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Thursday, October 11, 2007

8 articles about Seasonal Affective Disorder


Recently Dr Shock discovered a SAD in one of his patients. He knows her now for three years. Every autumn she gets a low mood, irritability, over sleeping and other depressive symptoms. She hates going outdoors. In Spring her symptoms disappear. It took a while before she agreed to use light therapy, she hates antidepressants due to their side-effects.

In autumn the number of articles on SAD increases, Dr Shock has collected the most valuable articles about SAD, see the end of this article.

DSM IV criteria for Seasonal Affective Disorder (SAD).

Any depressive disorder, be it recurrent depressive episode, major depressive episodes in bipolar I disorder, bipolar II disorder can have a seasonal pattern in which case the specification seasonal pattern can be applied if the following criteria apply.

a. There has been a regular temporal relationship between the onset of major depressive episodes and a particular time of year (e.g. regular appearance of the major depressive episode in autumn or winter)

b. Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of year (e.g. depression disappears in the spring).

c. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal season relationship defined in criteria a and b, and no non-seasonal major depressive episode has occurred during the same period.


d. Seasonal major depressive episodes (as described above) substantially outnumber the non-seasonal major depressive episodes that may have occurred over the individual’s lifetime.

Note: Do not include cases in which there is an obvious effect of season-related psychosocial stressors (e.g. regularly being unemployed each winter)

Unlike classically depressed patients, most SAD patients develop ‘atypical’ symptoms of increased fatigue, increased sleep duration and increased appetite and weight. Not only do SAD patients crave carbohydrates, but also they actually report eating more carbohydrate-rich foods in the winter.

Especially these atypical symptoms and the disappearance of symptoms after the winter makes it hard to diagnose this variant of depression.

Treatment
For mild to moderate seasonal affective disorder, bright light therapy is often effective. This involves sitting in front of full-spectrum lights that mimic sunlight on a regular basis -- typically for about 30 minutes to 60 minutes before 10 each morning. (These are specially designed lights for this purpose that are made to minimize eye and skin damage; don't just go buy bright lights.) Starting before the darkest days in September each year

For severe SAD, lights are often inadequate. The treatment is medication, psychotherapy and possibly the lights.


Blog Articles On SAD


On ScienceDaily an article with interviews of researchers in the field of SAD.

Familydoctor.org as well as the Baltimore Sun claim that SAD should be treated by primary physicians.

They don't have to consult a psychiatrist; they can discuss how they feel with the family physician.


On medicalnewstoday a psychiatrist from Fort Worth discusses light therapy. Fort Worth is in Texas right? Do they have SAD there?

On "A blog around the clock" one of the science blogs, an outline of the very basic mechanism of SAD is explained.

On Corpus Callosum light therapy is discussed. A recent article shows that the use of blue LED light might be very efficacious in the treatment of SAD.
perhaps there is a more convenient way to administer bright light treatment. All it would take is a light source that emits only blue light, is more efficient than fluorescent bulbs, smaller, that lasts longer.


Neurontic another science blog, has an article about sun and SAD. If you buy the argument that a lack of sun contributes to SAD, wouldn't people in places like Switzerland and Denmark be more prone to SAD?

Corpus Callosum has another article about:
I am wondering if people with SAD living in the high latitudes either moved South or, being all gloomy, had a lower reproductive rate in the past, thus lowering the rates of SAD in the population.
It has some nice comments on this question.



4 comments:

sunlight lover said...

It's interesting to see the DSM criteria for SAD: thanks for posting them. Very informative.

Dr. Shock said...

I like your website about light therapy:
http://www.lumie.com/

I hope a lot of people will find it if needed.
Regards Dr Shock

B said...

Is it important to use the light box at a specific time each morning or just sometime in the morning? I found some good advice here too: http://www.howtodothings.com/health-fitness/how-to-deal-with-seasonal-affective-disorder but I think I need a light box...

Also, how do you find the "right" light box?

Dr. Shock said...

The best practice is to get up on time, and use the light box after you get up. So not somewhere in the morning but best is between 7.00 and 9.00 am.
You have to reset your circadian rythm so to speak.
Some googling will end up with good light boxes, be sure to have a light box up to 10.000 lux.
Regards Dr Shock