Seasonal Affective Disorder

Seasonal Affective Disorder

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The Impact of Seasonal Affective Disorder on Mental Health: Causes, Symptoms, and Treatment Options.

Causes of Seasonal Affective Disorder
What environmental or biological factors can lead to Seasonal Affective Disorder (SAD)?

Seasonal Affective Disorder (SAD) is a type of recurring major depression with a seasonal pattern [1]. It is believed to be caused by lack of daylight in winter [2]. Although the condition is seasonally limited, patients may have significant impairment from the associated depressive symptoms [3]. Further, it is a combination of biologic and mood disturbances with a seasonal pattern,occurring in the autumn and winter,and affecting around 5 percent of the U.S. population [3]. Research has suggested a combination of factors contribute to SAD [3], such as variations in the 5-HTR2A gene [4], environmental factors like latitude and temperature,reduced exposure to sunlight,melatonin levels and serotonin levels [1], circadian phase delay and advance,retinal sensitivity to light,neurotransmitter dysfunction,genetic variations affecting circadian rhythms [3], and difficulty in regulating serotonin [1]. Although the pathophysiological mechanism(s) of SAD remain(s) largely unknown,it has been found that several hypotheses have been put forth to explain the mechanism of light for SAD [4]. Moreover, SAD is more common in individuals with a family history of depression, bipolar disorder, or SAD,women,and those who live far from the equator [1]. Large population studies from northern Norway do not point to a higher prevalence of depression in winter than expected in any other general population [2].

What are the differences in SAD prevalence between different populations and seasons?

A study conducted by the Canadian Journal of Psychiatry observed the impact of latitude on SAD prevalence [2]. The results of this study revealed that there were distinct differences in the prevalence of SAD between different populations and seasons [2]. The researchers examined the percentage of the patient population that suffered from SAD in any one month [4]. The results further indicated that the prevalence of SAD had a high negative correlation (-0.94) with the length of the photoperiod [4]. This observation supports the photoperiod model for SAD, which proposes that shorter days and fewer hours of sunlight in winter trigger this disorder in vulnerable individuals [4]. Consequently, these findings suggest that environmental factors like latitude and temperature could play a role in the development of SAD [2]. However, the text does not provide any information about the differences in SAD prevalence between different populations and seasons [4].

Are there any lifestyle factors that can increase the risk of developing SAD?

While the exact cause of Seasonal Affective Disorder (SAD) remains unknown, researchers have identified several contributing factors [5], with light exposure being one of the most prominent ones [1]. The photoperiod model suggests that changes in the amount of available daylight influence the prevalence of SAD, and this was well supported by the findings of the Canadian Journal of Psychiatry study [4]. Furthermore, the study also discovered a high rate of bipolar affective disorder among the population [6]. It has been theorized that melatonin, a hormone that influences our sleep-wake cycles [7], could be responsible for the seasonal changes in humans [8]. However, it is uncertain whether this hormone is directly related to SAD [2]. Treatments such as light therapy, pharmacotherapy and psychotherapy are used to alleviate the symptoms of SAD [3], and these may be complemented by lifestyle changes such as regular outdoor exercise and healthy eating habits. These measures can help reduce the risk of developing SAD in individuals [9]; however, further research is needed to investigate all the lifestyle factors that may increase the risk of SAD.

Symptoms and Treatment Options for Seasonal Affective Disorder
What are the common symptoms of SAD?

Seasonal Affective Disorder (SAD) is a type of depression that is related to changes in season. It typically starts in the fall and continues into the winter months [1]. People with SAD usually experience a decrease in activity levels, social withdrawal, weight gain due to overeating, tiredness and lethargy, difficulty concentrating, a desire to sleep more than normal, sad mood, low energy, frequent crying, craving for carbohydrates and sugars.These symptoms are similar to those of other forms of depression,however, SAD is a unique disorder with its own diagnostic criteria [3]. Carbohydrate craving and hyperphagia are not diagnostic for SAD but they are commonly seen in patients with SAD [3]. SAD subjects show a differential clinical and cognitive profile when compared to other depressive-related disorders [10]. They may experience cognitive impairments,less severe clinical symptoms [10] and may even experience a subsyndromal type of SAD known as ‘winter blues’ [1]. Although SAD is usually associated with winter months, it can also occur in the spring or summer [1]. In conclusion, SAD is characterized by sad mood and low energy levels and its symptoms tend to begin in fall and continue into winter months [1].

How is SAD diagnosed?

There is a debate about the validity of SAD as a distinct psychiatric disorder [11]. While some researchers believe that SAD is an independent disorder, others argue that it is a subtype of major depression [12]. Moreover, the symptoms of SAD overlap with other, more established subtypes of depression [11]. The DSM-IV does not classify SAD as a unique mood disorder,but rather as a specifier of major depression [12]. Patients with SAD experience episodes of major depression that recur at specific times of the year [12]. A full evaluation using current DSM-IV-TR depression criteria is needed if SAD is suspected [3]. Screening for depression and determining its severity can be done using a number of instruments like the Beck Depression Inventory and the Hamilton Rating Scale for Depression [3]. Screening for depression can help identify patients with SAD [12]. Summer depression appears to respond to the same antidepressant pharmacotherapy used to treat nonseasonal depression,while winter depression responds to treatment with monoamine oxidase inhibitors (MAOIs), which also treat atypical depression [11]. The USPSTF recommends screening for depression in primary care settings to improve accurate identification of patients with depression, including SAD,as treatment for depression decreases clinical morbidity [12].

What are the available treatment options for SAD?

The Canadian Journal of Psychiatry study further mentions various treatment options for SAD [12]. Light therapy is an effective treatment for SAD [3], and a variety of light therapy units are available for this purpose [12]. However, it is important to note that units not specifically designed for SAD may not be able to provide the necessary ultraviolet filtration,or provide adequate brightness [12]. Apart from light therapy, antidepressants have also been assessed for SAD [12]. Fluoxetine, propranolol, and d-fenfluramine have been found effective in controlled trials,and moclobemide, tranylcypromine, and bupropion have shown favorable results in open trials [11]. Factors suggesting the use of medications in patients with SADs are listed in Table 6 [11]. The largest trial on SAD showed that patients had a better response to sertraline therapy than control patients [12]. Furthermore, patient receiving light therapy or other psychoactive medications were excluded from the trial [12]. No other available treatment options for SAD are mentioned in the text, however, treatment approaches for SAD usually involve a combination of antidepressant medication, light therapy, Vitamin D, counselling, stress management, spending more time outdoors, increased physical activity, avoiding social withdrawal, and improving diet by limiting starches and sugars.Additionally, other forms of counselling integrate elements of cognitive behavior therapy (CBT) for SAD and S-SAD [1]. Thus, it can be concluded that each treatment option has been proven beneficial in treating SAD, but no large studies have found any treatment to be superior [12]. Therefore, treatment planning for SAD should consider all available treatment options [11].

  1. Melrose, S. [HTML][HTML] Seasonal affective disorder: an overview of assessment and treatment approaches. (n.d.) Retrieved September 28, 2023, from www.hindawi.com/journals/drt/2015/178564/abs/
  2. Hansen, V., Skre, I., Lund, E. What is this thing called “SAD”? A critique of the concept of seasonal affective disorder. (n.d.) Retrieved September 28, 2023, from www.cambridge.org
  3. Kurlansik, S., Ibay, A. [HTML][HTML] Seasonal affective disorder. (n.d.) Retrieved September 28, 2023, from www.aafp.org/pubs/afp/issues/2012/1201/p1037.html
  4. Lee, T., Blashko, C., Janzen, H., Paterson, J. Pathophysiological mechanism of seasonal affective disorder. (n.d.) Retrieved September 28, 2023, from www.sciencedirect.com/science/article/pii/S0165032797000761
  5. Zauderer, C., Ganzer, C. Seasonal affective disorder: an overview. (n.d.) Retrieved September 28, 2023, from journals.rcni.com/doi/pdfplus/10.7748/mhp.18.9.21.e973
  6. Rosenthal, N., Sack, D., Gillin, J. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. (n.d.) Retrieved September 28, 2023, from jamanetwork.com
  7. Rosenthal, N. [BOOK][B] Winter blues: Everything you need to know to beat seasonal affective disorder. (n.d.) Retrieved September 28, 2023, from books.google.com
  8. Tonello, G. Seasonal affective disorder: Lighting research and environmental psychology. (n.d.) Retrieved September 28, 2023, from journals.sagepub.com/doi/abs/10.1177/1477153507083929
  9. Flaskerud, J. Seasonal affective disorders. (n.d.) Retrieved September 28, 2023, from www.tandfonline.com/doi/full/10.3109/01612840.2011.617028
  10. Mersch, P., Middendorp, H., Bouhuys, A. Research report Seasonal affective disorder and latitude: a review of the literature. (n.d.) Retrieved September 28, 2023, from www.sciencedirect.com/science/article/pii/S0165032798000974
  11. Saeed, S., Bruce, T. Seasonal Affective Disorders | AAFP. (n.d.) Retrieved September 28, 2023, from www.aafp.org/pubs/afp/issues/1998/0315/p1340.html
  12. Lurie, S., Gawinski, B., Pierce, D., Rousseau, S. Seasonal Affective Disorder. (n.d.) Retrieved September 28, 2023, from www.aafp.org/pubs/afp/issues/2006/1101/p1521.html
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