‘Aunt Corrie is back to Bakkum’ – When the leaves fall, we have to go to the light

Aunt Corrie has returned to Bakkum. That was an announcement made every fall. ‘Bakkum’ was the Psychiatric Institution Duin en Bosch in Castricum. Not to be confused with the campsite which is historically an overflow municipality-cum-refugee camp for young Amsterdam families. Both the Amsterdammers and Aunt Corrie went to the North Holland beaches in the summer. Corrie to Egmond aan Zee, she was born about there on the beach.

It couldn’t be because of a vitamin D deficiency that Corrie collapsed every year after the summer, you might say. She was as brown as Cousin Arie’s horse. Her mood later in the year also gave no reason to experience her as depressed. Cheerful, helpful and sporty, that came to mind earlier. (She had received gymnastics training from fellow countryman Klaas Boot, who had defended the Dutch tricolor at the 1928 Olympics.) The family knew more about her beautiful qualities than about her gloomy autumns.

Ask around, everyone knows a story of people who get upset ‘when the leaves start to fall’. It is not always taken seriously. How Aunt Corrie was treated in Bakkum has disappeared in the fog of family history. She did come out every spring, when the sun started shining again earlier in the day. Aunt Corrie’s happiness in life was determined by the length of the days and the turning of the seasons. It shows once again how dependent humans are on the sun.

There are people who enjoy autumn. Who appreciate the beautiful colors of the leaves in the photos of weatherman Gerrit Hiemstra. They look forward to Christmas and hope for skating weather. They see no objection in the down time from nature. Others lament the end of summer, because the heat and freedom are over. At most they suffer from some ‘winter blues’, but that dip will be over by Sinterklaas.

The light therapy is done with a strong, white light of approximately 10,000 lux. There is no ultraviolet radiation in this light. So it’s not bad for the skin

There are also people who seriously suffer from SAD, seasonal affective disorder. The abbreviation was not chosen without a sense of dark humor, it seems. Winter depression – the good news right away – is successfully treated in specialized clinics.

Sometimes with medication or talk therapy, but mainly through exposure to what was missing: light.

10.000 Lux
“The light therapy is done with a strong, white light of approximately 10,000 lux. There is no ultraviolet radiation in this light. So it is not bad for the skin. The light is comparable to daylight 45 minutes after sunrise,” according to the explanation on the site of the University Medical Center Groningen (UMCG).

Regular exposure to light according to a treatment plan restores the balance (of production and breakdown) of the hormone melatonin in the brain. Melatonin’s function is to ‘inform’ the physiological processes in the body about the day-night rhythm and the seasonal changes. It is a strong working mechanism, but extra intake of melatonin from a jar of the drugstore has hardly any effect. It is taken by people who suffer from jet lag or work at night, but the effect of this exogenous administration is unproven.

By shortening the days, the production of melatonin continues, resulting in fatigue, drowsiness and lack of energy. Those who have winter depression will also start snacking and sniffing a lot (and therefore gain weight), will have difficulty getting out of bed for school or work and listlessly withdraw from social interaction.

General practitioners have seen in their practice for some time that patients with depressive symptoms more often seek help when winter approaches. The Aunt Corries are numerous. This is apparent from a survey of 75 general practices. ‘When the leaves fall… Meteorological conditions and depression in general practice’ is the title of the 2006 report.

“In the autumn, when the leaves fall, latent depressive feelings are more and more pronounced in many people than in other seasons. At least that’s the popular belief. Opinions are divided on this in the literature,” researchers Robert Verheij and Hans te Brake wrote at the time. They chose a simple approach to test that ‘popular belief’. They asked the general practitioners to report when they most often had patients with depressive symptoms and compared these figures with meteorological data from the KNMI.

Vitamin D
A bit of winter dip is still manageable for most, but ‘latent depressive feelings’ can become manifest in people who already (due to predisposition) tend to be depressed. “Depression” is an often misused or overused term, but that’s no reason to underestimate signs of depression. The change of seasons can give the push, according to a lot of research, which also evaluates the possible treatments.

A little winter blues is still doable for most, but ‘latent depressive feelings’ can become manifest in people who already (due to predisposition) tend to depression

Phototherapy appears to be the most effective, in addition to antidepressant medication and talk therapy. But – there she is – a good vitamin D status is indispensable. Most cases of SAD (see the graph) occur in the winter, when the production of vitamin D in the skin from sunlight has already been minimized and supplementation is recommended. A link with too little D and SAD is very likely. However, extra vitamin D, more than for a healthy level, does not help.

SAD experts generally advise against experimenting with daylight lamps yourself, but they are becoming popular. With an advanced lighting system in the bedroom it is possible to simulate an earlier sunrise. The question is whether it will do much. The biological systems in the body that depend on sunlight and darkness are controlled by multiple molecular clocks and are not so easily fooled.

In The New York Times one expert mentions most daylight lamps on the (American) market garbage. If you still want to try it yourself, you should buy a good daylight lamp and sit in front of it for half an hour every day before eight o’clock in the morning for at least three weeks.

How do people in northern regions deal with the winter blues or worse? The New York Times also writes about this. In the Scandinavian countries people like to visit nature and each other. Spending a lot of time outside, walking in the (white, so luminous) snow and then snuggling up under warm plaids, wearing thick socks and wearing your Mart Smeets sweater, lighting candles, something tasty at hand. Fun in Danish, cozy in Norwegian, mys in Swedish and ‘sociable’ in Dutch.

If only Aunt Corrie knew all this.