What is seasonal
affective disorder?
Seasonal affective disorder is a major
(serious) form of depression that occurs at the same
time each year. Researchers have identified two types
of SAD. The most common type, known as "winter depression,"
usually begins in the late fall to early winter months
and ends in spring. Seasonal affective disorder can
also occur in the summer (known as "summer depression").
Surveys estimate that 4 to 6 percent of
the general population experience SAD. Women with SAD
outnumber men four to one. The disorder usually begins
in person's early twenties and the risk for developing
SAD decreases with age (Saeed and Bruce).
What are the
symptoms of seasonal affective disorder?
People who suffer from SAD can have the
common symptoms of depression such as sadness, anxiety,
lost of interest in usual activities, withdrawal from
social activities, and an inability to concentrate.
Symptoms most common to winter depression include:
Increased sleep
Increased appetite W
eight gain " Irritability
Interpersonal difficulties (especially feelings of rejection)
A heavy leaden feeling in the arms and legs
How is seasonal
affective disorder diagnosed?
Physicians can diagnose SAD based on criteria
(a set of standards) developed by the American Psychiatric
Association. Your physician can determine if you are
suffering from depression and if this depression is
a seasonal affective disorder. Tables 1 and 2 below
list the criteria used for diagnosing a depressive episode
and SAD.
What causes SAD?
The exact cause of SAD is unknown, but
researchers suspect changes in the availability of sunlight
plays an important role. Statistics show that winter
depression becomes increasingly more common the farther
people live north or south of the equator. Episodes
of winter depression also tend to be longer and more
severe at higher latitudes (Saeed and Bruce).
How is seasonal
affective disorder different from the "holiday blues?
Many people use the expression "holiday
blues" to refer to a sadness or depression occurring
during winter or the holiday season. This term should
be differentiated from SAD. The holiday blues are related
to psychosocial factors such as increased family obligations,
isolation, decreased exercise, expectations that one
"should" feel good, or association of the holidays with
early memories and possible unresolved childhood conflicts.
In contrast, SAD is a subtype of a major depressive
disorder (or bipolar disorder) with seasonal patterns
and appears to be more biological in origin. (Rosenthal).
How is winter
depression treated?
Research now shows that light therapy,
or exposure to light, is an effective treatment for
winter depression. Light therapy is administered by
a 10,000-lux light box, which contains white fluorescent
light tubes covered with a plastic screen that blocks
ultraviolet rays. Full-spectrum light is not necessary
(Saeed and Bruce). The patient sits in front of the
box with his or her eyes open, but should not look directly
into the light. The therapy begins with daily sessions
of 10 to 15 minutes, which are gradually increased to
30 to 45 minute sessions. Ninety minutes of exposure
per day is often prescribed. The therapy typically continues
until spring.
When should light
therapy by prescribed?
Circumstances supporting the first-line
use of light therapy5 " The patient is not severely
suicidal. " There are medical reasons to avoid the use
of antidepressants. " Patient has no history of significant
negative effects to light therapy. " The patient requests
light therapy. " An experienced practitioner deems that
light therapy is indicated.
How soon does
light therapy work?
Most people notice improvement in 2 to
4 days. In some cases, symptoms may not improve for
several weeks. If symptoms are worsening or do not improve
after 4 to 6 weeks of therapy, see your physician. You
may require a change in treatment. "
What other forms
of treatment are available?
Treatments that may be helpful for SAD
but require further testing include: " Medications (fluoxetine,
propranolol, d-fenfluramine, moclobemide, tranylcypromine,
bupropion and others) Counseling (especially interpersonal
psychotherapy and cognitive therapy)
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