Seasonal affective disorder Totally Explained

Everything about Seasonal Affective Disorder totally explained

Seasonal affective disorder (SAD), also known as winter depression, is a mood disorder whose sufferers experience normal mental health throughout most of the year, but experience depressive symptoms in the winter. As stated by the U.S. National Library of Medicine: ť "Some people experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Though symptoms can be severe, they usually clear up."

Pathophysiology

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5% Cloud cover may contribute to the negative effects of SAD.
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. although this has been disputed. Mice incapable of turning serotonin into N-acetylserotonin (by Serotonin N-acetyltransferase) appear to express "depression-like" behaviors, and antidepressants such as fluoxetine increase the amount of the enzyme Serotonin N-acetyltransferase, resulting in an antidepressant-like effect. Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland.
Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% vs. 6.1% of the U.S. population. 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. Connections between human mood, as well as energy levels, and the seasons are well-documented, even in healthy individuals.

Diagnostic criteria

The Mayo Clinic describes three types of Seasonal Affective Disorder, each with its own set of symptoms.
According to the American Psychiatric Association, for a diagnosis to qualify as SAD, it must meet four criteria: depressive episodes at a particular time of the year; remissions or mania/hypomania also at a characteristic time of year; these patterns must have lasted two years with no nonseasonal major depressive episodes during that same period; and these seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime.

Treatment

There are many different treatments for classic (winter-based) seasonal affective disorder, including light therapies, medication, ionized-air reception, cognitive-behavioral therapy, and carefully timed supplementation of the hormone melatonin.
Bright light treatments are common although as many as 19% of patients stop use because of the inconvenience. Patients using light therapy can experience improvement during the first week, but increased results are evident when continued throughout several weeks. Both fluoxetine and light therapy are 67% effective in treating SAD according to direct head-to-head trials.

Throughout the world

The Nordic countries

Winter depression (or winter blues) is a common slump in the mood of inhabitants of the Nordic countries. Doctors estimate that about 20% of all inhabitants are affected, and it seems to be genetically heritable. It was first described by the 6th century Goth scholar Jordanes in his Getica wherein he described the inhabitants of Scandza (Scandinavia).

Iceland

A study of more than 2000 people in Iceland found the prevalence of seasonal affective disorder and seasonal changes in anxiety and depression to be unexpectedly low in both sexes. The study's authors suggested that propensity for SAD may differ due to some genetic factor within the Icelandic population. A study of Canadians of wholly Icelandic descent also showed low levels of SAD.

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 sluggish 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's a SAD rate of 8.9%, and an even greater rate of 24.9% for subsyndromal SAD.

Ireland

Around one Irish person in five is affected by SAD, according to a survey conducted in 2007. The survey also shows women are more likely to be affected by SAD than men.

SAD and Bipolar

Most people with SAD experience unipolar depression, but as many as 20% may have or may go on to develop a bipolar or manic-depressive disorder. It is important to discriminate the improved mood associated with recovery from the winter depression and a manic episode because there are important treatment differences. In these cases, persons with SAD may experience depression during the winter and hypomania in the summer.

Famous sufferers

Science fiction-fantasy author Barbara Hambly suffered with undiagnosed SAD for many years and speaks freely of it.
Monty Don, a British gardner and TV presenter.

Further Information

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