From Maclean's... January 14th, 2002 Surviving the winter KRISTIN JENKINS Wu was suicidal before he learned to treat his problem David Wu, 32, a registered acupuncturist who lives in Richmond, B.C., had seen many doctors and taken many medications before being diagnosed just over a year ago with seasonal affective disorder, or SAD. Until then, nothing worked. For two decades, Wu had struggled to cope with the mental, physical and emotional lethargy that started as early as August and didn't ease up until April. The disorder had a profound impact on everything from personal relationships to his schoolwork and vacation schedule. He changed his major from biology because he lost the ability to sustain the effort. "My interests became more introspective," he says, and he switched to psychology. Still, it was a nine-year struggle to complete his degree at the University of British Columbia. Then in December, 2000, Wu's state worsened. "I had an overwhelming impulse to end my life," he says, and he ended up in hospital. But when doctors analyzed the patterns of his moods with the help of journals he'd been keeping, Wu finally came to understand what was bothering him. Now, back into the winter months, Wu is being careful to stick to his new treatment regimen, one that includes exercise, psychotherapy, an antidepressant -- and anywhere from 30 to 45 minutes of light therapy first thing in the morning. Welcome to the world of SAD, also known as the winter blues. On dark mornings, some people's biological clocks don't receive a strong enough light signal to get them going. The result is a sluggish, irritable feeling that persists throughout the day. Although Wu's case may be extreme, seasonal affective disorder leaves at least 600,000 Canadians mildly to moderately depressed each winter. In most cases, the condition surfaces in October, then disappears with the return of longer days in April. Many Canadians suffer for years before being diagnosed. Others don't seek treatment because they don't think anything can be done. Now dozens of clinical studies have shown that light therapy -- simply exposing a patient to bright light for a period of time each day -- can be highly effective in treating two-thirds of SAD patients. Other studies have established that antidepressant medications can also help. But just who will respond to light therapy, to an antidepressant, or to both, remains a mystery. Soon, much-anticipated findings from a unique cross-Canada investigation will pave the way for doctors to make that determination. The three-winter SAD study, currently in its second year, will enrol 210 patients all told in Vancouver, Winnipeg, Toronto and Saint John, N.B. "There were no good studies where both light therapy and antidepressants are used," says Dr. Raymond Lam, professor of psychiatry at the University of British Columbia and principal investigator in the study. If therapy can be individually tailored, that could greatly improve the success rate for treating people with SAD, says Dr. Anthony Levitt, associate professor of psychiatry at the University of Toronto and one of five researchers conducting the national study. It could also help patients avoid unnecessary medication. "People are sitting on the edge of their chairs waiting for the results," says Levitt. Help could also be on the way in the form of a highly portable light-producing device called Litebook. If it proves to be as effective as the larger, heavier units in general use, says Lam, Litebook could provide "a significant advance" for the treatment of SAD as well as other conditions that appear to respond to light therapy. One of those conditions is jet lag. "Travellers and business people," Lam notes, "generally don't have the luxury of several days to recover after a long flight." The brainchild of Medicine Hat, Alta., entrepreneur Larry Pederson, Litebook uses light-emitting diodes (LEDs) to create an intense beam while consuming just one-tenth the power of an incandescent bulb. Pederson, 44, who has suffered from SAD since his teens, admits to being skeptical about light therapy. But in the fall of 1994, he found that sitting in front of a big light box every morning for 30 minutes "literally changed my life." The problem was that he, like other light therapy users, found the large unit inconvenient and something less than portable. There was also, he says, a stigma attached to its appearance: "It looked like a medical device." Deciding to "build a better mousetrap," Pederson took his idea to a former schoolmate at the Defence Research Establishment Suffield, 40 km northwest of Medicine Hat. There, high-tech experts working on robotic land mine detection systems devoted their own time to producing a design for a light box the size of a laptop computer. Too big, Pederson told them -- he wanted something he could hold in one hand. Then in November, 1999, Pederson read an article in an obscure electronics journal about the invention of a white LED that shone a beam about half the diameter of a pencil. "I couldn't believe how bright it was," says Pederson. "And there was no heat and no ultraviolet." Armed with this information, he enlisted the help of two industrial design students who came up with a device no bigger than a portable CD player. "It looked like Sony or Phillips had built it," says Pederson. "Everybody loved it." Last winter, he sent 20 prototypes out to be tested by SAD sufferers as well as business travellers and flight crews seeking relief from jet lag. His problem then? "I had trouble getting them back." Now Pederson is selling the units, for $549, in a growing number of home care and natural food stores. While the anecdotal evidence looks good, it could be a year or two before there is clinical verification of the effectiveness of the Litebook for treating SAD. But there is plenty of evidence that existing light boxes, widely available for $300 to $500, do actually work. For David Wu, the diagnosis of SAD was a turning point. But his quest for a better quality of life continues. Wu knows he needs more than light therapy, medication and counselling to prevent the return of depression. "I make a point of keeping a busy schedule, doing a lot of physical exercise and talking to supportive friends," he says. "I do things that give me joy, like singing in a choir and volunteering one morning a week at a local preschool." Wu, who swims and practises martial arts, also plans to escape to a retreat in Southern California this winter. There, for a week to 10 days, he will work outdoors planting and harvesting fruits and vegetables -- and soaking up the sun. "I know I'm vulnerable," says Wu. "I have to take care of myself." LET THERE BE LIGHT Researchers report some success in using light therapy to treat health problems, other than seasonal affective disorder (SAD), that may result from disruption of the body's internal clock, or circadian rhythm. Major breakthroughs in treatment may take time, however, as the fledgling industries that produce light therapy equipment don't have deep pockets for research. The story so far: Sleep disorders: There is clinical evidence light therapy can help night owls who have trouble falling asleep until the wee hours, as well as people who suffer from excessive daytime sleepiness. Non-seasonal depression: Several studies indicate that light therapy may relieve symptoms quickly. Still to be determined is whether it works as well as the new antidepressants. Jet lag: Light therapy -- not just exposure to light but also avoiding it -- has helped treat jet lag among travellers who cross several time zones. Beyond that, time is the only cure for the flyer's lethargy, lack of alertness and inability to concentrate. Premenstrual syndrome: In San Diego, Dr. Barbara Parry has shown that light therapy can reduce such SAD-like symptoms as depression and an increased need for sleep and food among women with PMS. Bulimia: Light therapy may reduce symptoms in women with the binging/purging eating disorder, particularly in the third of sufferers whose symptoms get worse in the winter. Depression during pregnancy: A clinical trial under way at Yale, Columbia and the University of Louisville is studying the use of light to treat depression among pregnant women. Depression affects up to 10 per cent of expectant mothers, and a non-drug therapy is particularly important for these patients to avoid any risk to their unborn children.