SEASONAL AFFECTIVE DISORDER

If you notice patterns of depression and non-depression that seem to be triggered by the seasons of the year, you may suffer from Seasonal Affective Disorder (SAD).

This condition is characterized by recurrent episodes of depression in certain months of the year, alternating with periods of normal mood the rest of the year. Usually those affected by SAD become depressed in the fall and winter and feel better during the spring and summer. Atypical cases are also known in which the person becomes depressed during the summer.

Many patients with SAD are women whose illness typically begins in their twenties. Milder versions of SAD have been reported in children and adolescents. Many patients with SAD report at least one close relative with a psychiatric condition, most frequently a severe depressive disorder (55%) or alcohol abuse (34%).

What Are the Patterns of SAD?

The usual characteristics of recurrent winter depression include insomnia, carbohydrate craving, and weight gain. Other symptoms include the usual features of depression, especially decreased sexual appetite, lethargy, hopelessness, suicidal thoughts and social withdrawal.

Recurrent summer depression may also include insomnia, but is more likely to be characterized by decreased appetite, weight loss, and constant agitation or anxiety. Patients with SAD in the summer often have histories of summer trips to the north, where they find relief from depression in cold climates. Generally, normal air conditioning is not sufficient to relieve depression in these patients during

the summer months.

Symptoms of winter SAD usually begin in October or November and subside in March or April. Depressions are usually mild to moderate but can be severe. Only 6% of patients with SAD seen at the National Institute of Mental Health (NIMH) have required hospitalization, and 1% have been treated with electro-convulsive therapy.

The most common characteristic of patients with SAD is their reaction to changes in environmental light. Patients living at different latitudes note that their winter depressions are longer and more profound the farther north they live.

Patients with SAD also report that their depression worsens whenever the weather is overcast at any time of the year and/or their indoor lighting is decreased.

SAD is often misdiagnosed as hypothermia, hypoglycemia, infectious mononucleosis, and other viral infections.

How is SAD Treated?

Bright fluorescent (not ordinary) light has been shown to reverse the winter depressive symptoms of SAD. In a l986 study, 80% of 112 patients improved significantly with therapy.

Scientists believe that light therapy works by reducing the level of a certain brain chemical (the neurotransmitter melatonin) normally present at night.

Specific research on the use of antidepressant medications for treating SAD has not been done. However, clinical experience suggests that some patients may respond to tricyclics medications (such as Elavil and Imipramine), monoamine oxidase inhibitors (MAOIs such as Nardil and Parnate), or Lithium.

How Does Light Therapy Work?

Patients generally begin with two hours of treatment in the morning. Light in the evening may cause insomnia. If this is successful, the patient can, after a week or two, experiment with reducing the daily duration of treatment.

The most common light source is a full spectrum fluorescent light. This fixture provides a reflecting surface behind the lights and a plastic diffusing screen in front. The light box is placed either horizontally on a desk or table or vertically on the floor. The intensity of light from a light source is equivalent to the amount of light exposure the patient would receive from looking out a window on a sunny spring day.

Side effects of phototherapy are uncommon. Some patients complain of irritability, eye strain, headaches, or mania. No evidence has been produced of long term adverse effects, however.

What Should I Do If I Think I Have SAD?

Learn as much as you can about SAD. If your symptoms are mild, that is, if they don’t interfere too much with your daily living, you may want to try light therapy as described above or experiment with adjusting the light in your surroundings with full spectrum lights.

If your depressive symptoms are severe enough to significantly affect your day to day functioning, consult a mental health professional qualified to treat SAD. He or she can help you find the most appropriate treatment for you.

What is the Effect of Sunlight on Mood and Behavior?

The recent discovery that some forms of depression respond to daily treatment with bright light has called attention to the popular notion that sunlight is “soul restoring.”

Many people with seasonal mood swings seem to gravitate toward sunlight, they also tend to walk around the house turning on lights.

Such observations of the mood-elevating effects of sunlight may also partly explain the high rates of suicide and alcohol abuse in places like Seattle and Sweden, where sunshine in winter is extremely limited.

To counteract the depressing effects of short winter days, psychiatrists suggest taking advantage of sunlight by scheduling time outdoors each day.

Is There a Support Group for Sufferers of SAD?

The National Organization for Seasonal Affective Disorder (NOSAD) distributes information about causes, nature and treatment of SAD. It also encourages the development of services to patients and families and research into causes and treatment. Write NOSAD, P.O. Box 40133, Washington, D.C. 20016 or call 301-229-2897.

ALLIANCE FOR THE MENTALLY ILL

NAMI OF GREATER CHICAGO

1536 West Chicago Ave., Chicago, IL 60622

(312) 563-0445

Fax: (312) 563-0467