Seasonal Affective Disorder

Introduction

In present day society, many people have reported seasonal changes in their energy and eating patterns, sleeping patterns and to a lesser degree, changes in their moods that have necessitated research into the causes, symptoms, diagnosis and treatment of such seasonal changes. All these changes however take place at different levels for different kinds of people in which case some people may experience few or no seasonal changes at all; others will go through mild changes which get easily accommodated in their everyday lives; while yet another group may experience changes that can be a nuisance, and though not deserving the attention of a physician, they are troublesome anyway.

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This later group of people can be described to be suffering from a disorder commonly referred to as holiday blues or in other words, winter blahs. Persons going through extreme mood and behavior changes in such a manner that such changes cause problems to their daily lives are said to be suffering from a more serious condition referred to as Seasonal Affective Disorder (SAD) (Rosenthal 2005, pp.18-19).

Main Discussion

The term Seasonal Affective Disorder (SAD) has been coined to refer to a type of seasonal depression that often attacks its victims in the fall to winter season and then disappears as the spring and summer seasons set in. SAD is highly severe as compared to winter blahs or holiday blues which have instead displayed very mild symptoms. This condition causes temporary withdrawal symptoms with the victims getting into hibernation during the dark and very dreary winter months. Such withdrawal is often characterized by a general withdrawal from the outside world, a craving for high-calorie foods and carbohydrates, as well as lengthy sleeping hours.

About a decade ago SAD was officially recognized in the legitimate diagnostic category by psychiatrists and others in the medical fraternity who estimated that about 10 million Americans were at the time suffering from the disease, majority of the victims being women.

As a result of high frequency of the disorder among females than males, speculation has consequently developed that links the disorder with hormonal changes in the female reproductive system. SAD is however a condition that affects people of every caliber, and victims have been reported from different races, ethnic groups, and even different occupations. The disorder affects every age group although most victims tend to fall within the 20-40 years age bracket (Rosenthal 2005, p.19; Carlson, Eisenstat & Ziporyn 2004, pp.531, 533).

Although researchers have not yet fully established the main causes of SAD, available evidence has increasingly associated the disorder with the effects that different levels of light have on the hormone melatonin, which is produced in the brain. Melatonin supposedly affects the regulation of circadian in the body or in other words controls the daily sleep-wake cycle. The regulation is highly dependant on ample availability of sunlight, a factor that leads to a disruption of the circadian rhythm during the shorter winter days.

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Reduced sunlight alters brain chemistry, leading to an overproduction of melatonin and this creates a tendency in SAD victims to sleep for longer hours. Sunlight has also been proved to cause an improvement in the production of serotonin, another of the neurotransmitters that regulate mood. During the short winter days, the brain produces low amounts of serotonin and this mixture of high melatonin and low serotonin production can lead to a state of depression and associated symptoms especially in individuals who are genetically predisposed. The purpose of this paper is to distinguish SAD symptoms from other depressive symptoms as well as highlight the best methods of treatment (Carlson, Eisenstat & Ziporyn 2004, p. 532).

In most cases, SAD symptoms begin to appear in the late teens or early 20s, and tend to disappear much later in life. For women victims, symptoms often disappear after menopause. SAD symptoms are quite similar to those diagnosed in people suffering from such other disorders as depressions or hypothyroidism, except that SAD symptoms reflect a very seasonal pattern, disappearing during the spring and summer months and recurring as the fall and winter months set in. A common characteristic among all SAD victims is energy level problems expressed in different ways, although majority of the victims describe the feelings as fatigue.

Most victims have reported changes in sleeping patterns, sex drive and eating habits. During winter, majority of the victims tend to eat more than usual and also experience changes in their diet preference; shifting from a preference of salads, fruits, and other light foodstuffs in the brighter summer months to carbohydrate rich foods such as potatoes, pasta, breads and other sugar foods during winter. SAD victims have often reported that carbohydrates give them more energy, a factor that can be associated with higher levels of serotonin production in the brain resulting from consumption of dietary carbohydrates.

High consumption of carbohydrates could also result from high insulin secretions from the pancreas which lowers blood sugar levels, creating a general craving for starches and other sweet goodies. Over-secretion of insulin is highly risky and could cause heart disease, diabetes and obesity and it is therefore both psychologically and physically beneficial to treat SAD as soon as symptoms are detected (Rosenthal 2005, pp.35-37, 40-44, 49; Carlson, Eisenstat & Ziporyn 2004, p.534).

During winter, most people are less active and changes in diet tend to lead to an outright weight gain in SAD patients. Victims also experience changes in their sleep patterns which include sleeping longer but feeling less refreshed upon waking up; experiencing low quality sleep and interrupted sleep as well as difficulties in waking up. Most people suffering from SAD also experience a markedly reduced sex drive.

Many of the victims also report less decision-making capacity or power and conspicuous mood changes such as being snappy, unpleasant towards others, and generally irritable. Like other depressed people, victims of SAD have a tendency to withdraw from reality by unfairly blaming others or even themselves for problems resulting from the condition. Physical illnesses such as muscle aches, headaches, backaches and an assortment of infections are also common, the most common illness being Fibromyalgia, a condition that causes muscle aches and pains especially around the shoulder and neck areas.

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When treated, this condition responds quite well to antidepressants although its correlation with SAD is yet to be fully explored. Another very common symptom but which is found among women victims of SAD is Premenstrual Dysphonic Disorder (PMDD) or Premenstrual Syndrome (PMS). Victims also display a certain craving for light which pushes many of them to repeatedly take winter vacations while others may even relocate permanently. SAD symptoms however often occur alongside other very serious medical conditions such as chronic depression or dysthymia, eating disorders like anorexia nervosa and bulimia and PMS (Rosenthal 2005, pp.35-37, 40-44, 49; Carlson, Eisenstat & Ziporyn 2004, p.534).

The fact that depressive symptoms detected in SAD are similar to those detected in other medical conditions such as hypothyroidism or hypoglycaemia makes diagnosis for the condition to be quite a tricky process. To diagnose an individual as suffering from SAD, psychiatric evaluation must therefore rule out practically all other obvious social, emotional and psychological factors that are likely to lead to a diagnosis of such symptoms.

Various testing methods have been developed and are subsequently used for diagnoses of SAD and these include diagnostic tests, physical examination, psychiatric history, medical history as well as detailed interview. Diagnostic tests such as blood tests are carried out as a safety measure of ruling out the presence of any physical disorder while a physical examination will be carried out to assess if a patient has an underlying physical disorder.

Because several types of medication have been proved to trigger depression, a medical history of the patient assists the practitioner to rule out any symptoms of depression that could have arisen from usage of certain types of drugs. The psychiatric history of a patient is a very crucial measure of ruling out the presence of other forms of depression while detailed interviews shed light about such other factors as the particular time when symptoms began to occur. Psychiatric history also helps to assess whether these symptoms are varied at different times of the year; the diet and sleeping habits of the patient; as well as other factors in a patient’s lifestyle (Carlson, Eisenstat & Ziporyn 2004, p.534).

One of the most recent developments in the treatment of SAD and which is currently being promoted is the use of phototherapy. This treatment has been based on a general theory which highlights diminished exposure to light as a major triggering factor for SAD symptoms. Relocating to the tropics appears to be a very simple form of phototherapy but one which is also quite impractical for most patients, making basking in artificial light a much and more convenient alternative.

Through phototherapy, artificial light that is approximately 5-20 times brighter than ordinary light was produced through certain devices called light boxes and subsequently administered on the patients. Although this kind of treatment is carried out in medical centers, it can also be carried out at home and is often administered in durations of between 50-120 minutes every day during the mood season. Phototherapy should however be administered only under the guidance or supervision of qualified clinicians. Household lamps can also be fitted with full-spectrum light bulbs to assist in production of essential light during the treatment process.

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From available evidence, phototherapy has been proved to create relieve of SAD symptoms in about four out of five number of people undergoing treatment. Phototherapy however has some side effects which include and yet are not limited to eye strain, irritability and headaches, insomnia and hypomania. Suicide risks resulting from administration of light therapy have been reported on very rare cases. Though an effective treatment of SAD, phototherapy cannot however be used in the treatment of people who have had recent eye surgery or are currently under certain types of medication that accelerate light sensitivity.

UV and infrared waves are quite dangerous to the health of a person and experts recommend that every effort must be made to filter light during treatment. Phototherapy can however be administered alongside antidepressants to create a combined treatment process for SAD. SAD patients can also be encouraged to practice self-help options such as good eating and sleeping habits; exposure to adequate sunlight during the SAD season; exercise which helps to relief anxiety and depression; as well as removing any objects window curtains, bushes and trees which obstruct light from getting into the house.

A patient can also be encouraged to place working desks near the window so as to ensure that he or she receives adequate sunlight. Those who can afford it can also take a holiday to the sunny places during winter (Loue, Sajatovic & Longhofer 2007, p.125; Carlson, Eisenstat & Ziporyn 2004, pp.534-535).

Most SAD patients have also positively responded to low doses of the hormone melatonin administered in the bright morning light and again in the afternoon. Taken at the right time each day, melatonin supplements can greatly help to re-set the strayed rhythms.

During recent randomized research, a comparison was made between SAD patients undergoing light therapy in combination with a placebo pill and others receiving 20mg/day of the antidepressant fluoxetine together with a dose of 100 lux of non-therapeutic light. From the analysis, both groups displayed significant decreases in depressive symptoms from baseline but no significant differences were noted between the two groups. More sleep disturbance, agitation and palpitations were however reported from the group under the antidepressant fluoxetine (Loue, Sajatovic & Longhofer 2007, p.125; NIMH 2006).

Conclusion

During trials for the treatment of SAD and other seasonal depressive disorders using light therapy, very promising results have been achieved with reports of very mild to moderate side effects reported as compared to treatment using with antidepressants. Light therapy has however reflected a major drawback in that rates of relapse are quite high and can be as high as 75%. It is for this reason that clinicians highly recommend daily administration of light therapy for a considerable duration during the SAD season; a practical recommendation in the sense that some patients may lack any type of motivation to continue with treatment. Administration of light therapy programs should therefore be closely followed by trained clinical (Loue, Sajatovic & Longhofer 2007, p.125).

References

Carlson, K.J, Eisenstat ,S.A., and Ziporyn, T.D. (2004). The New Harvard guide to women’s health. London, UK: Harvard University Press.

Loue, S., Sajatovic, M., and Longhofer, J.L. (2007). Diversity issues in the diagnosis, treatment, and research of mood disorders. Oxford, UK: Oxford University Press.

National Institute of Mental Health (NIMH). (2006). Properly timed light, melatonin, lift winter depression by syncing rhythms. Science Update. Web.

Rosenthal, N.E. (2005). Winter blues: Everything you need to know to beat seasonal affective disorder. New York: Guilford Press.

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