| Some people, and this number may actually be larger | | | | should shut off pineal secretion of melatonin because |
| than once supposed, do not do well in the winter. | | | | of the light exposure on the eyes. A light box has to |
| They develop a severe mood disorder that has been | | | | be high intensity emitting at least 10,000 lux. A |
| referred to as seasonal affective disorder. SAD may | | | | variety of these "sun boxes" are available. They cost |
| be more common in patients already suffering from | | | | approximately $400-600. The light box should be |
| fibromyalgia. | | | | used after consulting with your medical specialist. |
| Modell and colleagues studied 226 patients with SAD | | | | Careful adherence to instructions will help prevent |
| and found that it actually was a syndrome consisting | | | | eyestrain and headaches. |
| of multiple symptoms (Modell, JG, et al. Biol | | | | Alternatively, selective serotonin reuptake inhibiting |
| Psychiatry. 2005; 58: 658-667.) These consisted of | | | | medicines (SSRIS) may also be used. The drug that |
| depression, fatigue, social withdrawal, anxiety, feelings | | | | has been studied the most is Prozac. While usually |
| of guilt, carbohydrate craving, insomnia, increased | | | | well tolerated, it does have potential side-effects |
| appetite, weight gain, and gastrointestinal symptoms. | | | | including palpitations, sleep disturbance, and loss of |
| The onset of these symptoms may simulate a | | | | libido. |
| fibromyalgia flare. And in fact, there is very little | | | | Melatonin taken in a small dose (0.1 mg) in the late |
| difference from a clinical viewpoint. Symptoms begin | | | | afternoon may also be effective for SAD. This dose |
| in the late fall and continue through the end of March | | | | is small enough not to cause drowsiness but is |
| with January and February being the worst month | | | | enough to make the pineal gland reset the body's |
| for symptoms. | | | | biological clock. Since the usual over-the-counter dose |
| SAD is felt to be due to abnormal functioning of the | | | | is 3 mgs, a patient may need the help of a |
| pineal gland at the base of the brain. The normal | | | | compounding pharmacy to be able to get the tiny 0.1 |
| circadian rhythm is regulated by the pineal. The pineal | | | | mg dose. |
| gland secretes melatonin in the evening and shuts off | | | | Combining the low-dose melatonin with a light box |
| melatonin during daylight hours. Dysregulation of | | | | also seems to be effective. |
| melatonin secretion, both in the amount as well as | | | | Exercise is another treatment that is useful. Non |
| the timing appears to be the major glitch. Srinivasan | | | | impact aerobic exercise helps stimulate blood flow, |
| proposed that the morning fatigue- non-restorative | | | | increases energy, and stimulates endorphin production |
| sleep- occurring with SAD could be due to prolonged | | | | in the brain. All of these help with the fatigue and |
| melatonin secretion in the morning (Srinivasan V, et al. | | | | mood problems that occur with both SAD and FM. |
| J Biol Psychiatry. 2006; 7: 138-151.) | | | | Finally cognitive behavioral therapy should not be |
| Treatments for SAD should be familiar to | | | | neglected. It is a cornerstone of FM care and also is |
| fibromyalgia patients. The first involves use of a light | | | | beneficial for SAD. |
| box for 30 minutes in the morning. Theoretically, this | | | | |