seasonal-affective-disorder but I think I need a light box...

Also, how do you find the "right" kind of light box?

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11:50 PM, June 07, 2009  

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