Like an estimated 5 percent or so of Americans, I have seasonal affective disorder, better known by its all-too-appropriate acronym, SAD.
And, like many, I use a light box through the long, dark winter months as light therapy. (“Box” might be a misnomer, because many light boxes are the shape of a thicker-than-average tablet, and their sizes vary.)
Basking in the light as I sit at my desk with my coffee and emails has become part of my morning ritual, allowing me to start each day with a little more energy and a lighter mood.
I also hate my light box.
I’ve had an on-again, off-again relationship with light boxes since first attempting light therapy in college. The box sits in my peripheral vision — you shouldn’t stare directly at it — but it still jars me awake, blasting me with 10,000 lux of light, or what’s supposed to be daylight in a box.
It’s one of the first things I experience in the morning, and I find it to be quite aversive.
But clinical trials have shown that light therapies are effective while having relatively few, minor side effects.
Was I just weird for having a love-hate relationship with my light box?
I posed this question to Norman Rosenthal, a psychiatrist at Georgetown University’s School of Medicine who first described SAD in 1984 and pioneered light therapy as a treatment.
“I have not heard anybody articulating it in quite the way that you’ve done,” Rosenthal said. But, having used light as a therapy for a long time, he said: “It’s going to be a thing. People are going to resonate with the subject, because they will have struggled themselves.”
How light helps with SAD
Wintertime SAD is probably caused by reduced daylight, which can knock our circadian rhythms out of alignment with the natural light cycle.
Research has shown that light has powerful effects on our body and mind, even while we sleep.
Specific light-sensitive receptors in our retinas connect directly to mood areas in the brain. Light has antidepressant and alerting properties, and it’s recommended as therapy for other nonseasonal mood disorders.
Bright-light therapy is the standard treatment for SAD. It seeks to mimic outdoor light and can reduce symptoms in about 67 percent of patients with milder SAD and in about 40 percent of patients with severe SAD. (The causes of and treatments for the rarer summertime SAD are less known.)
The side effects of light boxes are also fewer when compared with those of psychotropic medications, said Sophie Faulkner, an occupational therapist researcher at the Greater Manchester Mental Health NHS Foundation Trust.
In a 2020 meta-analysis of 77 studies, Faulkner and her colleagues found that light-therapy users tend to report minor side effects, such as headaches, eyestrain or restlessness, and were able to continue the therapy.
Many studies did not report on patient adherence or adverse effects of the treatment. Faulkner said people are unlikely to sign up for research involving light boxes if they already know they do not like using them.
We also do not know how well people use light boxes outside of a clinic or lab, with researchers monitoring their use for the few weeks the study is ongoing.
“Light is not so much like a temporary intervention,” Faulkner said. “It’s more like an environmental modification that you need, probably permanently.”
She added: “The endpoint is, ‘How do we now do this in a way that’s practical and fits into people’s lives?’”
Learning to love the light
Rosenthal, who became interested in the effects of light on mood after experiencing New York City winters following his move from South Africa, also uses light boxes.
But his methods are more gradual and mindful than mine. When he wakes, he uses a dimmer to slowly turn on his bedside lamp before turning on lights around the room to allow his eyes to adjust. Then he may open the curtains and turn on his light boxes, first farther, then nearby.
You don’t have to copy his routine, but can instead find something that works for you. “I’m simply saying that you should make the morning welcoming of the light,” Rosenthal said. “You should make it a joyful and pleasurable transition.”
Here are some ways to make it a better experience:
- Have the light box at 45 degrees. (Not directly in front, and not too far to the side.)
- Place the light box higher up, at least at eye level. “Brightness is usually at the top of our field of vision,” Faulkner said. “The sky is at the top, and it’s darker at the bottom.”
- Add warmth to the light. Whether it’s cool white or warm white can make a difference in how pleasant it feels for some people, Faulkner said.
- Use a larger light box. In “almost all the studies that have shown efficacy of light boxes, the surface area of the box has been at least a foot square,” Rosenthal said.
- Try different brightnesses and durations. Typically, 30 minutes of light exposure at 10,000 lux is a starting recommendation. Brightness and duration may not be completely interchangeable, but a slightly less bright light box for longer may still do the trick, Faulkner said.
Don’t rely on just the light box either, Rosenthal said.
- Behavioral therapy and antidepressants are other treatment options to consider.
- Exercising and socializing can also help, especially outdoors. “I’m a very big advocate of going outside,” Faulkner said. “Natural daylight is really bright, even on an overcast day.” Plus, it’s free.
“The good news is — and I’m convinced of it — that most of us can really enjoy our winters again if we just put our minds to it and add together all the things that can help,” Rosenthal said.
For my part, I purchased a new, larger light box with added settings for warmer white light and different brightness settings that I ramp up more mindfully in the morning.
And I have also started taking walks outside more regularly.
It’s still too early to confirm my relationship status with my light box, but so far, I’ve been finding my mornings feeling just a bit brighter.
Do you have a question about human behavior or neuroscience? Email firstname.lastname@example.org, and we may answer it in a future column.
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