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Seasonal
Affective Disorder (SAD) Clinic Information
The Seasonal
Disorders Clinic At UNC provides an opportunity
for those who think they might be suffering
from Seasonal Affective Disorder (SAD) or
Winter Depression to receive a comprehensive
evaluation for this condition and to receive
a trial of Light Therapy when indicated.
The Clinic
is located on the first floor of the UNC
Neurosciences Hospital in Chapel Hill, NC
and appointments can be made by phone or
e-mail.
Please note
that this is a CONSULTATION Clinic rather
than a treatment clinic. This means that
we provide evaluations for Seasonal Affective
Disorder and an opportunity for a Light
Therapy trial. Beyond this short trial you
will need to seek follow-up treatment elsewhere
if needed. (Please note that we will be
happy to make recommendations and assist
with this process). The Light Therapy trial
serves as an opportunity for you to see
if this treatment modality will help you
before actually purchasing or renting a
light unit.
Patients
can refer themselves directly or can be
referred by another clinician. Those referred
by another clinician for this consultative
service will be expected to return to that
person for long-term follow-up.
Appointment
Information
You can make an appointment by calling Dr.
Mick Hill directly at (919) 966-3690 or
by e-mailing him at: mick_hill@med.unc.edu.
In all cases he will personally call you
back (or e-mail you) to set up an actual
appointment. Appointment times are limited
and because of the nature of this consultation
it is best if you are symptomatic at the
time of the appointment (though you shouldn't
wait until you are severely symptomatic
before calling)
SAD
Clinic Consultation Cost
The Comprehensive Evaluation, 2-week Light
Therapy Trial, and One Follow-up Appointment
are bundled together for $200. For those
who receive an evaluation and then do not
decide to pursue the Light Therapy Trial
and Follow-up, the cost is $150.
What
about insurance?
Unfortunately, most insurance companies
(read: practically all) do not cover the
purchase of a light box. (They also do not
cover a vacation to the Bahamas which is
clearly an effective treatment for this
disorder as well). However, if you have
mental health coverage then it usually will
pay for Psychiatric evaluations/consultations
such as what you receive in this clinic.
When in doubt, talk to your insurance company.
Seasonal
Affective Disorder (aka Winter Depression)
First reported on in 1984 by Dr. Norman
Rosenthal at NIMH, Seasonal Affective Disorder
(S.A.D.) is a seemingly common condition
associated with recurrent winter depressions
in susceptible individuals. Typically symptoms
begin in the Fall (often as the day noticeably
shortens in length) and then spontaneously
remit in the Spring. Symptoms include depressed
mood, difficulty concentrating, excess sleep
(hypersomnia), increased appetite (hyperphagia),
decreased energy and in some cases carbohydrate
craving. These symptoms often lead to difficulties
at work and/or home. Severe cases can be
associated with pronounced dysfunctionality
and/or suicidal ideation. Some individuals
'rebound' in the Spring with excess energy,
reduced sleep and elevated mood though this
is the exception rather than the rule.
Seasonal
changes in sleep, appetite and/or energy
reportedly occur in the majority of Americans
with some evidence for an increase in prevalence
in more northern climates. However, most
indivduals are not affected to the point
of significant dysfunctionality, and for
those that are (perhaps 10% of the population)
treatment is available. The most benign
and consistently effective treatment is
the use of Hi-intensity light exposure for
certain periods of time each day ostensibly
to re-regulate dyssynchronous circadian
rhythms. The most natural source of light
therapy is sunlight and for those that can
get out each day it is an effective (and
certainly the cheapest) treatment modality.
For those where daily sun exposure is impractical,
Light Boxes can be used instead. These devices
must be UV-blocked to prevent retinal damage
and need to optimally provide a
10,000 LUX dose
exposure so that time in front of the box
can be minimized (to 30 minutes or so). Various
light boxes, light glasses, light pipes, etc.
have been developed by companies eager to
get a slice of this potentially very big pie.
Data on the effectiveness of novel devices
(such as light glasses) is limited and sometimes
conflicting.
Medications
are also effective in the treatment of S.A.D.
Serotonin specific reuptake inhibitors (aka
SSRIs) such as fluoxetine (Prozac) and paroxetine
(Paxil) to name two have been quite effective
in many individuals. They are usually well-tolerated
and easier to use (for some) than light
boxes. However side effects include nausea,
headache, agitation and sexual dysfunction
and these drugs are generally quite expensive
for the uninsured.
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