Psychology
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a type of depression that occurs at a specific time of year, usually in the winter months when daylight hours are shorter. Symptoms may include low energy, oversleeping, weight gain, and feelings of hopelessness. Light therapy, counseling, and medication are common treatments for SAD.
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11 Key excerpts on "Seasonal Affective Disorder"
eBook - ePub- Thomas E Schlaepfer, Charles B. Nemeroff(Authors)
- 2012(Publication Date)
- Elsevier(Publisher)
Handbook of Clinical Neurology , Vol. 106, No. Suppl (C), 2012ISSN: 0072-9752doi: 10.1016/B978-0-444-52002-9.00017-6Chapter 17 Seasonal Affective DisorderKonstantin V. Danilenko1 * , Robert D. Levitan21 Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia2 Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada* Correspondence to: K.V. Danilenko, MD, Institute of Internal Medicine SB RAMS, Bogatkova 175/1, Novosibirsk 630089, Russia. Tel/fax: 007 383 2642516,E-mail address: [email protected]Definition, symptoms, and clinical course
Seasonal Affective Disorder (SAD) was originally defined in 1984 as “recurrent depressions that occur annually at the same time each year” (Rosenthal et al., 1984 ). Since that time, the term “SAD” has become virtually synonymous with “winter depression” as the vast majority of seasonal depressions occur in the fall/winter period. The current Diagnostic and Statistical Manual of Mental Disorders , 4th edition, text revision (DSM-IV-TR) classification system considers seasonality as an episode specifier for recurrent major depression (American Psychiatric Association, 2000 ; Table 17.1 ); the International Statistical Classification of Diseases and Related Health Problems , 10th revision (ICD-10: World Health Organization, 1993 ) also gives provisional criteria for SAD.Table 17.1 Criteria for major depressive disorder with a seasonal pattern (equivalent to Seasonal Affective Disorder) (can be applied to the pattern of major depressive episode in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent)A. There has been a regular temporal relationship between the onset of major depressive episodes and a particular time of the year (e.g., regular appearance of the major depressive episode in the fall or winter). Note: do not include cases in which there is an obvious effect of seasonal-related psychosocial stressors (e.g., regularly being unemployed every winter)
eBook - PDFEncyclopedia of Emotion
[2 volumes]
- Gretchen M. Reevy(Author)
- 2010(Publication Date)
- Greenwood(Publisher)
518 Seasonal Affective Disorder sudden death in apparently healthy young people. SAD diagnoses are usually made by qualified health professionals using criteria from the Diagnostic and Statistical Man- ual of Mental Disorder ( DSM-IV-TR; American Psychiatric Association, 2000). Most episodes begin in fall or winter and remit (go away) in the spring. According to the DSM-IV-TR, SAD involves a pattern of seasonal onset of at least two depressive epi- sodes with remissions, and no nonseasonal depressive episodes, that have occurred during the past two years. Also, seasonal depressive episodes must outnumber non- seasonal episodes over the person’s lifetime. With SAD, seasonal depression cannot be better explained by psychosocial stressors such as unemployment during the winter months or a seasonal school schedule (American Psychiatric Association, 2000). SAD can range from mild dysphoria (feeling unwell or unhappy) to severe depression. In addition to sadness or depressed mood, SAD symptoms include lack of energy, hy- persomnia (sleeping a lot), overeating, weight gain, and carbohydrate cravings. Major depressive disorder or bipolar episodes (usually bipolar II) may be seasonal in nature. There are high rates of SAD among adults with attention-deficit hyperactivity dis- order (ADHD; Rybak, McNeely, Mackenzie, Jain, & Levitan, 2007). If an individual has seasonal bipolar disorder, full-spectrum light therapy (phototherapy) may cause switching to manic or hypomanic episodes. SAD occurs more frequently in women and at higher latitudes (closer to the North Pole). Winter depressive episodes occur more in younger people. SAD is also seen in individuals who work at night or do shift work, and in areas with significant cloud cover or pollution that blocks out sunlight (Preston, O’Neal, & Talaga, 2008). SAD is thought to occur by lack of exposure to bright light, and because of deficits of the neurotransmitter (chemical messenger) serotonin.
- Charles B. Nemeroff, Alan F. Schatzberg, Natalie Rasgon, Stephen M. Strakowski, Charles B. Nemeroff, Alan F. Schatzberg, Natalie Rasgon, Stephen M. Strakowski(Authors)
- 2022(Publication Date)
- American Psychiatric Association Publishing(Publisher)
631PART VIISubtypes of Mood Disorders
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633CHAPTER 34
Seasonal Affective Disorder and Light Therapy
Norman E. Rosenthal, M.D. Dan A. Oren, M.D.Seasonal Affective Disorder (SAD) was first described in the mid-1980s (Rosenthal et al. 1984). Patients with SAD report a close relationship between their mood changes and the changing seasons. Typically, depressive episodes occur regularly in autumn and winter and respond when patients with SAD are exposed to bright environmental light. Later, a summer version of SAD was described by two groups (Boyce and Parker 1988;Wehr et al. 1991). In this chapter, the term SAD is used to describe winter SAD, and the summer version is referred to as summer SAD . We also discuss a milder version of SAD, often termed subsyndromal SAD (Kasper et al. 1989a). This condition is also known as “winter blues.” We deal with the clinical and epidemiological features of SAD in adults, children, and adolescents and its treatments.Bright light therapy (BLT), which is a first-line treatment for SAD (Lam and Levitt 1999), has also been found to be useful for nonseasonal depression (Golden et al. 2005), including major depressive disorder (MDD) and bipolar depression (Lam et al. 2016). We discuss the use of BLT for these conditions.Diagnosis of Seasonal Affective Disorder
Shortly after SAD was defined, the diagnosis entered the next edition of DSM, DSM-III-R (American Psychiatric Association 1987), as MDD “with seasonal pattern,” an adjectival modifier designed to enable seasonality to be incorporated alongside any recurrent mood disorder. “Seasonal pattern” has not been enthusiastically embraced by the field, which has generally preferred the diagnosis of SAD, as have those diagnosed with the condition. Nevertheless, the adjectival modifier has proven extremely durable among classifying committees, which have passed it down from one generation to the next despite vigorous arguments to the contrary (Rosenthal 2009). The original criteria for SAD are shown in Table 34–1 alongside the DSM-5 (American Psychiatric Association 2013
- Karen J. Carlson M.D., Stephanie A. Eisenstat M.D., Terra Ziporyn Ph.D., Karen J. Carlson, Stephanie A. Eisenstat, Terra Diane Ziporyn(Authors)
- 2007(Publication Date)
- Harvard University Press(Publisher)
Because until recently the timing of symptoms was not a standard way of differentiating one disease from another, many people with SAD were misdiagnosed as suffering from other condi-tions. Many of the symptoms of SAD are similar to those of depression or hypothyroidism—except that they occur only during the fall and winter. These include fatigue, a tendency to sleep more, irritability, poor concentration, apathy, crying spells, a desire to withdraw from social contacts, and a change in eating habits—in particular, irresist-ible cravings for carbohydrates. It is typical for people with SAD to gain about 10 pounds every winter and then to lose weight with ease every spring. Other people with SAD suffer from headaches, leth-argy, and restless sleep. Seasonal Affective Disorder 19 g How is the condition evaluated? SAD is essentially a diagnosis of exclusion. This means that it is diagnosed only after a psychiatric evaluation reveals no other obvi-ous psychological, emotional, or social factors that might account for the symptoms. To be diagnosed with SAD a person must have had at least one major depression or a history of at least two con-secutive fall-winter depressions. g How is SAD treated? Recently there has been a great deal of success treating SAD with light therapy (phototherapy). This is based on the theory that light suppresses the secretion of melatonin—and that people with SAD may develop symptoms because of diminished exposure to light. The simplest form of phototherapy is a temporary relocation to the tropics, but of course this is not always practical. Instead, most people undergoing phototherapy bask in the artificial light from one of various devices called light boxes. These boxes, some of which are portable, rest on tables or desks and emit a broad spectrum of fluo-rescent light that is 5 to 20 times brighter than ordinary indoor lighting and is free of ultraviolet rays.
eBook - ePub- Trevor Harley(Author)
- 2018(Publication Date)
- Routledge(Publisher)
2Weather and HealthSeasonal Affective Disorder
The study of the relationship between weather and health is called biometeorology . While some effects are on reflection very plausible, others are rather more surprising, and the underlying mechanics of the link are sometimes poorly understood. In extreme cases lack of sunshine can lead to clinical depression, a disorder known as Seasonal Affective Disorder (SAD). SAD is marked by symptoms of clinical depression occurring in late autumn and winter, and normal or even slightly elevated mood (known as hypomania ) in spring and summer. SAD sufferers may also show extreme fatigue, extra sleepiness and difficulty waking, and weight gain in winter, symptoms not typically associated with non-seasonal depression. Low mood can be accompanied by several other characteristics, such as an increased need for sleep, carbohydrate craving, and a noticeable decrement in cognitive performance. It’s estimated that 5% of Americans may suffer from SAD; SAD is four times more in common in women than men, particularly in women of child-bearing age, and people typically start suffering in early adulthood, although children can be affected.Naturally sunshine is more likely to be lacking in winter, when because of the tilt of the earth on its axis days are shorter in the northern hemisphere, and get shorter the further north you go. Daylight is at its shortest on the winter solstice, which in the northern hemisphere is around 21 December. In Casablanca on that day sunrise is at 7:30 and sunset is at 17:26; in London the figures are 8:03 and 15:53; in my hometown of Dundee it is 8:44 and 15:35; but in somewhere like Tromsø, Norway, which is north of the Arctic Circle, there is no daylight at all (and in fact there isn’t any between 28 November and 15 January). In northern latitudes even if there is sun in principle it might be greatly reduced by hills.
- Nicoladie Tam(Author)
- 0(Publication Date)
- Nicoladie Tam, Ph.D.(Publisher)
Mania is the opposite of depression. Depression is characterized by the dysphoric mood state whereas mania is characterized by the euphoric mood state. Manic phase is the frantic state of mind that is highly motivated to do something to stimulate the brain, except that these activities are high-risk behaviors that often lead to dire consequences.What is Seasonal Affective Disorder (SAD)? Seasonal Affective Disorder (SAD) is a depressive state with the onset of depression correlated with the season (often during the winter with lesser amount of daylight). SAD is commonly called the “winter blues.” It is the depressive state caused by the reduced exposure to sunlight during the winter, when the daylight hours are significantly reduced. The depressive state is biologically related to the amount of daylight experienced. People living in the arctic zone or in cloudy cities are more likely to develop SAD.The pineal gland is regulates the seasonal changes in behaviors in most animals, such as migration, based on the averaged amount of daylight. Pineal gland also regulates the amount of sleep of an animal by releasing the hormone, melatonin. Evolutionary, pineal gland is the “third eye” of an animal, with visual pathways to sense the amount of light sensed by an animal (rather than using it as vision).The amount of daylight exposure in diurnal animals is the stimulus for migration in the migratory animals. Thus, animal’s activities are regulated by daylight exposure. What are the causes of SAD? SAD is caused by the reduced exposure to daylight.Most terrestrial diurnal animals are evolved to regulate their activities by the daylight cycle. They are stimulated by the light, as opposed to nocturnal animals, which are stimulated by the darkness. Without sufficient light cues, diurnal animals can get depressed.
eBook - ePub- Constance Hammen, Ed Watkins(Authors)
- 2018(Publication Date)
- Routledge(Publisher)
As the days become shorter and the weather cold and gloomy, her spirits sink. She becomes more and more lethargic, going to bed a bit earlier each night and having trouble getting up in the dark mornings. In contrast to her summer favourites of fruits and vegetables, she finds herself eating heavier foods, with a special interest in rich, thick sauces, oily meats, breads and pastries of any kind. Often, by December she slips into a depressive episode, marked by low energy and inactivity – with sleeping and eating representing her main enjoyments. Although she believes that she will never feel good again and sometimes finds herself wishing for death, she has learned that by March or April she begins to emerge from her gloom and return to her normal life. Seasonal pattern depressions refer to those that have an apparent regular onset during certain times of the year, and which also disappear at a characteristic time of the year. In the Northern hemisphere, the most common pattern is autumn or winter depressions, remitting in the spring. Depression with a seasonal pattern, also known as Seasonal Affective Disorder (SAD) (Rosenthal et al., 1984), which has a prevalence of approximately 2 per cent in temperate climates, demonstrates some stability in presentation across time and is more common in women (Pjrek et al., 2016; Steinhausen, Gundelfinger and Metzke, 2009). Such depressive episodes are especially marked by low energy, more sleeping, overeating and weight gain, and craving for carbohydrate foods (Jacobsen, Wehr, Sack, James and Rosenthal, 1987). A recent long-term prospective study indicated that a seasonal pattern toward a small increase in depressive symptom burden in the months surrounding the winter solstice (e.g., December–February) was found in a sample of individuals with major depression, suggesting a continuum in seasonal affective response, with individuals with SAD at one extreme (Cobb et al., 2014)
eBook - ePubClinical Psychology
An Introduction
- Alan Carr(Author)
- 2012(Publication Date)
- Routledge(Publisher)
For a subgroup of people who suffer from depression, deficits in visually processing light and the season of the year are risk factors for depression (Rosenthal, 2009). These people, who experience regularly recurring depressive episodes in the autumn and winter, with remission in the spring and summer, are said to have Seasonal Affective Disorder. They develop symptoms in the absence of adequate light and respond favourably to enhanced environmental lighting, often referred to as ‘light therapy’ (Golden et al., 2005).In community samples about 3.4% of people with a major depressive disorder commit suicide; the rate in clinical samples is about 15%; and about 60% of completed suicides (studied by psychological autopsy) are depressed (Berman, 2009).Aetiological theories
Theoretical explanations for depression and related treatments have been developed within biological, psychoanalytic, cognitive-behavioural and family systems traditions. Much research on depression has been guided by these theories. In addition, research on depression has been informed by psychological constructs such as stress, temperament, personality traits, cognitive biases, coping strategies and interpersonal styles. A number of influential theories, hypotheses and related treatments and research findings from these areas will be briefly reviewed below.Biological theories
Biological theories of depression point to the role of genetic factors in rendering people vulnerable to the development of mood disorders, and to the role of structural and functional brain abnormalities; dsysregulation of neurotransmitter, neuroendocrine and immune systems; and sleep architecture and circadian rhythm abnormalities in the aetiology of depression. There is considerable support for biological theories from neuroimaging, pharmacological, psychophysiological and other neuro-biological studies, although current knowledge of these abnormalities is incomplete (Davidson et al., 2009; Hamilton et al., 2011; Levinson, 2009; Sullivan et al., 2000; Thase, 2009). However, there is a consensus about certain aspects of the neurobiology of depression which will be presented below.
- Joseph E. Pizzorno, Michael T. Murray, Herb Joiner-Bey(Authors)
- 2016(Publication Date)
- Churchill Livingstone(Publisher)
• Lessened productivity • Difficulty in concentrating or making decisionsManic phase:• Mood typically elation, but irritability and hostility not uncommon• Signs and symptoms: inflated self-esteem, grandiose delusions, boasting, racing thoughts, decreased need for sleep, psychomotor acceleration, weight loss from increased activity and lack of attention to dietary habitsSeasonal Affective Disorder (SAD): regularly occurring winter depression frequently associated with summer hypomaniaAffective disorders are mood disturbances; mood with prolonged emotional tone dominating outlook; transient moods (e.g., sadness, grief, elation) are part of daily life—demarcation of “pathologic” difficult to determine; depression and mania, alone or in alternation, are the most common disorders, and depression alone is much more common; unipolar is depression alone; bipolar is either mania alone or mania alternating with depression.Eight factors modify functional state of brain and affect mood and behavior:• Genetic inheritance • Age of neuronal development (age-specific variability) • Functional plasticity of brain during development • Motivational state affected by biologic drives, channeling behavior toward goals by priorities or prejudicing context of incoming information • Memory-stored information and processing strategies • Environment that adjusts incoming input according to momentary significance
eBook - ePubMelatonin
Biosynthesis, Physiological Effects, and Clinical Applications
- Hing-Sing Yu, Russel J. Reiter(Authors)
- 2020(Publication Date)
- CRC Press(Publisher)
Chapter 19PHOTOTHERAPY AND MELATONIN IN RELATION TO Seasonal Affective Disorder AND DEPRESSION
Björn-Erik Thalén, Bengt Kjellman, and Lennart Wetterberg
TABLE OF CONTENTSI. Introduction II. Melatonin and Depression III. Melatonin and Seasonal Affective Disorders (SAD) IV. Suppression of Melatonin by Light V. Melatonin and Light Test VI. Melatonin and Premenstrual Syndrome VII. Nightly Melatonin Secretion in Patients with Winter Depression and Its Relation to the Outcome of Light Therapy VIII. Conclusions References I. INTRODUCTION
Sunlight strongly influences circadian rhythms of most living beings with an active phase during the day and one of rest during the night. The light which enters the eye affects man visually as well as nonvisually. Poor lighting conditions at work can result in complaints of ocular fatigue and reduced visual acuity, but it has not been equally apparent that the nonvisual effects of light are also important for health and well being.Light treatment in depression hypothetically rests on the effects that changes in light-darkness have on neural structures which generate and regulate biological rhythms of varying frequencies. The system that generates the diurnal rhythms of melatonin includes signal transmission of light impulses via the retina to the hypothalamus and via the superior cervical ganglia (SCG) to the pineal gland. According to an alternative hypothesis, light induces a general increase in receptor sensitivity in the central nervous system which results in an antidepressant effect. The potential use of melatonin as a biological marker in depression is obvious since melatonin is dependent on both noradrenergic and serotoninergic transmission for its regulation. Mood swings and sleep disorders may also be related to disturbances in the function of the pineal gland and the secretion of melatonin.II. MELATONIN AND DEPRESSION
- Stephen F. Davis, William Buskist, Stephen F. Davis, William F. Buskist(Authors)
- 2007(Publication Date)
- SAGE Publications, Inc(Publisher)
Ellen exhibits symptoms of dysthymic disorder. Her symp-toms have persisted for the required two-year period. Julie’s symptoms meet the criteria for major depressive dis-order, recurrent, with seasonal pattern. (This disorder is known informally as “Seasonal Affective Disorder,” or SAD.) Debra exhibits symptoms of substance-induced mood dis-order, with mixed features. In her case, use of corticosteroids appears to have elicited the mood disturbance. Ron probably does not qualify for a mood disorder diagnosis at this time, as his symptoms appear to have arisen in response to his wife’s death. Following bereavement, an individual may develop a mood disorder. However, a mood disorder diagnosis is typically not given unless the symptoms persist for more than two months after the loss. Ron’s loss occurred six weeks ago. Further, Ron’s thoughts of death are consistent with “survivor guilt,” which is not uncommon during bereavement. Of course, his thoughts of death and his general distress would be of concern to a clinician. Despite the lack of a formal diagnosis, Ron may benefit from supportive psychotherapy. 1 Jon’s symptoms may represent mania. If his symptoms are not due to a general medical condition or due to the physiological effects of a substance, he may qualify for a diagnosis of bipolar I Disorder. Ellen exhibits symptoms of dysthymic disorder. Her symp-toms have persisted for the required two-year period. Julie’s symptoms meet the criteria for major depressive dis-order, recurrent, with seasonal pattern. (This disorder is known informally as “Seasonal Affective Disorder,” or SAD.) Debra exhibits symptoms of substance-induced mood dis-order, with mixed features. In her case, use of corticosteroids appears to have elicited the mood disturbance. Ron probably does not qualify for a mood disorder diagnosis at this time, as his symptoms appear to have arisen in response to his wife’s death. Following bereavement, an individual may develop a mood disorder.
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