Archives 2022

Fortunately, as with other forms of depression, treatments are available for SAD. Exercise, psychotherapy, dietary modification (and, in severe cases, antidepressant medication) are all prescribed, to varying degrees, by clinicians who encounter seasonal depression in their patients. But ever since Norman Rosenthal first began describing SAD in the 1980s, Light Therapy has been the go-to treatment.

While there’s still plenty we don’t know about the disorder (and about depression, in general), we do know that onset of SAD seems to coincide directly with a lack of sunlight. So, the easiest and most-effective solution, for the last 40-odd years, has simply been: “replace the missing light.”

For this treatment: depressed individuals spend 30 to 45 minutes under a special lightbulb every day, usually first thing in the morning, from fall to spring. The bulbs are about 20 times more potent than ordinary indoor lights – emitting 10,000 lux, and often more – effectively extending a person’s experience of “daytime.” The bulbs mimic our sun while filtering out damaging UV light, making this a safe treatment for almost everybody.

This all sounds kind of silly. I mean, a lightbulb? For depression? Turning that over in my mind feels ridiculous. It feels like a placebo… But, studies show that bulbs below the threshold of 10,000 lux seem to have no therapeutic effect whatsoever. Only these extremely-bright sun-like lights seem to melt the depression.

So there’s clearly something at work here. But what?

Consider the following:

First: Occam’s Razor. When faced with competing explanations of a phenomenon, the simplest explanation – the one which makes the fewest assumptions – is often the most correct.

Second: Did you know that scientists don’t know how Paracetamol – the active ingredient in Tylenol and the most commonly used medication in the world – actually works? I’m serious. We just don’t know! There have been some good guesses – that it inhibits COX enzymes: the creators of our bodies’ pain messenger molecules, that it blocks prostaglandin formation… but the drug interacts with so many mechanisms within the nervous system, we just can’t say with certainty why it works. We just know that it does.

It seems trivial, but these two factoids essentially sum up the history of human medicine: trial and error until something – a plant, a stretch, a change in setting – has the desired effect. And when we find that desired effect? Well, after sacrificing countless hours, dollars (and often, animal and human lives) to the search, we tend not to question those rare, positive results. And when trying to explain ourselves, the theories with fewer “moving parts” are necessarily easier to test – to prove true or false. Describing, in detail, what actually happens inside our brains during a prolonged loss of sunlight? That’s far less meaningful to an individual than preventing the consequences of that loss. If it’s as simple as replacing a light – why question it?

Thankfully, the timing of winter-pattern SAD is highly predictable. And Light Therapy lamps have exploded in popularity over the last decade, with the brightest bulbs becoming relatively affordable, even outside of an insurance plan. If you have SAD, or even just a history of depression: consider beginning Light Therapy in early Autumn. You’ll be surprised at how much a simple lightbulb can improve your day-to-day mood.

In the early 1980s, a researcher at the National Institute of Mental Health (NIMH) named Norman E. Rosenthal noticed that he would grow depressed, each year without fail, at the onset of winter. A sober, scientific individual – he set out to systematically describe and report on this odd, familiar depression that seemed to ebb and flow with the seasons. And although industry experts were initially skeptical of the condition’s existence, Dr. Rosenthal’s work struck a personal chord with many other researchers – many of whom privately struggled with precisely what Rosenthal described, not just their patients – prompting further research into the subject.

The condition, now known as Seasonal Affective Disorder, and appropriately-abbreviated “SAD,” is a well-known feature of life in colder climates. It’s known among clinicians as one of the most common factors implicated in major depressive disorder, which means that SAD is not a separate disorder but a specific type of depression – one characterized by a recurring, seasonal pattern, with symptoms lasting about 4 to 5 months per year, and receding upon the changing seasons. Most people who experience SAD have also experienced at least one other episode of major depression in their lives, and the two are closely related.

It’s best thought of in terms of susceptibility and triggers. Specific individuals are born with different brain chemistry, making them naturally prone to depressive moods. And SAD statistics overlap precisely with those of other forms of depression. It occurs more commonly in women than men and occurs more often in people with pre-existing mental health conditions – especially bipolar type-II, ADHD, and eating disorders. It also seems to have a genetic component, as SAD is more common in people who have relatives with mental illnesses.

But climate remains the best, most-obvious predictive feature. In Florida, about 1.5% of the population reports seasonal mood changes. While in Alaska, a full 10% of the population reports struggling with SAD.

But like depression as a whole, we don’t fully understand the disorder. Research suggests that the culprit is dysfunction within two chemical systems – serotonin and melatonin. The former chemical is responsible for mood regulation, and our body relies on sunlight to create the precursor molecules, or building blocks, of serotonin. The latter is a hormone produced inside the body which regulates our circadian rhythm – again, a function of how much sunlight we get. So, the prevailing theory is that decreased sunlight reduces serotonin and boosts melatonin production, throwing our daily rhythms out of whack. As a result, affected individuals cannot adjust to the dramatic seasonal changes in the length of their day – sleeping longer, eating the wrong food at the wrong times, and falling into a self-perpetuating cycle of insomnia.

But where does this leave us? Fortunately, as with other forms of depression, treatments are available for SAD. In a separate post, I’ll cover some of the typical ways we address depression, as well as SAD-specific tips for beating the Winter Blues.

Caffeine is, originally, a pesticide.

That’s our best conclusion, at least. It matches all the criteria. We know it’s a bitter-tasting chemical concentrated in the bodies and leaves of a select few plants. We know that when insects and small animals consume caffeine, it overloads their nervous and digestive systems – severely impacting memory, motor functioning, and gut enzymes. We know that it is fatally toxic to many animals, even in relatively small doses compared to their body weight. And we can observe that this relationship existed long, long before humans did, as a means of self-preservation for the plant.

But interestingly enough: the only animals that are not negatively affected by caffeine? Pollinators.

While caffeine kills many insects outright, it robustly improves bees’ memory and motor functions. And, of course, humans, too. But it seems that the two animals most responsible for the proliferation of these unique plants are, in a way, rewarded for their efforts to continue the species. When the bees go for pollen, they quickly remember the coffee plants and return frequently. The plant didn’t just evolve an ability to repel predators – it evolved an ability to attract dedicated partners. That’s uncommon in nature, to say the least.

Our brains and nervous systems are so complex – so rich in chemical receptors – we can enjoy as an afternoon pick-me-up, that which is a lethal dose of speed for most of the animal kingdom. To think that this chemical, which existed only as a poison for so much of its time on earth, was directly responsible for the flourishing of civilization and thought? It boggles my mind.

And it’s only in light of this fundamental truth about caffeine that I can genuinely appreciate it. Too little, and I miss out on the remarkable ability of the human brain to turn poison into potential. Too much, and it becomes poison, once again.

It is a biological privilege to put this molecule to use, to experience the sharpening of the senses and memory brought on by the ingestion of caffeine. And it is a perversion to overuse this privilege – proven true by the gradual slipping away and diminishing marginal returns of these positive effects. Ultimately, we are punished with addiction and anxiety for our overindulgence in this magic molecule and forced to reset.

Moral of the story? Respect the plant. Respect the brew. Respect yourself.

Four coffee shops.

Today, I went to four coffee shops, searching for a booth with an outlet: an old diner, a slick espresso bar, a bagel shop, and a chain. And none of them had a table with an outlet nearby. Nowhere to hunker down and recharge – nowhere to write. I understand that COVID has changed things. But these coffee shops weren’t built without outlets, were they?

It should be clear, by this point, I have a bit of a bone to pick with caffeine culture – despite my complicity. After all, I do love my morning coffee. I can even be a snob about it, at my worst. But it occupies too great a place in my life, in my heart, in my routine, to entertain any abstinence. My morning feels incomplete without it. The news, my robe, a slice of toast – are as incomplete without coffee as the morning is without sunrise. I’ll always have one cup, each day. But I’m starting to question cups number two, three, and four. And I’m beginning to wonder: is anyone else having this much trouble sleeping?

I mean: let’s look at the caffeine molecule itself. For one, it’s got an extremely long half-life, even for a stimulant, which means that it takes, on average, a full 5 hours for healthy humans to metabolize half of the caffeine in their system. But tolerance varies widely from person to person, more than it does for other drugs. Some people drink all day, metabolizing their caffeine in as quickly as 2 hours. Some people are extremely sensitive, feeling the effects of their morning cup for as long as nine hours.

So – bearing that in mind – tell me: when’s the last time you saw anything resembling “dosage” information on your bag of coffee? It’s a drug – why don’t they list caffeine content? Or at least a range of how many milligrams might be in your cup, depending on brew strength? Maybe it’s easier to form a habit when you’re not keeping tabs. Maybe there’s a lot of money to be made off the enthusiastically uninformed. Or maybe, there’s nothing all that wrong with being addicted to something cheap, plentiful, and harmless in normal doses.

But the notion of what’s “normal” is changing. I look around, and everywhere, caffeine culture is changing. The culture of ideas that existed in those old Arabian qahveh khaneh? And the intellectual communities that coalesced around the Viennese coffee houses? It’s not like I had any firsthand experience… But, tell me: do you see anything resembling a “School of the Wise” or “Penny University?”

I don’t.

I don’t even see people talk to each other for the most part. I worked in a drive-thru coffee shop as a teenager, and what I saw there still scares me. Single-serve beverages, with as many calories as a thanksgiving dinner, and as much caffeine as a pot of coffee. The same people, ordering them every day, drawn back not by a sense of community or social enthusiasm, but by the substance, alone.

This miracle drug, one of the great gifts of our natural world, is being abused on a global scale. We’ve lost respect for the power of this molecule to the point where we’re allowing it to alter our humanity on a systemic level.

As much as I love my coffee, I can’t ignore the problems posed by the multibillion-dollar global behemoth that is the caffeine industry. This is, at the root, a group of business interests upon which most consumers – most people – are dependent. A dependency which is, at best, ignored – and at worst, seen as one of many necessary evils inherent in a capitalist system. It’s won wars, birthed new economies, and the industrial revolution could not have been possible without it. But this dependency is no longer just a personal addiction to a favorite beverage. It’s a collective, worldwide reliance on a substance to keep up with the pace demanded by our ultra-competitive, (frequently) zero-sum global economy. We’re addicted to staying awake because everyone around us is, too. We have a chemically-altered baseline; that an “awake” human is a caffeinated one.

Our professional lives demand, at once, that we show up for the day both well-rested and out of our minds on stimulants. We wake up tired, consume more and more to stave off withdrawal, stay wired well past our bedtime, sleep terribly, rinse and repeat. It’s unsustainable – in many, many ways. Modest market predictions estimate at least a 10% growth in the coffee industry alone over the next decade. But as the climate warms, the plant becomes harder to grow. The extreme elevations needed for growing the plant aren’t as cold anymore, the soil worsens, and the available, farmable land shrinks.

And there will be a point, in the near future, where this whole system catches fusion. Where demand for caffeine vastly exceeds supply. Thinking back to the line outside the La Guardia Starbucks, I’m picturing a zombie-apocalypse scenario… I’ll be back – right after I finish stocking my bunker with frozen sacks of espresso beans.

Exercise is often beneficial to those suffering from mild to moderate depression. Studies suggest that physical activity is, in almost all cases, an essential intervention for treating the disorder. Even modest amounts of aerobic exercise provide a protective, preventative effect against depression and anxiety.

While the psychological mechanisms behind major depressive disorder are not yet fully understood, some studies suggest that it results from impaired neuroplasticity – a term referring to the brain’s ability to create new synaptic connections in response to experience. It’s a sensible conclusion. It seems that the more severe forms of depression tend to coincide with increasingly-reduced synaptic density in the brain. As in, the greater your depression – the fewer electrical impulses your brain can create. But the same studies suggest that exercise can even increase neuroplasticity, above baseline, in healthy subjects, which has researchers seriously considering that physical activity itself might stimulate the growth of new neural pathways.

In cases of mild depression – exercise is one of the sharper tools at our disposal. But I want to emphasize: mild depression.

Despite being one of the most common mental disorders in the United States, depression is complicated and poorly understood. It often involves environmental stressors outside any person’s realm of control, and the severity of symptoms varies greatly – frequently exceeding the reach of holistic treatments. As many as 19 million people – that’s 7.8% of all U.S. adults – have had at least one major depressive episode in their lives. And if you were to ask all these people how they beat their depression? Pills would be the most likely answer. During 2015-2018, 13.2% of all adults in the U.S. used antidepressant medication.

Are they overprescribed? Absolutely. Many disorders resemble depression, or have depression as a significant symptom, thereby escaping treatment. Also, antidepressants are only a form of symptom management – they do not address the myriad environmental causes of imbalanced brain chemistry. But they’re the primary treatment, simply because we haven’t developed anything more effective at pulling people out of major depression in the short term.

Exercise is not a magic bullet. If a person has major depressive disorder to the point that their day-to-day functioning severely diminishes, it won’t have the same effect. Exercise simply doesn’t help push a person out of a major episode. Since depression is both a symptom and a cause of reduced physical activity among adults in the Western world, many people who struggle with depression tend to lose their motivation as time goes by. So, quality exercise becomes more and more challenging to achieve. “Just work out” is often well-aimed, but inconsiderate advice.

And that’s the Catch-22. The best tool at our disposal for fighting a motivation-sapping disorder requires motivation. This is why medication is usually the first thing prescribed by doctors, and not exercise. It tends to produce more robust results, and quickly, requiring no effort from the depressed individual other than following the instructions.

If you’re feeling minor depression with just a few, but not all, of the usual symptoms – you should use exercise first, in conjunction with other non-medicative measures, as a means of improving mood and well-being. At the very least, the side effects are far more manageable in this case.

An exercise routine can be like a parachute during these minor depressive episodes. It can save you, sure. But the longer you wait to pull the cord, the less it slows your fall. And if you wait too long, it won’t help much at all.

It was December 26. A Sunday. That weird, quiet day after Christmas where nothing happens, and everyone sleeps in.

I awoke in a fog, having suffered through more absolutely wretched sleep. It was 1:13 PM – a third consecutive night of tossing and turning. Miserably, shamefully, I dragged myself downstairs – then back upstairs, where I’d left my phone. Then back downstairs, when I realized midway I’d forgotten to brush my teeth. Then back upstairs, then back downstairs – my head and back screaming at me all the while – and realized I’d forgotten my keys.

I sat down on the stairs. What was happening to me? It’d been years since I woke up that late. Usually, I’m up much earlier for work. And usually, I have my first cup of coffee within the first 10 minutes of…

Oh, right. I’m going through the first stages of withdrawal.

A long run, followed by one big cup of the good stuff, and I was feeling a little more like myself again. But since this occurred during my series on caffeine, I have to consider the implications. Perhaps, once again, I’ve been drinking too much coffee.

There really aren’t any significant adverse health effects associated with long-term caffeine use. Most clinicians agree that, on the whole, it’s a generally beneficial thing for those who use it. It’s one of the most familiar, well-studied drugs in existence. And the overdose threshold is ridiculously high – somewhere around the equivalent of 400 cups of coffee in 24 hours. So there’s a low potential for abuse. But there are plenty of minor issues associated with long-term high-dose caffeine use (digestive discomfort, TMJ pain, anxiety, to name a few), which all tend to compound and worsen over time. Not to mention, it absolutely forms a dependence – although withdrawal symptoms are typically mild and last no longer than a week. But the most dangerous and well-known side effect is, of course, sleep deprivation.

Here are some statistics on the subject: a recent annual poll by the American Sleep Association discovered that almost half of all Americans say they feel sleepy during the day three or more days of the week. And 35.2% of all adults in the US report sleeping less than 7 hours every week. When filtering out only working adults, 32.6% sleep only six or fewer hours a week – up from 28.4% in 2008.

That length of sleep deprivation produces impairment equivalent to a blood alcohol content of 0.05%. By the time you hit 24 hours, it’s 0.10% – the equivalent of three strong drinks, for most. Not to mention, the effects compound if one is both sleepy and drinking. And studies conducted by the University of Buffalo Research Institute on Addictions estimates that up to 15% of workers in the United States drink alcohol at least once during the workday.

That’s crazy! At any given time, a full third of the working population is so tired that they’re basically drunk. In the same survey, 1 of 25 adults surveyed reported falling asleep at the wheel in the last 30 days.

Why is this happening? Why, in a world where technology is supposed to be saving us time, are we left with so little for our most essential function? Why, in an economy where chemical stimulants are cheap and abundant, are we dragging ourselves along?

There is an unseen, undiscussed pandemic: persistent, global sleep deprivation.

I’m nodding off as I type this.

Maybe this time, I’ll take a nap instead of another cup.