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Sanjay Gupta MD

Millions In U.S. Suffer From Seasonal Affective Disorder; FDA To Approve Obesity Drugs; Press Conference On Trapped Miners

Aired January 21, 2006 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

TONY HARRIS, CNN ANCHOR: For the second time this month, a West Virginia church becomes the backdrop and rallying point in a rescue effort for two missing coal miners. The pair are somewhere inside the massive Aracoma Coal Mine in Melville.
They were lost following an underground fire late Thursday afternoon. And we are continuing to monitor the situation at the West Virginia mine. We're awaiting a news briefing. And we will bring that to you when it happens right here on CNN.

Still no word on the fate of a 28-year-old American journalist, who has been held hostage in Iraq over the past two weeks. Jill Carroll's captors are demanding the release of all Iraqi women prisoners being held by U.S. troops.

And it's a whale of a time to be in London, where a lost and possibly sick bottle-nose whale is causing a stir. A rescue plan is in the works off the banks of the Thames River, where the whale has been meandering upstream since Friday. Marine biologists speculate the mammal is injured. Those are the headlines.

HOUSE CALL with Elizabeth Cohen. Starts right now.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Elizabeth Cohen sitting in for Dr. Sanjay Gupta.

The hustle and bustle of the holidays is over, and perhaps you've already broken your New Year's resolutions. Well, this is the time when many people start to wind down. And if you've been feeling a little blue, you're not alone.

For millions of Americans, winter is not a wonderland, but a difficult time of year. Our Christy Feig has more.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): As he has for the last 21 years, Neal Owens starts his day with 20 minutes of light therapy. That's because he suffers from Seasonal Affective Disorder or SAD. A less severe form is called winter blues.

NEAL OWENS, SAD PATIENT: It's like you're weighted down. It's almost as if your brain batteries are running out of juice. You're lethargic. You just don't want to do much. You find it -- that it's a chore to get out of bed in the morning. FEIG: Owens is not alone. Millions of Americans feel the same way this time of year. It's a type of depression that strikes most people during the fall and winter months only. Up to 80 percent of those affected are women. And it's caused, experts say, by a chemical imbalance in the brain due to a lack of sunlight.

NORMAN ROSENTHAL, DR., AUTHOR, "WINTER BLUES": The light is providing us with certainly chemical changes in the brain. And when we take that away in susceptible people, the changes are not occurring and you then get the whole cascade of symptoms.

FEIG: Those symptoms can be mild, fatigue, low energy, oversleeping, craving for carbohydrates and sweets, or very debilitating.

ROSENTHAL: In severe cases, people with Seasonal Affective Disorder can be disabled, unable to work, unable to keep their commitments to other people, depressed, even suicidal.

FEIG: But there are a number of effective treatments available. Light therapy, early morning exposure to very bright light is effective. And doctors say exercising, modifying your diet, psychotherapy, and in some cases antidepressants can help you work through those dark and difficult days.

I'm Christy Feig reporting from Washington.

(END VIDEOTAPE)

COHEN: Thanks, Christy.

As many as one out of four of us suffer to some degree from SAD, Seasonal Affective Disorder. The majority are in the northern regions, where little sun and long nights can take their toll.

So how do you know if you have SAD or just a mild case of the winter blues? Our guests today can help answer that. You saw him in Christy's piece. He's Dr. Norman Rosenthal, a psychiatrist and the man who first described Seasonal Affective Disorder, and who suffers from the disease himself.

He's also author of the recently revised book "Winter Blues." Welcome, Dr. Rosenthal.

ROSENTHAL: Great to be here.

COHEN: Now doctor, many people feel a let down after the holidays and during gloomy weather. How do you know the difference between a case of the blues and true Seasonal Affective Disorder?

ROSENTHAL: Well, it's really a matter of degree. If you've just got the winter blues, and I say just, it can be bad enough, your quality of life suffers. There's less sparkle in your life. You're not as creative. You're not as productive.

So it bothers us, but it's not something you'd go to the doctor with. On the other end of the spectrum is Seasonal Affective Disorder, where you really have functional impairment. Relationships suffer, your work suffers, you can't concentrate, you can't get out of bed in the morning, energy is really low. Sleep you may need too much of that. And it may really cut into your day. And you may crave sweets and starches and gain a lot of weight.

All these things are very distressing. And it may, in fact, take you to a doctor. But remember, somebody could have winter blues one winter and SAD the next winter, depending on a number of variables.

COHEN: Well, thank you, doctor. That explains the difference.

Let's go to our inbox now. We've got a lot of e-mails lined up. We're starting with John from Pennsylvania, who wants to know. "How does Seasonal Affective Disorder fit in with other forms of depression?" Doctor?

ROSENTHAL: Well, SAD, in fact, is a kind of depression. Many people who have mood disorders get worse in the winter time. And they would benefit from all the same treatments as our good for SAD as well.

But it's a subgroup. It's a group of people who suffer depressions, particularly in the winter, but it can be just as bad as any other form of depression.

COHEN: Now Christy talked a bit in her story about treatments for Seasonal Affective Disorder, but Theresa from Ohio still has some questions. She writes us this e-mail.

"What are some of the most effective ways of combating winter depression?" Doctor, we know light therapy is an important form of treatment. And we'll talk more about that later. But what about talk therapy and antidepressants?

ROSENTHAL: Both are very helpful. In fact, I was involved in a study recently, where we gave the antidepressant Wellbutrin before the winter started and helped to prevent some people from relapsing into depression.

But any form of antidepressant may be helpful for Seasonal Affective Disorder. Talk therapy, especially cognitive behavior therapy, may be very good for reversing the vicious cycle of SAD, helping people not to veg and lie in the morning, but get up, get active, do pleasurable things, and combat negative thinking. So these can also be good treatments for SAD.

COHEN: Doctor, you suffer from this disorder. What have you found helpful?

ROSENTHAL: Well, I use all of my own advice, as I mention in the book. And I have enjoyed my winters for many years now. I get up in the morning. I go for a brisk walk. I enjoy the bright lights of a winter day. And even if it's cold, I bundle up. And I use light myself. I wake up into an illuminated room. And there are special devices called dawn simulators, which are very effective. They simulate a summer dawn by turning on your bedside lamp. But you can even use a timer, which is a $10 device to help wake up into a bright room.

I exercise, I modify my diet. And I keep busy and find that to be very, very helpful and enables me enjoy the winter seasons.

COHEN: Well, we're going to shine some light on those odd looking boxes after the break.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: From light boxes to light visors, do they really work? Couldn't a really bright light do the same?

Plus, what about tanning bed? Could they help you stop feeling SAD? That's after the break.

But first, take today's daily dose quiz. True or false, SAD occurs only during winter months. Find out after the break.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked, true or false, SAD occurs only during winter months? The answer is false. It's rare, but some people suffer from Seasonal Affective Disorder in the summer.

COHEN: We're talking about Seasonal Affective Disorder this morning. It's a problem that affects millions during the dreary months of winter.

In fact, just recently, a British researcher used a formula to calculate the most depressing day of the year and declared it to be January 24th, not that far away.

Dr. Norman Rosenthal is back with us to talk about beating winter depression.

Doctor, the most popular treatment for Seasonal Affective Disorder is light therapy. And you brought an example of a light box with you. Can you tell us, how does this therapy work?

ROSENTHAL: Yes, over here, I have the sun square, which is one of my more favorite boxes because it's very large. It has a lot of fluorescent light packed behind the diffusing screen, which also has an ultraviolet filter. You don't want the ultraviolet.

And I'll turn it on just to show you how bright it is. And it's much brighter than an ordinary room light. You have to sit in front of it. In other words, not to the side like it is now. But I would, for example, read my newspaper, have my breakfast with a light box in front of me and do that for maybe 20, 30 minutes each morning. And it's amazing how much energy and effect it has in terms of reversing the SAD feelings and making you feel good even all day long.

COHEN: But Dr. Rosenthal, I see that it's very bright. But does your body really think that that's sunlight? Do you trick your brain?

ROSENTHAL: You really do. I mean, one of my patients today was saying she doesn't care now if it's a rainy day or not because she's got her own sunlight right in her own bedroom. So it really does trick the brain in a remarkable way.

COHEN: Well, our viewers have lots of questions on light boxes. Let's take one from Peggy in Michigan, who wrote us this. "How strong of a light is preferable for treating SAD and how long do you need to be exposed to it?" Dr. Rosenthal?

ROSENTHAL: The light must be much brighter than room light. Approximately 20 times as bright. And if you calculate the measurements. That's why it's nice to get one of these pre-made boxes, because they've been calibrated to put out just the right amount of light.

In terms of the amount of light, it varies from person to person and from season to season. For example, at the beginning of the winter, you may only need 10, 15 minutes. Whereas in the midst of winter, you could need as much as an hour and a half in the morning.

And also depends on how bad your SAD is. So you have to be your own best judge as to how much light you need.

COHEN: And when you're buying a light box, should you be looking for a specific wattage or power?

ROSENTHAL: Yes, I think you should go with a reputable distributor, who's been around for a while. All these boxes should have a 30-day money-back guarantee. So you should check that out and be sure that you can return it for a full refund, if you don't like it.

I prefer the larger boxes, not these teeny-weeny ones. They're just not as effective, even though they are cheaper and more portable.

They should have a defusing screen in front with an ultraviolet filter. And they should produce 10,000 lux, which is the amount of brightness that we need according to research studies.

ROSENTHAL: Doctor, we received more than a few e-mails questioning whether light boxes are really that effective. Here's just one example.

Steve from Wisconsin writes, "Do these lights for SAD really work? Am I just as well off to purchase high intensity bulbs at the hardware store?"

Doctor, why are light boxes any more effective than just a plain bright light bulb? ROSENTHAL: Well, the question really is where are you going to put the light bulb? If you put them in the ceiling or far away from you, it's not going to be bright enough. If you put a naked light bulb too close to the eye, it can damage the eye because it doesn't have all the safety features built in.

The advantage of these pre-made light boxes is that they are the kinds of boxes that have been used in literally dozens of research studies. So you have all that data to support the efficacy and safety of the boxes.

If you go out into the hardware store, you're really on your own. On the one hand, you may be left with an ineffective box or bulb. On the other hand, you may actually hurt your eyes.

COHEN: Doctor, are there some people who shouldn't use light boxes?

ROSENTHAL: People with retinal problems. If you've got retinal illnesses, like macular degeneration or retinitis pigmentosa, if you've got any eye problem, you should certainly consult with your ophthalmologist before using a bright light box.

COHEN: Well, we have another e-mail now from Gwen in Ohio, who asks, "Can using a tanning booth sparingly help with winter depression?"

Doctor, this was another common question. A lot of people wanting to know if tanning booths would help with SAD.

ROSENTHAL: I recommend against tanning booths for SAD, because the ultraviolet that's in the tanning lamps can actually damage the skin. And it can also cause cancer, including the deadly melanoma.

So I don't recommend tanning beds. That having been said, several of my patients do say that they feel better after being in a tanning bed. And it may be that there's another way in which lights can be beneficial.

But the light box that I showed you, and the light fixtures that we generally use, work through the eyes with a direct connection between the eye and the brain, and don't have any ultraviolet light in them.

COHEN: We're talking with Dr. Norman Rosenthal, answering your questions on SAD. Stay tuned for more HOUSE CALL.

UNIDENTIFIED FEMALE: Melatonin, serotonin, circadian rhythms, what really causes seasonal depression? And can you prevent it?

And later, 15 minutes a day that could cut your risk of dementia.

First, this week's medical headlines in "The Pulse".

(BEGIN VIDEOTAPE) KELLY CALLAHAN, CNN CORRESPONDENT (voice-over): The FDA is expected to approve two drugs to fight obesity within the next month. The drug Acomplia is a prescription appetite suppressant pill that blocks the brain receptors that make you hungry. The drug Alli has been sold as the prescription drug Xenical for seven years. It prevents the body from absorbing fat. Pending approval, it would be available over the counter.

If you've ever felt like a pin cushion while giving blood or during a hospital stay, meet the vein finder. Researches at Georgia Tech have developed an inexpensive handheld device that uses Doppler ultrasound to find veins quickly. The vein finder's accuracy will make treating trauma patients or those who need ongoing IVs or blood work much easier.

Kelly Callahan, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

HARRIS: And let's take you now to Melville, West Virginia for the latest information on rescue efforts to save two missing miners.

JESSE COLE, MINE SAFETY & HEALTH ADMIN.: Also, the roof needs to be supported before we can advance into that. And the heat has to dissipate. So those are the kind of things that we're dealing with.

Also, using -- you only have certain areas of access to the fire. As you know, it's the square blocks and the entries that you have. You only have access to that fire through those blocks.

You got 100 foot blocks that you have no access to it. Then you have an entry, a 20-foot entry over here, that gives you access.

So you're only able to come at it at whatever the mine layout allows you to do that.

So that's been the problem right now. And we need for the safety of our teams, we need to make sure that we had containment of that fire to a level that we felt comfortable with.

QUESTION: How many crews are in there right now?

COLE: We had six at least when we left.

QUESTION: About how many people is that?

COLE: Thirty -- we've got a lot more people than that. We've got company employees that are driving the man trip vehicles or the vehicles transporting the teams. We have some company employees that are not mine rescue members that are up in here in areas transporting materials up to the fire area.

UNIDENTIFIED MALE: We have one of our people with each team.

COLE: Yes, it's -- probably close to 50 people.

QUESTION: How many are dealing with rescue? How many are here in ventilation for you to ...

COLE: Well, they're all dealing with rescue.

QUESTION: So actually search as opposed to fighting the fire or airing the vents?

COLE: Well, when we left, we had two teams that were fighting the fire. And we had four teams up here that were poised ready to advance into the entries on search and exploration.

QUESTION: And are employees ready for that?

COLE: That -- well, that was...

UNIDENTIFIED MALE: Thirty minutes or 40 minutes ago...

COLE: An hour ago.

QUESTION: What kind of progress have you made in the last nine hours?

COLE: Well, the progress that we made that we have...

UNIDENTIFIED MALE: We did those ventilation...

COLE: We did the ventilation changes, which take time. And we're putting air down nine and ten, which allows, we hope, that if it did what it's supposed to, we tried to clear out all the entries.

QUESTION: Have the rescue teams progressed in the last nine hours, square footage wise?

COLE: Yes. We did a lot of exploration, as we made one of the earliest air changes. See, as you recall we had a lot of smoke-filled entries in here. We made the one run up to the face area. It was only in the one entry, number one entry. It was up onto the section.

But two and three entries down through here, we had zero visibility. So therefore, we're not examining those.

We've made an air change. And I don't know what point.

UNIDENTIFIED MALE: Probably up to six, eight foot of visibility right now. But we haven't been able to go back and look at it simply because we had a team in here earlier this morning, let's say, in the a.m. hours. And they were there, but their cap lamps, they had been underground a long period of time. And they had a backup team. And we had to get new cap lamps for them or refreshed cap lamps, charged cap lamps, and go back in.

So we were over in here trying to look and make sure the entries were clear.

QUESTION MALE: What side of the mine have you searched that you want to search so far?

COLE: Well, what we want to search is whatever we need to search.

QUESTION: But what percentage have you been able to look at?

COLE: But what we've looked at primarily -- the fire and heat here has limited access to some of these areas. The ventilation changes we made early yesterday allowed to us give some examinations to these entries.

We examined up on to the section. What we need to move down to is number 10 and number nine entries, where we made ventilation changes that would make that a, you know....

Reporter: Ten percent, 15 percent?

UNIDENTIFIED FEMALE: We'll take two more questions.

(CROSSTALK)

QUESTION: Last night, you had mentioned that you were about 150 feet away from finishing the drilling. Where are you on that?

COLE: OK, that's a good question. We were drilling this hole, as you remember over in this area. And we had approximately 190, 200 feet to cover. We were 130 feet down.

We put that hole through. That hole went through in the a.m. hours. And we left the drill still down enough to pound on the drill steel to try to get signals, if there were to be anyone alive.

So we did not get any signals back. The next thing we told you we were going to do if we didn't get signals back, we were going to lift the steel and put a camera and a microphone in the hole. We did that. We did not get any response with that either.

So that hole is pretty much finished. There is water going from the surface to the underground part of the mine, down through that hole. It was a wet hole.

We drill it through as a wet hole. We put water in it, so that they would not change any of the environment or cause a safety concern to the miners if they were to have been there.

QUESTION: You have been fighting this fire now for 40 some hours. It -- has this thing been significantly more stubborn than you expected? Is it in danger of spreading into the coal seam? How would you characterize this fire as clearly 40 hours into this operation is hampering your ability to perform a rescue?

COLE: Well, what's happening is that, yes, it is into the coal seam in places. It is some of the belt structure and belting that has been on fire.

And as that environment is constantly changing, the roof falls, make it difficult to get in there. The heat in a very -- you've got a fire in an extremely enclosed confined space. And the heat has no place to dissipate. So it's very hot around the area.

So there are conditions that are making it difficult. And it has spread. It's air. You've got to keep air flowing. We've tried to make some changes here to keep the air and the ventilation off of it from fanning, if you will, the fire.

But yes, it's been difficult. And it did flare up. We thought we had it pretty well contained.

But again, you can only see it from -- we're looking at it from a distance because we can't get close to it. And then you're only looking at it through very selective areas in the mine.

UNIDENTIFIED MALE: I'm sorry, with...

QUESTION: Is it in danger of spreading and becoming a much bigger conflagration inside the mine at this point?

COLE: That's what we're attempting to limit. And so, we're approaching it with different methods, as we talked about one other time with high expansion foam. And also, we're going to try to put water up over top of the fall because you have to be back a good distance because of the heat and the roof falls that limit your travel into the area.

UNIDENTIFIED MALE: With that, let's allow Doug and...

QUESTION: How...

UNIDENTIFIED MALE: Wait. With that, let's allow Doug and Jesse to get back to the mine site. They've been away now for almost an hour, because we've spent an extended period of time with the families. One question.

QUESTION: How hot is it? What level of heat are we talking about?

UNIDENTIFIED MALE: I have -- we're not measuring temperature.

COLE: The determination is how close the individuals can physically get to the fire.

UNIDENTIFIED MALE: OK, guys, with that, let's go ahead and let them get back to the mine site at this time.

At this time, I'll go ahead and bring Congressman Ray Hall forward. He's been spending time with the families down at the church along with Governor Joe Manchin. And he can talk about the mood of the families at this hour and address that issue with you.

REP. NICK RAHALL, WEST VIRGINIA: The families understandably want to be at peace with themselves during this difficult time. They want to see closure, as we all do. They have been through a tremendous amount of agony, that perhaps none of us can truly understand. Our hearts and our prayers are with them. It has been one big and close family. It has been in the church for close to two days now.

Governor Manchin has been there every step of the way. He has been forthright with the families in providing them the briefings on our regularly scheduled basis. They have asked questions. And they are truly, truly praying at this point, as we all are, that their loved ones be returned to them as soon as possible.

TOM HUNTER, PRESS SECRETARY FOR GOVERNOR MANCHIN: Quick questions for Congressman Rahall? OK, with that, we'll conclude our briefing.

UNIDENTIFIED MALE: Who are you?

UNIDENTIFIED MALE: Again, we are going to -- I'm Tom Hunter, press secretary for the governor. At this time, we'll continue the briefings, basically working on the schedule that we've been working on the past several hours.

When we have new developments to bring to you, we will give you all an early heads up and let you know when the federal and state officials are addressing the family. So you can get in place for a briefing. We'll give you at least 10, 15 minutes notice when we have our next briefing. Thank you.

UNIDENTIFIED MALE: You don't know when that will be now?

UNIDENTIFIED MALE: At this time, we've...

HARRIS: We've been listening to an update, a briefing from West Virginia, Melville, West Virginia, as the efforts continue, Betty, to rescue those miners trapped now in that mine in West Virginia.

As you heard, there was a lot of praying going on right now. You heard that from Congressman Nick Rahall. The family members are praying that they get their loved ones back right now.

Let's see if we can bring you the latest information that we were able to receive from that briefing. The fire, which is -- it continues to be a big issue there, the fire in the mine continues to burn. There were times when the fire officials and other officials thought they had the fire under control, and only to see the fire flare up again. And that is a real problem.

There is very little that can be done right now until that fire is brought under control. Fifty people involved in this rescue at this point.

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