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In their study recently published in the journal, it show that Seasonal
affective disorder (SAD) describes a subtype of major depression which has
a seasonal pattern. A common approach is to treat the condition as for non
-seasonal depression, for example, using SSRI antidepressants and/or
cognitive behavioural therapy (CBT). Light therapy has been suggested for
treating people with SAD. People with more severe symptoms should be
treated with antidepressant drugs, with or without light therapy and/or
CBT. For prevention of subsequent episodes, there is limited evidence for
a benefit of CBT or bupropion (an unlicensed indication in the UK).
Throughout the centuries, poets have described a sense of sadness, loss
and lethargy which can accompany the shortening days of fall and winter.
Many cultures and religions have winter festivals associated with candles
or fire. Many of us notice tiredness, a bit of weight gain, difficulty
getting out of bed and bouts of "the blues" as fall turns to winter.
However some people experience an exaggerated form of these symptoms.
Their depression and lack of energy become debilitating. Work and
relationships suffer. The typical symptoms of SAD include begin in the
fall, peak in the winter and usually resolve in the spring. Some
individuals experience great bursts of energy and creativity in the spring
or early summer. Susceptible individuals who work in buildings without
windows may experience SAD-type symptoms at any time of year. If the
symptoms are mild, no treatment may be necessary. If they are problematic,
then a mood stabilizer such as Lithium might be considered. There is a
smaller group of individuals who suffer from summer depression. Some
people with winter depression also have mild or occasionally severe manic
mood swings in the spring and summer. If these episodes are severe, the
individual might be diagnosed with Bipolar Disorder. About 70-80% of those
with SAD are women. The most common age of onset is in one's thirties. The
incidence of SAD increases with increasing latitude up to a point, but
does not continue increasing all the way to the poles. Some very sensitive
individuals may note changes in mood during long stretches of cloudy
weather. In 1984, a psychiatrist at NIMH, Norman Rosenthal, published a
paper on the use of bright light therapy in patients with this disorder.
Since then, a large number of well-designed studies have confirmed and
refined these findings. Researchers are still investigating mode by which
bright light can lift depression or reset a sleep cycle. One theory is
that an area of the brain, near the visual pathway, the suprachiasmatic
nucleus responds to light by sending out a signal to suppress the
secretion of a hormone called melatonin. Brain studies suggest that there
is impairment serotonin function in neurons leading to the suprachiasmatic
nucleus. Initial theories suggested a pathway from the retina to the
suprachiasmatic nucleus. However some recent research indicated that
bright light applied to the back of an individual's knee could shift human
circadian rhythms. Since one of the symptoms of SAD can be difficulty
awakening in the morning, some find it helpful to have the light turn on
just before they are supposed to wake up. Some individuals like to use a
Dawn Simulator. This is a bright light that is programmed to gradually
increase its intensity such that it reaches its full intensity a set
period before the individual is scheduled to awaken. Although it is less
gentle, some people will put their light box beside their bed and hook it
up to a timer set to turn on shortly before awakening.
Other treatments--
Outdoor light, even when the sky is overcast, provides as much or more
light than a light box. There has been a study showing improvement in SAD
symptoms when individuals took a one-hour daily walk outside. Outside
light is often brighter than the light boxes. Spending an hour outside
each day can often produce beneficial results in some individuals.
However, one cannot get early morning outside light in the winter. Not
everyone's job will allow for an hour-long outside walk. Only highly
motivated people will continue their daily walk when it the rains or
snows. SSRI have been shown to be effective in SAD . Some people prefer to
take a pill because it is less time consuming than sitting in front of a
light box. Some individuals need a combination of light therapy,
medication, and psychotherapy.
For those with winter depression and spring-summer mania, a mood
stabilizer such as Lithium may be useful. Daily exercise has been shown to
be helpful, particularly when done outdoors.
For those who tend to crave sweets during the winter, eating a
balanced diet may help one's mood. Psychotherapy can help the depressed
individual look at her depressive assumptions and negative expectations.
It can also help one identify relationship difficulties so that
interpersonal mistakes might not be repeated.
Some individuals continue to have a certain amount of energy
fluctuation with the seasons. If one is aware of this, one can plan for it
and work the expected fluctuations into one's life plans.
References:
Seasonal Affective Disorder and Phototherapy edited by Rosenthal and
Blehar 1989 Guilford Press
Management of seasonal affective disorder
Dear Editor,
In their study recently published in the journal, it show that Seasonal
affective disorder (SAD) describes a subtype of major depression which has
a seasonal pattern. A common approach is to treat the condition as for non
-seasonal depression, for example, using SSRI antidepressants and/or
cognitive behavioural therapy (CBT). Light therapy has been suggested for
treating people with SAD. People with more severe symptoms should be
treated with antidepressant drugs, with or without light therapy and/or
CBT. For prevention of subsequent episodes, there is limited evidence for
a benefit of CBT or bupropion (an unlicensed indication in the UK).
Throughout the centuries, poets have described a sense of sadness, loss
and lethargy which can accompany the shortening days of fall and winter.
Many cultures and religions have winter festivals associated with candles
or fire. Many of us notice tiredness, a bit of weight gain, difficulty
getting out of bed and bouts of "the blues" as fall turns to winter.
However some people experience an exaggerated form of these symptoms.
Their depression and lack of energy become debilitating. Work and
relationships suffer. The typical symptoms of SAD include begin in the
fall, peak in the winter and usually resolve in the spring. Some
individuals experience great bursts of energy and creativity in the spring
or early summer. Susceptible individuals who work in buildings without
windows may experience SAD-type symptoms at any time of year. If the
symptoms are mild, no treatment may be necessary. If they are problematic,
then a mood stabilizer such as Lithium might be considered. There is a
smaller group of individuals who suffer from summer depression. Some
people with winter depression also have mild or occasionally severe manic
mood swings in the spring and summer. If these episodes are severe, the
individual might be diagnosed with Bipolar Disorder. About 70-80% of those
with SAD are women. The most common age of onset is in one's thirties. The
incidence of SAD increases with increasing latitude up to a point, but
does not continue increasing all the way to the poles. Some very sensitive
individuals may note changes in mood during long stretches of cloudy
weather. In 1984, a psychiatrist at NIMH, Norman Rosenthal, published a
paper on the use of bright light therapy in patients with this disorder.
Since then, a large number of well-designed studies have confirmed and
refined these findings. Researchers are still investigating mode by which
bright light can lift depression or reset a sleep cycle. One theory is
that an area of the brain, near the visual pathway, the suprachiasmatic
nucleus responds to light by sending out a signal to suppress the
secretion of a hormone called melatonin. Brain studies suggest that there
is impairment serotonin function in neurons leading to the suprachiasmatic
nucleus. Initial theories suggested a pathway from the retina to the
suprachiasmatic nucleus. However some recent research indicated that
bright light applied to the back of an individual's knee could shift human
circadian rhythms. Since one of the symptoms of SAD can be difficulty
awakening in the morning, some find it helpful to have the light turn on
just before they are supposed to wake up. Some individuals like to use a
Dawn Simulator. This is a bright light that is programmed to gradually
increase its intensity such that it reaches its full intensity a set
period before the individual is scheduled to awaken. Although it is less
gentle, some people will put their light box beside their bed and hook it
up to a timer set to turn on shortly before awakening.
Other treatments--
Outdoor light, even when the sky is overcast, provides as much or more
light than a light box. There has been a study showing improvement in SAD
symptoms when individuals took a one-hour daily walk outside. Outside
light is often brighter than the light boxes. Spending an hour outside
each day can often produce beneficial results in some individuals.
However, one cannot get early morning outside light in the winter. Not
everyone's job will allow for an hour-long outside walk. Only highly
motivated people will continue their daily walk when it the rains or
snows. SSRI have been shown to be effective in SAD . Some people prefer to
take a pill because it is less time consuming than sitting in front of a
light box. Some individuals need a combination of light therapy,
medication, and psychotherapy.
For those with winter depression and spring-summer mania, a mood
stabilizer such as Lithium may be useful. Daily exercise has been shown to
be helpful, particularly when done outdoors.
For those who tend to crave sweets during the winter, eating a
balanced diet may help one's mood. Psychotherapy can help the depressed
individual look at her depressive assumptions and negative expectations.
It can also help one identify relationship difficulties so that
interpersonal mistakes might not be repeated.
Some individuals continue to have a certain amount of energy
fluctuation with the seasons. If one is aware of this, one can plan for it
and work the expected fluctuations into one's life plans.
References:
Seasonal Affective Disorder and Phototherapy edited by Rosenthal and
Blehar 1989 Guilford Press
Competing interests:
None declared
Competing interests: No competing interests