Seasonal Affective Disorder (SAD) Clinic

Northern Light Technologies: Light Box
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 may 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 in 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 may refer themselves directly or they may be referred by 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 may make an appointment by calling Dr. Mick Hill 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 decide not 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 who 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 who can get out each day it is an effective (and certainly the cheapest) treatment modality.  For those for whom 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
Medications are also effective in the treatment of SAD.  Serotonin-specific reuptake inhibitors (aka SSRIs) such as fluoxetine (Prozac) and paroxetine (Paxil), to name two, have been quite effective for many individuals.  They are usually well-tolerated and easier to use (for some) than light boxes.  However side effects may include nausea, headache, agitation and sexual dysfunction, and these drugs are generally quite expensive for the uninsured.

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