March 31, 1998
Browse the Archives Index
Articles from The New York Times archives have not been edited to reflect the most recent research. Consult your health professional for the most up-to-date information.
New Tack Promising On Winter Depression
By JANE E. BRODYNow that spring has begun and those plagued by winter depression are emerging from their annual doldrums, new studies suggest that a few tiny doses of the hormone melatonin each afternoon might have helped to keep their demons of darkness at bay all winter.
In two preliminary studies, Dr. Alfred Lewy and his colleagues at Oregon Health Sciences University in Portland showed that properly timed doses of melatonin in amounts much smaller than are being sold could reset people's body clocks and lift their spirits. Dr. Lewy maintains that the findings strongly support the theory that winter depression is a form of jet lag in which people's daily rhythms increasingly fall out of line with clock time when dawn is delayed. By midwinter, people with winter depression feel as if they are being forced to wake up hours before their bodies are ready -- as if they have just flown from California to New York.
In an interview, Dr. Lewy said the effectiveness of melatonin indicated that people with winter depression suffered more as winter darkness deepened. Their internal rhythms become adapted to darkness in the morning and do not mesh with the requirements of their lives, which force them to arise and function effectively when their body clocks say it is night. Not until spring approaches does their depression begin to lift.
Dr. Lewy, a psychiatrist and an expert on circadian rhythms, said the preliminary findings suggested that taking melatonin in the afternoon might be nearly as effective as intense morning light in relieving winter depression. He predicted that a similar regimen could be used to help people recover faster from jet lag, adapt better to changing work shifts and adjust more quickly to daylight saving time.
Winter depression, also known as seasonal affective disorder, afflicts as many as 20 percent of the population. The disorder causes many people in northern latitudes to spend the winter beset by blues and lethargy. They tend to sleep more, eat more, crave carbohydrates, gain weight, think slower, concentrate poorly and feel fatigued, irritable and unhappy.
If the melatonin remedy holds up in larger studies, it could become the treatment of choice. Simply taking a few pills each day would greatly simplify the treatment of winter depression, which most commonly requires patients to sit in front of a light box that simulates sunlight for about an hour upon awakening every morning. For some people with winter depression, Dr. Lewy said, his studies suggest that melatonin alone might work; for others, the needed lift may come from the popular hormone and light treatment.
At the least, Dr. Lewy and others believe, melatonin might be a useful adjunct to light therapy, enabling patients to spend less time in front of a light box or enhancing the lift provided by light therapy.
Another expert on winter depression, Dr. Michael Terman, a research psychologist at New York State Psychiatric Institute, has given melatonin to a few patients who had incomplete responses to light therapy and found that the combination worked better than light alone. But Dr. Terman said the approach must be tested in large controlled studies.
Melatonin is a hormone produced only at night by the pineal gland in the brain. With sunlight, the body's primary timekeeper, melatonin helps to set the brain's biological clock, which determines all of the body's circadian rhythms, including the sleep-wake cycle, digestive functions and hormone releases.
By giving doses of melatonin equal to levels normally produced by the body in the afternoon, the Oregon researchers were able to readjust the circadian rhythms of the study subjects, convincing their bodies that night was beginning to fall in midafternoon, which meant that physiological dawn would come earlier.
Dr. Lewy and his colleagues are not sure why a disrupted circadian rhythm results in depressive symptoms in so many people. But they found that when melatonin was used to synchronize the internal timing mechanism with the need to get up when it was still dark outside, symptoms of depression were alleviated in most of the patients studied.
The researchers published the results of a pilot study of 10 patients in January in the journal Psychiatry Research. During the winter that began in 1996, half the patients were given 0.125 milligrams of melatonin at 2 P.M. and 6 P.M. and the other half got a look-alike dummy medication. In three patients taking melatonin but only one on the placebo, the symptoms of depression were reversed, Dr. Lewy said. He added that he and his colleagues had also completed a second melatonin study this winter of 26 patients to determine whether the hormone, properly timed, advanced their body clocks. Nine patients took melatonin in the morning, nine took it in the afternoon and eight took a placebo.
Dr. Lewy said that the placebo and the morning melatonin, which in effect prolonged night for the patients, had virtually no antidepressant effect, but symptoms improved significantly in a substantial number of patients who took melatonin in the afternoon -- this time in three doses of 0.1 milligram at 2 P.M., 4 P.M. and 6 P.M., which Dr. Lewy said better imitated the way melatonin was naturally released beginning at dusk.
Dr. Lewy and Dr. Terman emphasized the preliminary nature of these findings and cautioned against self-treatment by depressed people. There are three potential problems: possible interaction with other medications, achieving a proper dose (melatonin is sold as a "dietary supplement" without a prescription in doses no smaller than 0.3 milligrams, which is three times the amount Dr. Lewy used) and the soporific effects of melatonin. Dr. Lewy warned that some people with winter depression may become sleepy even on the very low dose he used.
Easing Change To Early Dawn
Although the change on Sunday to daylight saving time involves only a one-hour shift forward, it takes many people a week to adjust.
This is because the increase in daylight at the end of the day works against the body's ability to advance its biological clock so that it meshes with the new clock time.
Dr. Alfred Lewy at Oregon Health Sciences University in Portland suggests that small well-timed doses of melatonin can ease the adaptation. Start with tablets containing 0.3 milligram of melatonin. Cut each tablet into three parts. Starting on Thursday, take one-third of the tablet eight hours after your usual wake-up time, take another one-third two hours later, and the final third two hours after that. (Dr. Lewy cautioned that even these doses make some people sleepy. If this occurs, cut out one or two doses.) Get out in the morning light without sunglasses, but wear dark glasses in the late afternoon until dusk. Continue this regimen for a few days.
Copyright 1998 The New York Times Company
Copyright 1998 The New York Times Company