Tuesday, January 15, 2013

Light therapy better than pills for some SAD patients

Dr. Michael Camardi

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About Dr. Michael Camardi

Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.

Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.

Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.

Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.

If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.

Dear Dr. Camardi:

I'm writing to you because I know my wife would not and I wanted to tell you what happened.

I thought you could help her the way you helped her mother. Everybody knows she's tough to live with during the wintertime, and after you asked all those questions and did those blood tests, you called it "Seasonal Affective Disorder."

She wanted pills, and when you started to talk about sitting in front of a lamp to help her mood, she wasn't hearing any of that.

Well, I bought the special lamp you told us about and we sat in front of it for about a half-hour a day reading and she started to perk up. But she still wanted pills, so we went to another doctor and he gave her pills and we stopped reading in front of the light.

She took what he prescribed but all she got was a feeling of being more tired than before and felt about as bad as when I brought her in to you.

Then she stopped the pills and we went back to reading in front of the lamp and her mood got better.

So now what? You gave her some information and I know we made a follow-up appointment with you but she isn't going to keep it. But she will read your article! Maybe you could encourage her.

- Roanoke

First things first. I am glad you, your wife and your wife's mother are feeling better.

I can always use medication if I need to, but I wanted to try a nonpharmaceutical approach first. That reasoning was based upon the way in which you answered my questions and the results of your lab tests.

Based on this, it gave me an impression that the syndrome you presented might respond favorably to light therapy without resorting to pills.

As you found out, while medication has its place, the pills can have unintended side effects. The key point is that all other causes have to be ruled out first.

That done, the conclusion of Seasonal Affective Disorder made sense.

My interest in this syndrome stems from my private practice days in New York when I saw a lot of people who were very active during the summer come in complaining of the "blahs" in fall and winter.

Some of them had underlying clinical disorders, but many others had SAD. Studies have shown that about 10 percent to 15 percent of people in our country are affected by this condition and some 3 percent to 5 percent need therapeutic intervention of some kind just to get through the day.

As I have continued to track the disorder, SAD has continued into the geriatric population where, in my opinion, it has been a cause of inappropriate use of antidepressants and sedatives.

Generally speaking, the problems start as the days shorten and the amount of sunlight we are exposed to diminishes. What these folks tend to complain of is easy fatigability, a lack of energy and a loss of interest in things.

And, with geriatrics, as patients show a loss of memory, the specter of dementia rears its ugly head. All of this will make a person feel depressed.

But as spring approaches and the days become longer, things begin to improve and the patient gradually reverts to normal.

Theories as to the cause of this condition seem to point to an imbalance between various neurotransmitters in the brain that affect mood and sleep - specifically serotonin and melatonin. How these agents become affected has recently been considered in how the patient's eyes deal with varying degrees of light.

Those with SAD seem to have a dysfunction of how light is metabolized as it is received by the eye. This is where the light therapy comes in.

I have come to use light therapy as a mode of diagnosis if the patient notes an improvement.

If after a complete evaluation you and your provider come to the conclusion that you may have SAD, sit down with a good book and be prepared to "see the light." You might be surprised how much better such a simple little thing can make you feel.

Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.

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