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EspañolSEASONAL AFFECTIVE DISORDER
'Seasonal affective disorder', also known as 'S.A.D.', 'winter depression' or the 'winter blues' is an affective, or mood, disorder. Most SAD sufferers experience normal mental health throughout most of the year, but experience depressive symptoms in the winter or summer. The condition in the summer is often referred to as Reverse Seasonal Affective Disorder.
Seasonal mood variations are believed to be related to light because of the effectiveness of bright light therapy. The Can-SAD Study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder, , RW, Lam, American Journal of Psychiatry, 2006 It is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5% Dawn simulation and bright light in the treatment of SAD: a controlled study, , D H, Avery, Biological Psychiatry, 2001 Cloud cover may contribute to the negative effects of SAD, such as in Seattle Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL Biological Psychiatry, , Jack, Modell, , 2005
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. 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. 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).
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,[1] although this has been disputed.[2] Another theory is that melatonin produced in the pineal gland is the primary cause since there are direct connections between the retina and the pineal gland. Mice incapable of synthesizing melatonin appear to express "depression-like" behaviors, melatonin receptor ligands produce an antidepressant-like effect[3] Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% vs. 6.4% of the U.S. population. Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure, , D. H., Avery, Acta Psychiatrica Scandinavica, 2001 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. Drop-out and mood improvement: a randomised controlled trial with light exposure and physical exercise, , Sami, Leppämäki, BMC Psychiatry, 2004 Connections between human mood, as well as energy levels, and the seasons are well-documented, even in healthy individuals. Particularly in high latitudes (50°N or S) it is common for people to experience lower energy levels.
There are many different treatments for seasonal affective disorder, including light therapies, medication, and ionized-air reception. Bright light treatments are common, however as many as 19% of patients stop use because of the inconvenience. Specially designed light, many times brighter than normal office lighting, is placed near the sufferer, and has proven to be effective at doses of 2500- 10,000 lux. Most treatments use 30-60 minute treatments, however this varies depending on the situation. The sufferer should sit roughly 30 cm in front of the box with their eyes open, staring at a predetermined point. Many patients use the light box in the morning, however it has not been proven any more effective than any other time of day. Discovering the best schedule is essential because up to 69% of patients find it inconvenient. Dawn simulation has also proven to be more effective in some studies, there is an 83% better response when compared to bright light. When compared in a study to negative air ionization however, bright light was proven to be 57.1% effective vs. dawn simulation, 49.5%. Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder, , M., Terman, American Journal of Psychiatry, 2006 Patients using light therapy can experience improvement during the first week, but increased results are evident when continued throughout several weeks. 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. SSRI (selective serotonin reuptake inhibitor) antidepressants have proven effective in treating SAD. Bupropion is also effective as a prophylactic. Effective antidepressants are fluoxetine, sertraline, or paroxetine.[4] Both fluoxetine and light therapy are 67% effective in treating SAD according to direct head-to-head trials. Negative air ionization, involving the release of charged particles into the sleep environment, has also been found effective with a 47.9% improvement. Depending upon the patient, one treatment (ie. lightbox) may be used in conjunction with another therapy (ie. medication).
''Winter depression'' (or ''winter blues'') is a common slump in the mood of Scandinavians. Doctors estimate that about 20% of all Swedes are affected, and it seems to be genetically heritable. It was first described by the 6th century Goth scholar Jordanes in his ''Getica'' where he described the inhabitants of Scandza (Scandinavia).[5] There are words in Icelandic and Swedish that directly describe Seasonal Affective conditions. The Icelandic word is "skammdegisthunglyndi". "Skamm" means short, "degi" is day, "thung" is heavy and "lyndi" means mood although there is some argument as to how long the word existed as the earliest records indicate it appeared in the late 1800s in print. [6]
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 muggish 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 an SAD rate of 8.9%, and an even greater rate of 24.9%[7] for subsyndromal SAD.
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.[8] In these cases, persons with SAD may experience depression during the winter and hypomania in the summer.
★ Winston Churchill, Abraham Lincoln, and Gustav Mahler[9]
★ Natalie Imbruglia, a famous Australian singer, suffered from SAD during a longer stay in London, England.[10]
★ Science fiction-fantasy author Barbara Hambly suffered with undiagnosed SAD for many years.[11]
★ Depression (mood)
★ Circadian rhythm sleep disorder
1. Seasonal affective disorder and serotonin-related polymorphisms, , C, Johansson, Neurobiology of Disease, 2001
2. The serotonin transporter promoter repeat length polymorphism, seasonal affective disorder and seasonality, , C, Johansson, Psychological Medicine, 2003
3. Prolonged swim-test immobility of serotonin N-acetyltransferase (AANAT)-mutant mice, , T, Uz, Journal of Pineal Research, 2001
4. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder, , A, Moscovitch, Psychopharmacology, 2004
5. Jordanes, ''Getica,'' ed. Mommsen, ''Mon. Germanae historica, V,'' Berlin, 1882.
6. [1]
7. Seasonal Affective Disorder and Latitude
8. SAD and depression
9. "Winter Blues", p.294 Norman E. Rosenthal
10. Interview with Natalie Imbruglia 17th June 2005
11. Andromeda Spaceways interview with Barbara Hambly, discusses SAD
★
★ List of academic articles discussing season affective disorder
★ The Seasonal Affective Disorder Association (SADA) (UK-based charitable organisation)
★ Outside In - Information and support forum for sufferers of seasonal affective disorder
★ Getting SAD Is More Than Having The Blues
★ Seasonal Depression Can Accompany Summer Sun (about reverse-seasonal affective disorder)
| Contents |
| Pathophysiology |
| Treatment |
| Throughout the world |
| Scandinavia |
| United States |
| SAD and bipolar disorder |
| Famous sufferers |
| See also |
| References |
| External links |
| Resources |
| Organizations |
| Articles |
Pathophysiology
Seasonal mood variations are believed to be related to light because of the effectiveness of bright light therapy. The Can-SAD Study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder, , RW, Lam, American Journal of Psychiatry, 2006 It is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5% Dawn simulation and bright light in the treatment of SAD: a controlled study, , D H, Avery, Biological Psychiatry, 2001 Cloud cover may contribute to the negative effects of SAD, such as in Seattle Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL Biological Psychiatry, , Jack, Modell, , 2005
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. 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. 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).
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,[1] although this has been disputed.[2] Another theory is that melatonin produced in the pineal gland is the primary cause since there are direct connections between the retina and the pineal gland. Mice incapable of synthesizing melatonin appear to express "depression-like" behaviors, melatonin receptor ligands produce an antidepressant-like effect[3] Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% vs. 6.4% of the U.S. population. Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure, , D. H., Avery, Acta Psychiatrica Scandinavica, 2001 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. Drop-out and mood improvement: a randomised controlled trial with light exposure and physical exercise, , Sami, Leppämäki, BMC Psychiatry, 2004 Connections between human mood, as well as energy levels, and the seasons are well-documented, even in healthy individuals. Particularly in high latitudes (50°N or S) it is common for people to experience lower energy levels.
Treatment
There are many different treatments for seasonal affective disorder, including light therapies, medication, and ionized-air reception. Bright light treatments are common, however as many as 19% of patients stop use because of the inconvenience. Specially designed light, many times brighter than normal office lighting, is placed near the sufferer, and has proven to be effective at doses of 2500- 10,000 lux. Most treatments use 30-60 minute treatments, however this varies depending on the situation. The sufferer should sit roughly 30 cm in front of the box with their eyes open, staring at a predetermined point. Many patients use the light box in the morning, however it has not been proven any more effective than any other time of day. Discovering the best schedule is essential because up to 69% of patients find it inconvenient. Dawn simulation has also proven to be more effective in some studies, there is an 83% better response when compared to bright light. When compared in a study to negative air ionization however, bright light was proven to be 57.1% effective vs. dawn simulation, 49.5%. Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder, , M., Terman, American Journal of Psychiatry, 2006 Patients using light therapy can experience improvement during the first week, but increased results are evident when continued throughout several weeks. 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. SSRI (selective serotonin reuptake inhibitor) antidepressants have proven effective in treating SAD. Bupropion is also effective as a prophylactic. Effective antidepressants are fluoxetine, sertraline, or paroxetine.[4] Both fluoxetine and light therapy are 67% effective in treating SAD according to direct head-to-head trials. Negative air ionization, involving the release of charged particles into the sleep environment, has also been found effective with a 47.9% improvement. Depending upon the patient, one treatment (ie. lightbox) may be used in conjunction with another therapy (ie. medication).
Throughout the world
Scandinavia
''Winter depression'' (or ''winter blues'') is a common slump in the mood of Scandinavians. Doctors estimate that about 20% of all Swedes are affected, and it seems to be genetically heritable. It was first described by the 6th century Goth scholar Jordanes in his ''Getica'' where he described the inhabitants of Scandza (Scandinavia).[5] There are words in Icelandic and Swedish that directly describe Seasonal Affective conditions. The Icelandic word is "skammdegisthunglyndi". "Skamm" means short, "degi" is day, "thung" is heavy and "lyndi" means mood although there is some argument as to how long the word existed as the earliest records indicate it appeared in the late 1800s in print. [6]
United States
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 muggish 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 an SAD rate of 8.9%, and an even greater rate of 24.9%[7] for subsyndromal SAD.
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.[8] In these cases, persons with SAD may experience depression during the winter and hypomania in the summer.
Famous sufferers
★ Winston Churchill, Abraham Lincoln, and Gustav Mahler[9]
★ Natalie Imbruglia, a famous Australian singer, suffered from SAD during a longer stay in London, England.[10]
★ Science fiction-fantasy author Barbara Hambly suffered with undiagnosed SAD for many years.[11]
See also
★ Depression (mood)
★ Circadian rhythm sleep disorder
References
1. Seasonal affective disorder and serotonin-related polymorphisms, , C, Johansson, Neurobiology of Disease, 2001
2. The serotonin transporter promoter repeat length polymorphism, seasonal affective disorder and seasonality, , C, Johansson, Psychological Medicine, 2003
3. Prolonged swim-test immobility of serotonin N-acetyltransferase (AANAT)-mutant mice, , T, Uz, Journal of Pineal Research, 2001
4. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder, , A, Moscovitch, Psychopharmacology, 2004
5. Jordanes, ''Getica,'' ed. Mommsen, ''Mon. Germanae historica, V,'' Berlin, 1882.
6. [1]
7. Seasonal Affective Disorder and Latitude
8. SAD and depression
9. "Winter Blues", p.294 Norman E. Rosenthal
10. Interview with Natalie Imbruglia 17th June 2005
11. Andromeda Spaceways interview with Barbara Hambly, discusses SAD
External links
Resources
★
★ List of academic articles discussing season affective disorder
Organizations
★ The Seasonal Affective Disorder Association (SADA) (UK-based charitable organisation)
★ Outside In - Information and support forum for sufferers of seasonal affective disorder
Articles
★ Getting SAD Is More Than Having The Blues
★ Seasonal Depression Can Accompany Summer Sun (about reverse-seasonal affective disorder)
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