Seasonal Affective Disorder

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Seasonal affective disorder From Wikipedia, the free encyclopedia Jump to: navigation, search Seasonal affective disorder Classification & external resources Light therapy lamp for Seasonal Affective Disorder DiseasesDB 11910 MedlinePlus 001532 MeSH D016574 Seasonal affective disorder (SAD), also known as winter depression, is a mood disorder. Most SAD sufferers experience normal mental health throughout most of the year, but experience depressive symptoms in the winter. When the depressive symptoms occur in summer rather than winter, the condition is often referred to as reverse seasonal affective disorder (RSAD) and can include heightened anxiety.[1] Contents // Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright light therapy.[2] SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%[3] Cloud cover may contribute to the negative effects of SAD.[4] SAD can be a serious disorder and may require hospitalization. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness.[4] The symptoms of SAD mimic those of dysthymia or clinical depression. At times, patients may not feel depressed, but rather lack energy to perform everyday activities.[2] Norman Rosenthal, a pioneer in SAD research, has estimated that the prevalence of SAD in the adult United States population is between about 1.5 percent in Florida and about 9 percent in the northern US.[4] Various etiologies have been suggested. One possibility is that SAD is related to a lack of serotonin, and serotonin polymorphisms could play a role in SAD,[5] although this has been disputed.[6] Mice incapable of turning serotonin into N-acetylserotonin (by Serotonin N-acetyltransferase) appear to express "depression-like" behaviors, and antidepressants such as fluoxetine increase the amount of the enzyme Serotonin N-acetyltransferase, resulting in an antidepressant-like effect.[7] Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland. Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% vs. 6.4% of the U.S. population.[8] The blue feeling experienced by both SAD and SSAD sufferers can usually be dampened or extinguished by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure.[9] Connections between human mood, as well as energy levels, and the seasons are well-documented, even in healthy individuals. [edit] Symptoms The most common symptoms of SAD include extreme fatigue, oversleeping, not being able to get out of bed, overeating, carbohydrate cravings and weight gain. It can also be accompanied by the regular symptoms of depression, such as low mood, loss of interest in activities and trouble concentrating. Another type of light therapy lamp There are many different treatments for classic (winter-based) seasonal affective disorder, including light therapies, medication, ionized-air reception, cognitive-behavioral therapy, and carefully timed supplementation of the hormone melatonin. Bright light treatments are common although as many as 19% of patients stop use because of the inconvenience.[3] A specially designed lamp, many times brighter than normal indoor lighting, is placed near the sufferer, and has proven to be effective at doses of 2500 - 10,000 lux.[8] Most treatments use 30-60 minute treatments, however this varies depending on the situation. The sufferer sits a prescribed distance, commonly 30-60 cm, in front of the box with her/his eyes open but not staring at the light source.[3] Many patients use the light box in the morning, however it has not been proven any more effective than any other time of day.[8] Discovering the best schedule is essential because up to 69% of patients find it inconvenient.[3] Dawn simulation has also proven to be more effective in some studies, there is an 83% better response when compared to other bright light therapy.[3] When compared in a study to negative air ionization, bright light was proven to be 57.1% effective vs. dawn simulation, 49.5%.[10] Patients using light therapy can experience improvement during the first week, but increased results are evident when continued throughout several weeks.[3] Most studies found it effective without use year round, but rather as a seasonal treatment lasting for several weeks until frequent light exposure is naturally obtained.[2] SSRI (selective serotonin reuptake inhibitor) antidepressants have proven effective in treating SAD. Bupropion is also effective as a prophylactic.[4] Effective antidepressants are fluoxetine, sertraline, or paroxetine.[2][11] Both fluoxetine and light therapy are 67% effective in treating SAD according to direct head-to-head trials.[2] Negative air ionization, involving the release of charged particles into the sleep environment, has also been found effective with a 47.9% improvement.[10] Depending upon the patient, one treatment (ie. lightbox) may be used in conjunction with another therapy (ie. medication).[2] Alfred J. Lewy of Oregon Health and Science University in Portland, OHSU, and others see the cause of SAD as a misalignment of the sleep-wake phase contra the period of the body clock, circadian rhythms out of sync, and treat it with melatonin in the afternoon. Correctly timed melatonin administration shifts the rhythms of several hormones en bloc.[12] Throughout the world Winter depression (or winter blues) is a common slump in the mood of Scandinavians. Doctors estimate that about 20% of all Scandinavians are affected, and it seems to be genetically heritable.[citation needed] It was first described by the 6th century Goth scholar Jordanes in his Getica wherein he described the inhabitants of Scandza (Scandinavia).[13] [edit] Iceland A study of more than 2000 people in Iceland found the prevalence of seasonal affective disorder and seasonal changes in anxiety and depression to be unexpectedly low in both sexes.[14] The study's authors suggested that propensity for SAD may differ due to some genetic factor within the Icelandic population. A study of Canadians of wholly Icelandic descent also showed low levels of SAD.[15] In the United States, a diagnosis of seasonal affective disorder was first proposed by Norman E. Rosenthal, MD in 1984. Rosenthal wondered why he became sluggish during the winter after moving from sunny South Africa to New York. He started experimenting increasing exposure to artificial light, and found this made a difference. In Alaska it has been established that there is a SAD rate of 8.9%, and an even greater rate of 24.9%[16] for subsyndromal SAD. [edit] Ireland Around one Irish person in five is affected by SAD, according to a survey conducted in 2007. The survey also shows women are more likely to be affected by SAD than men. [17] [edit] SAD and bipolar disorder Most people with SAD experience unipolar depression, but as many as 20% may have or go on to develop a bipolar or manic-depressive disorder.[18] In these cases, persons with SAD may experience depression during the winter and hypomania in the summer. Famous sufferers [edit] See also References
  1. ^ Seasonal Affective Disorder by Mayo Clinic
  2. ^ a b c d e f Lam, RW; Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, Tam EM (2006). "The Can-SAD Study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder". American Journal of Psychiatry 163 (5). PMID 16648320. Retrieved on 2007-05-12. 
  3. ^ a b c d e f Avery, D H; Eder DN, Bolte MA, Hellekson CJ, Dunner DL, Vitiello MV, Prinz PN (2001). "Dawn simulation and bright light in the treatment of SAD: a controlled study". Biological Psychiatry 50 (3): 205-216. PMID 11513820. Retrieved on 2007-05-05. 
  4. ^ a b c d Modell, Jack; Rosenthal NE, Harriett AE, Krishen A, Asgharian A, Foster VJ, Metz A, Rockett CB, Wightman DS (2005). "Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL Biological Psychiatry" 58 (8): 658-667. PMID 16271314. 
  5. ^ Johansson, C; Smedh C, Partonen T, Pekkarinen P, Paunio T, Ekholm J, Peltonen L,Lichtermann D, Palmgren J, Adolfsson R, Schalling M (2001). "Seasonal affective disorder and serotonin-related polymorphisms". Neurobiology of Disease 8 (2): 351-357. PMID 11300730. Retrieved on 2007-05-05. 
  6. ^ Johansson, C; Willeit M, Levitan R, Partonen T, Smedh C, Del Favero J, Bel Kacem S, Praschak-Rieder N,Neumeister A, Masellis M, Basile V, Zill P, Bondy B, Paunio T, Kasper S, Van Broeckhoven C, Nilsson LG,Lam R, Schalling M, Adolfsson R. (2003). "The serotonin transporter promoter repeat length polymorphism, seasonal affective disorder and seasonality". Psychological Medicine 33 (5): 785-792. PMID 12877393. Retrieved on 2007-05-05. 
  7. ^ Uz, T; Manev, H (2001). "Prolonged swim-test immobility of serotonin N-acetyltransferase (AANAT)-mutant mice". Journal of Pineal Research 30: 166-170. PMID 11316327. 
  8. ^ a b c Avery, D. H.; Kizer D, Bolte MA, Hellekson C (2001). "Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure". Acta Psychiatrica Scandinavica 103 (4): 267-274. PMID 11328240. Retrieved on 2007-05-12. 
  9. ^ Leppämäki, Sami; Haukka J, Lonnqvist J, Partonen T (2004). "Drop-out and mood improvement: a randomised controlled trial with light exposure and physical exercise". BMC Psychiatry 4 (22). PMID 15306031. Retrieved on 2007-05-12. 
  10. ^ a b Terman, M.; Terman, J.S. (2006). "Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder". American Journal of Psychiatry 163 (12): 2126-2133. 17151164. Retrieved on 2007-05-12. 
  11. ^ Moscovitch, A; Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S, Lane RM (2004). "A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder". Psychopharmacology 171: 390-397. Retrieved on 2007-05-12. 
  12. ^ Bhattacharjee, Yudhijit (14 September 2007). "Is Internal Timing Key to Mental Health?" (PDF). ScienceMag 317: 1488-90. AAAS. Retrieved on 2008-02-18. 
  13. ^ Jordanes, Getica, ed. Mommsen, Mon. Germanae historica, V, Berlin, 1882.
  14. ^ Magnusson, Andres; Axelsson, Johann; Karlsson, Mikael M.; Oskarsson, Högni (February 2000). "Lack of Seasonal Mood Change in the Icelandic Population: Results of a Cross-Sectional Study". Am J Psychiatry 157: 234-238. American Psychiatric Association. Retrieved on 2007-11-27. 
  15. ^ Magnússon A, Axelsson J (1993). "The prevalence of seasonal affective disorder is low among descendants of Icelandic emigrants in Canada". Arch. Gen. Psychiatry 50 (12): 947–51. PMID 8250680. 
  16. ^ Seasonal Affective Disorder and Latitude
  17. ^ BreakingNews.ie - One in five suffers from SAD
  18. ^ SAD and depression
  19. ^ Interview with Natalie Imbruglia 17th June 2005
  20. ^ Andromeda Spaceways interview with Barbara Hambly, discusses SAD
[edit] External links Seasonal Affective Disorder - The Basics