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Seasonal
Affective Disorder (SAD)
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This Friday,
December 21, is the Winter Solstice, the shortest day of the
year, and the event spawned an article in the weekly "Health"
page of the Washington Post on Seasonal Affective Disorder
(December 18, 2001). The article, "The Right week to
Lighten Up," is by Jennifer Huget. The Sub text is, "As
sunlight ebbs, the 'winter blues' arrive."
It seems unfair
that some individuals, who find the holidays stressful, if
not down right depressive, may also be affected by light deprivation
at the same time. As Ms. Huget points out, it is interesting,
and perhaps not so coincidental, that lights or candles are
prominent for these winter holidays.
I was interested
in learning that a Psychiatrist, Norman Rosenthal, coined
this name, with its appropriate acronym. When Dr. Rosenthal
reported on his study of 29 patients who suffered depression
in the winter but not in the summer in a 1984 issue of the
Archives of General Psychiatry, he was a researcher
at the National Institutes of Health. Presently, he is a clinical
professor of psychiatry at Georgetown University.
Four tips that
Rosenthal offers for " . . .making it through days of
darkness" are:
- Let there be
light.(Open the blinds and put on all your lights.)
- Get outdoors,
especially if it's snowy.
- Get moving.
- Wake up to light.
(Use a timer to have your bedside light to go on an hour
before the alarm clock wakes you.)
I found no references
to SAD in OT SEARCH; however, occupational therapy practitioners
treating individuals with this diagnosis are probably drawing
on their intervention methods with other types of depression.
Additionally, therapists and consumers hopefully have meaningful
occupations that divert their attention from the cold and
the dark.
Following is a
list of web sites and references, including the 1984 articles
and its 1996 follow-up, concerning seasonal affective disorder
(SAD) for professionals and consumers.
Web Sites:
References:
Cass, H. (2001).
Update on Seasonal Affective Disorder: Light Therapy and Herbs
Relieve Many Symptoms. Alternative and Complementary Therapies,
7(1), 5-7.
Dess, N.K. (2000).
Nancy K. Dess, Ph.D. talks to Norman Rosenthal, M.D. about
the roots of seasonal affective disorder (SAD) and new ways
of treating it. Psychology Today, 33(6), 26 .
Giedd JN, Swedo
SE, Lowe CH & Rosenthal NE. (1998). Case series: pediatric
seasonal affective disorder. A follow-up report. Journal
of the American Academy of Child & Adolescent Psychiatry,
37(2), 218-20.
Six subjects who
as children had received a diagnosis of seasonal affective
disorder consented to participate in a 7-year follow-up study.
Structured and semistructured interviews were conducted to
assess the course of illness, response to treatment, and current
clinical state. Seasonal patterns of symptoms and response
to light therapy remained relatively stable over a 7-year
period. Two subjects were using adjunctive fluoxetine. Seasonal
affective disorder can occur in children and adolescents,
responds to light therapy, and should be considered in the
differential diagnosis of pediatric affective symptoms or
cyclic school performance.
Krauchi K, Reich
S, Wirz-Justice A. (1997). Eating style in seasonal affective
disorder: who will gain weight in winter? Comprehensive
Psychiatry, 38(2), 80-7.
ABSTRACT: Patients with seasonal affective disorder (SAD)
selectively eat more carbohydrates (CHO), particularly sweets
but also starch-rich foods, during their depression in winter.
The Dutch Eating Behaviour Questionnaire (DEBQ) was administered
to female SAD patients, healthy female controls, and female
medical students to determine their eating style, together
with the modified Seasonal Pattern Assessment Questionnaire
(SPAQ+). SAD patients showed higher values for "emotional"
(EMOT) eating than the students, and these in turn had higher
values than the controls. In comparison to controls, SAD patients
and students head high values for the factor "external"
(EXT) eating, but there was no difference between the groups
with respect to "restraint" (REST) eating. This
is in strong contrast to patients with bulimia and anorexia
nervosa, who are high REST eaters, indicating that SAD patients
do not have a similar eating disorder. Additional items showed
that SAD patients selectively eat sweets under emotionally
difficult conditions (when depressed, anxious, or lonely).
Configural frequency analysis showed that seasonal body weight
change (SBWC) is high in subjects with high EMOT and REST
eating together with a high body mass index (BMI). This result
is in accordance with the concept of disinhibition of dietary
restraint in extreme emotional situations, e.g., the depressive
state.
Meesters Y, Beersma DG, Bouhuys AL & van den Hoofdakker
RH. (1999). Prophylactic treatment of seasonal affective disorder
(SAD) by using light visors: bright white or infrared light?
Biological Psychiatry, 46(2), 239-46.
ABSTRACT: BACKGROUND: Thirty-eight patients with SAD participated
in a light visor study addressing two questions. 1. Can the
development of a depressive episode be prevented by daily
exposure to bright light started before symptom onset in early
fall and continued throughout the winter? 2. Does the light
have to be visible in order to have beneficial effects? METHODS:
Three groups participated in the study: I (n = 14) received
bright white light (2500 lux); II, (n = 15) received infrared
light (0.18 lux); III (n = 9, control group) did not receive
any light treatment at all. RESULTS: Infrared light is just
as effective as bright white light. Both are more effective
than the control condition. CONCLUSIONS: Light visors can
be effectively used to prevent the development of SAD. The
fact that exposure to infrared light was as effective as exposure
to bright white light questions the specific role of visible
light in the treatment of SAD.
Rosenthal, N.E. (1993). Seasons of the mind. New York, NY:
Guilford Press.
Rosenthal, N.E.
(1998). Winter Blues: Seasonal affective disorder: What
it is and how to overcome it. (Rev. Ed.). New York, NY:
Guilford Press.
Rosenthal NE, Sack
DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS,
Newsome DA, Wehr
TA. (1984). Seasonal affective disorder. A description of
the syndrome and preliminary findings with light therapy.
Archives of General Psychiatry, 41(1), 72-80.
Seasonal affective
disorder (SAD) is a syndrome characterized by recurrent depressions
that occur annually at the same time each year. We describe
29 patients with SAD; most of them had a bipolar affective
disorder, especially bipolar II, and their depressions were
generally characterized by hypersomnia, overeating, and carbohydrate
craving and seemed to respond to changes in climate and latitude.
Sleep recordings in nine depressed patients confirmed the
presence of hypersomnia and showed increased sleep latency
and reduced slow-wave (delta) sleep. Preliminary studies in
11 patients suggest that extending the photoperiod with bright
artificial light has an antidepressant effect.
Schwartz PJ, Brown
C, Wehr TA & Rosenthal NE. (1996). Winter seasonal affective
disorder: a follow-up study of the first 59 patients of the
National Institute of Mental Health Seasonal Studies Program.
American Journal of Psychiatry, 153(8), 1028-36.
ABTRACT: OBJECTIVE:
The purpose of this study was to characterize the long-term
course of patients with seasonal affective disorder. METHOD:
The first 59 patients with winter seasonal affective disorder
who had entered winter protocols were retrospectively followed
up after a mean interval of 8.8 years. Detailed life charts
were constructed through use of a semistructured interview
and collateral records. RESULTS: The disorder of 25 patients
(42%) remained purely seasonal, with regular recurrences of
winter depression and no depression or treatment through any
summer. The course of illness was complicated by varying degrees
of nonseasonal depression in 26 patients (44%). The disorders
of eight patients (14%) had fully remitted. Certain features
of the group with complicated seasonal affective disorder
suggested that they were more severely ill. Twenty-four patients
(41%) continued to use light treatment regularly throughout
the follow-up period. Light treatment was preferred to medication
for winter recurrences, although antidepressants had been
used in the winter by most (63%) of the patients who still
used lights at follow-up. CONCLUSIONS: The pattern of winter
depressions and summer remissions remained fairly persistent
over time in this group of patients. The temporal distribution
of depressive episodes both within and across individual patients
was consistent with the results of several recent follow-up
studies of seasonal affective disorder, providing support
for the predictive and construct validity of the Rosenthal
et al. diagnosis ofwinter seasonal affective disorder. Light
treatment, while remaining a safe and satisfactory treatment
for many, may be insufficient for more severely ill patients.
The appearance of nonseasonal depressions in patients with
winter seasonal affective disorder may be associated with
greater severity of illness and less responsiveness to light
treatment.
Sher L, Matthews
JR, Turner EH, Postolache TT, Katz KS & Rosenthal NE.
(2001). Early response to light therapy partially predicts
long-term antidepressant effects in patients with seasonal
affective disorder. Journal of Psychiatry & Neurosience,
26(4), 336-338.
ABSTRACT: OBJECTIVE: To determine if the antidepressant effect
of 1 hour of light therapy is predictive of the response after
1 and 2 weeks of treatment in patients with seasonal affective
disorder (SAD). PATIENTS: Twelve patients with SAD. SETTING:
National Institutes of Health Clinical Center, Bethesda, Md.
INTERVENTIONS: Light therapy for 2 weeks. OUTCOME MEASURES:
Scores on the Seasonal Affective Disorder Version of the Hamilton
Depression Rating Scale (SIGH-SAD) on 4 occasions (before
and after 1 hour of light therapy and after 1 and 2 weeks
of therapy) in the winter when the patients were depressed.
Change on typical and atypical depressive scores at these
time points were compared. RESULTS: Improvement of atypical
depressive symptoms after 1 hour of light therapy positively
correlated with improvement after 2 weeks of therapy. CONCLUSION:
In patients with SAD, the early response to light therapy
may predict some aspects of long-term response to light therapy,
but these results should be treated with caution until replicated.
Stamenkovic, M.;
Aschauer, H. N.; Riederer, F.; Schindler, S. D.; Leisch, F.;
Resinger, E.; Neumeister, A.; Hornik, K.; Kasper, S. (2001).
Study of Family History in Seasonal Affective Disorder. Neuropsychobiology,
44(2), 65-69.
ABSTRACT: OBJECTIVE:
In our investigation we assessed the risk of morbidity for
psychiatric disorders among the first-degree relatives of
patients with seasonal affective disorders (SAD) and compared
it with a control group of patients suffering from nonseasonal
mood disorders (NSMD). METHODS: Over a period of 12 months
(June 1994 to May 1995) we recruited patients consecutively
admitted to our psychiatric university outpatient clinic in
a prospective study. All patients were diagnosed according
to the Diagnostic and Statistical Manual of Mental Disorders,
revised 4th edition. A total of 344 patients presented themselves
with a diagnosis of affective disorder. Out of these, 36 were
diagnosed as having SAD. From the same group of 344 patients,
we selected a matched control group of 36 patients suffering
from NSMD. The experimental and control groups were matched
according to sex, age, severity of illness and number of siblings.
RESULTS: There was no significant difference concerning the
lifetime prevalences for psychiatric disorders among the fist-degree
relatives in both groups (SAD = 16.5% and NSMD = 19%). CONCLUSION:
It seems that there is no difference in familiarity for psychiatric
disorders between SAD and NSMD. Copyright 2001 S. Karger AG,
Basel
Sumaya IC, Rienzi BM, Deegan JF 2nd & Moss
DE. (2001). Bright light treatment decreases depression in
institutionalized older adults: a placebo-controlled crossover
study. The journals of gerontology. Series A, Biological
sciences and medical sciences, 56(6), 356-360.
ABSTRACT: BACKGROUND:
An important parallel exists between patients with seasonal
affective disorder and institutionalized older adults. Many
older patients, as a result of global physical decline and
immobility, are confined to their rooms, experiencing little
natural sunlight. Thus, institutionalized older adults are
at risk for chronic light deprivation. Testing the hypothesis
that chronic light deprivation might be responsible, at least
in part, for some depression among institutionalized older
adults, the aim of this study was to investigate the efficacy
of morning bright light treatment on depression among older
adults residing in a long-term care facility. METHODS: In
a placebo controlled, crossover design, participants (N =
10, six women and four men; M age = 83.8) received each of
the following: (i) 1 week (5 days) of 10,000 lux (therapeutic
dose); (ii) 1 week (5 days) of 300 lux (placebo); or 1 week
of no treatment (control). Each week of light treatment was
5 consecutive days, 30 minutes daily, with a wash-out period
consisting of 1 week between conditions. RESULTS: Geriatric
Depression Scale (GDS) scores at baseline during all treatment
conditions were positively correlated (r = .81, p < .01)
with months of institutionalization, where participants with
higher GDS scores experienced more time institutionalized.
Scores on the GDS remained unchanged during the placebo and
control conditions, but depression scores decreased significantly
during the 10,000 lux treatment (pretest GDS M = 15 vs posttest
GDS M = 11, p < .01). After the 10,000 lux treatment, 50%
of the participants no longer scored in the depressed range.
Improvement during the 10,000 lux condition was positively
correlated (r = .62, p < .05) to baseline GDS scores, where
participants with higher GDS scores experienced greater improvement
following the 10,000 lux treatment. CONCLUSIONS: The results
of the present study suggest that bright light treatment may
be effective among institutionalized older adults, providing
nonpharmacological intervention in the treatment of depression.
Furthermore, the length of institutionalization may play an
important role in determining the efficacy of bright light
treatment for older adults in the nursing-home setting.
Swedo SE, Allen
AJ, Glod CA, Clark CH, Teicher MH, Richter D, Hoffman C, Hamburger
SD, Dow S, Brown C & Rosenthal NE. (1997). A controlled
trial of light therapy for the treatment of pediatric seasonal
affective disorder. Journal of the American Academy of
Child & Adolescent Psychiatry, 36(6), 816-21.
OBJECTIVE: To evaluate
the efficacy of light therapy for the treatment of pediatric
seasonal affective disorder (SAD). METHOD: 28 children (aged
7 to 17 years) at two geographically distinct sites were enrolled
in a double-blind, placebo-controlled, crossover trial of
bright-light treatment. Subjects initially entered a week-long
baseline period during which they wore dark glasses for an
hour a day. They were then randomly assigned to receive either
active treatment (1 hour of bright-light therapy plus 2 hours
of dawn simulation) or placebo (1 hour of clear goggles plus
5 minutes of low-intensity dawn simulation) for 1 week. The
treatment phase was followed by a second dark-glasses phase
lasting 1 to 2 weeks. After this phase, the children received
the alternate treatment. Response was measured using the parent
and child versions of the Structured Interview Guide for the
Hamilton Depression Rating Scale, Seasonal Affective Disorders
version (SIGH-SAD). RESULTS: Data were analyzed as change
from baseline. SIGH-SAD-P total depression scores were significantly
decreased from baseline during light therapy compared with
placebo (one-way analysis of variance, rho = .009), and no
differences were found between the placebo and control phases.
Subscores of atypical and typical depression were also significantly
decreased during the active treatment (rho =.004 and .028,
respectively). A similar trend was noted with the SIGH-SAD-C,
but this did not reach significance. At the end of the study,
78% of the parents questioned and 80% of the children questioned
rated light therapy as the phase during which the child "felt
best." CONCLUSION: Light therapy appears to be an effective
treatment for pediatric SAD.
Thompson, C. &
Cowan, A. (2001). The Seasonal Health Questionnaire: a preliminary
validation of a new instrument to screen for Seasonal Affective
Disorder. Journal of Affective Disorders, 64(1), 89-98.
ABSTRACT: BACKGROUND:
The main screening tool for Seasonal Affective Disorder (SAD)
is the Seasonal Pattern Assessment Questionnaire, but its
reliability and validity have been thrown into doubt by several
studies. METHOD: In this study we developed a new questionnaire,
the Seasonal Health Questionnaire (SHQ), which is scored by
computer to derive the four main operational criteria for
diagnosis of SAD. A group of clinically diagnosed SAD patients
was contrasted with a group of patients with recurrent non-seasonal
depressive disorder using the SPAQ and the SHQ. RESULTS: The
SHQ could be completed without difficulty by patients with
long histories of recurrent mood disorder. The SPAQ and the
Rosenthal Criteria were the least specific of the criteria
for identifying SAD - misclassifying many non-seasonal patients.
CONCLUSIONS: After further development the SHQ may be a more
appropriate screening instrument for SAD. The SPAQ should
no longer be used for this purpose as it gives misleadingly
high estimates of prevalence.
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