SAD Medical Students
Thomas Robey -- If you're like me, there comes a time in the winter (right about now, actually) when the go-get-'em, ready-to-ward mentality starts to break down. Raise your hand if any of this sounds familiar. Arriving at the hospital with sufficient time to pre-round requires an alarm set a few snooze cycles earlier. The little victories (a first successful ECG read, choosing the right empiric antibiotic therapy for community acquired pneumonia, finding a parking spot...) that were common each day in earlier clerkships are nowhere to be found. You show up at the hospital an hour before sunrise and leave long after dark. Night to night, it's enough just to get through the day -- if it's even the day shift you're working.
The third year of medical school is frenetic to say the least. Six months in, clerks are bound to get worn down. But there's something else going on. Those of you in northern climes know what I'm talking about: the winter blues. Think it's just in your head? You're right! It's actually in your eyes -- more on that later. Estimates are that between 0.5% and 3% of Americans suffer from seasonal affective disorder (SAD: what a great acronym). That's about 5 million of you. And guess where these people live... New England, Minnesota, the Pacific Northwest. The further north you go, the greater chance of seeing patients, colleagues, or that attractive soon-to-be doctor in the mirror with a real depression. So real, it has its own DSM-IV entry. Readers in the UK and Canada are even more likely to be SAD.
If you've heard of SAD, you've also heard about light therapy. If you pass off light boxes as voodoo, you've overlooked a body of scientific literature indicating otherwise. Long story short, SAD originates in the same neural centers as the circadian rhythm. The neurotransmitters that help humans understand night and day are activated (at least in part) by a pathway that initiates in the retina. In order to keep us on schedule, the brain needs to see a certain amount of light each day. Those overheads on the wards don't count. Neither do tanning beds. It turns out that the light has to be bright. That's where the light boxes come in: 15 to 30 minutes every day in front of one of those boxes each day is as good a prescription for SAD as SSRI antidepressants. Related to (but not as effective as) light boxes are dawn simulators. They gradually illuminate your room so that it is bright when your alarm clock sounds. Many people report that this is an easier way to wake up -- even if they aren’t SAD.
Either way, these devices will set you back at least $150. They're not the only way to beat the winter blues. Diet, exercise, anti-depressants and psychotherapy each have shown benefit, too. Whatever your strategy is to beat the winter blues, the ultimate antidote is just around the corner. With lengthening days, SADness goes away...
Or you can just be lucky and live on a Caribbean island, like I do. :) But, I'll actually be moving back to the States in about 4 months, so next winter, I will have to beat the blues alongside everyone else. And I actually think that SAD is an underdiagnosed condition. Thanks for writing this article!
Posted by: Kendra | Jan 11, 2008 10:01:11 AM
I agree about SAD being under-recognized... a friend of my father has used light therapy and it made a significant difference in his affect during the dreary New England winter months! Anecdotal, I know, but true nonetheless.
Have you ever seen this sort of alarm clock that gradually brightens to wake you more naturally? I've contemplated buying it for a few years, because I personally hate waking up to a loud noise and heart palpitations every morning!! But I've never made the leap.
Posted by: Amanda | Jan 15, 2008 5:53:36 PM
The alarm clock that gradually brightens your room is a type of "dawn simulator" device. These have been shown to have some benefit for SAD, but usually in conjunction with other treatments. Many people anecdotally report that the dawn simulators make it easier to wake up in the morning.
Posted by: Thomas | Jan 15, 2008 11:05:05 PM
After spending two years in the Caribbean and returning home up north (with very cold weather I might add) I find that I'm struggling each morning to get out of bed. I think it's even more pronounced because I've had two years of daily sunlight. My motivation and enthusiasm for just about everything is greatly decreased. I was a bit of a skeptic about the lamps, but after reading this article and some of the research I think I may invest in one!
Posted by: Marissa | Jan 16, 2008 3:07:55 PM
I'm about to start rotations in March and I've been trying to wake up every weekday morning at 6 AM to prepare for when I have to do that for rotations.
It's really been a struggle for me to wake up that early and I've tried all kinds of things to remedy the situation.
I used to be a night owl and study all night, so I started going to bed at midnight every night. That didn't work, so I cut my bedtime back an hour to 11 PM every night. That's not working so well, either.
I also cut back my caffeine intake because I drink it constantly when I'm studying. I try not to drink caffeine after 7 PM and I don't take any B vitamins after 7 PM, either (I take a MVT and a B vitamin supplement every day).
The weird thing is that I let myself sleep in on the weekends and stay up late on Friday and Saturday nights and I end up sleeping until like 3 or 4 PM sometimes. I've even slept until 6 PM some days.
I don't understand why I have these problems waking up in the morning at 6 AM and why I sleep so late when I let myself sleep in on the weekends. I apologize for venting, lol. I'm just wondering if anybody else has/had this problem or knows how to remedy it. I'm thinking about buying one of those dawn simulators. Thanks for this post,
Posted by: lonecatalyst | Jan 20, 2008 8:08:38 PM
SAD is real, and is not only real in the northern USA or Canada or the UK. i am from Romania, and it is so real here also. i see it every morning when i need to get up and go to the hospital. and the strange thing is that no matter how early or late i stay up the night before it is just the same the morning after. just wish we had those dawn simulators you're talking about in the stores here, i must look into it... we may have them hidden somewhere. best of luck with all your rotations everyone
Posted by: george | Jan 23, 2008 10:23:01 AM
I have had SAD all my life, diagnosed about 15 years ago. I moved to a coastal community for medical school. We see sunshine virtually every day, and for the first 3 years of med school, my SAD was still present, but far less than in the past. I still have SAD, worse this year (4th year), with lots of interviews (north of here), especially after a week long stay in central Ohio a few weeks ago during an illness - so I have decided to rank my coastal community high for residency. Just the thought of being able to reach the beach in less than 30 minutes alleviates my SAD. This morning, sunrise was noticeably earlier than the past few weeks, and I awoke bright & early, in a better mood than I have felt in weeks. I am considering the alarm thing that brightens the room.
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