DEAR DR. ROACH: I am 78 and dislike the short gray days of winter. I know that light therapy is used for seasonal affective disorder (SAD), and I would like to try it. How do I know which light box or lamp is a good choice? (Does it block ultraviolet rays, provide the right amount of light, etc.?) — K.J.

ANSWER: SAD is a subcategory of major depression that has a clear seasonal pattern over at least two consecutive years. It’s not just disliking the short gray days of winter. The diagnosis of major depression requires meeting several criteria such as a change in appetite or weight; sleep pattern changes; poor concentration; feelings of guilt; and fatigue or thoughts of hurting oneself, in addition to feeling either a depressed mood or a loss of pleasure and interest nearly every day for at least two weeks.

With a diagnosis of SAD, treatment may include medication therapy, bright light therapy, or both. If you are prescribed bright light therapy, the usual recommendation is 10,000 lux of white light for 30-60 minutes. The morning, right after awakening, is the most effective time for light therapy.

I found several consumer recommendations online for devices that can provide this. You should insist on a device that is free from ultraviolet light. People with eye conditions such as cataracts, macular degeneration or glaucoma should be sure to see their eye doctor regularly.

Bright light can be effective for nonseasonal depressive symptoms, but it is most effective with seasonal depression. Any kind of depression should be managed by your doctor or a mental health professional. There is an “inverse” form of SAD where people develop depressive symptoms in the summer. As you might imagine, light therapy is not effective for this form.

DEAR DR. ROACH: I have osteopenia in my spine and hips per a DEXA scan, and in my forearms and wrist, I have osteoporosis. I recently saw a pulmonologist as my asthma is worsening. (Thanks, COVID.) I am 71 years old.

The pulmonologist put me on a long-acting inhaled treatment for asthma: 320 mcg of budesonide per day and formoterol (Breyna). When I read about these steroids, it cautions against using them with osteoporosis. Both the specialist and my internal medicine doctor said not to worry. My primary care doctor recommended a spacer. I’m on my third year of a five-year course of Fosamax. What are your thoughts? — A.W.

ANSWER: There are times when physicians must use a therapy while knowing that it is going to cause harm. This takes judgment and a fine weighing of the benefits of the planned treatment against its expected harms — and whether the harm that the treatment causes can be ameliorated.

In your case, your doctors are on the right course. It is true that steroids like budesonide can sometimes worsen bone strength. However, the dose of inhaled steroids that you are taking is low enough; most studies at this dose have shown only a very small (or no) increase in fracture risk. You are also on an appropriate treatment for most women with osteoporosis.

I agree completely with your doctor who recommended a spacer for the steroid inhaler. Spacers make more medicine go into the lungs where it is useful and less into the mouth where it can predispose people to fungal infections (“thrush”).

In my opinion, the effectiveness of inhaled steroids for asthma that is more than mild outweighs the risks of worsening osteoporosis for most people. Careful bone density monitoring is called for, especially in older women, who are at the highest risk for osteoporosis. There are other options besides inhaled steroids to treat asthma in people whose osteoporosis is very severe.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.(c) 2026 North America Syndicate Inc. All Rights Reserved