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Health Condition

Seasonal Affective Disorder

About This Condition

Seasonal affective disorder (SAD) is an extreme form of common seasonal mood cycles, in which depression develops during the winter months.

How seasonal changes cause depression is unknown, but most of the research into mechanisms and treatment has focused on changes in levels of the brain chemicals melatonin and serotonin in response to changing exposure to light and darkness.

Symptoms

SAD is characterized by typical symptoms of depression, such as sadness, hopelessness, and thoughts of suicide (in some cases), and “atypical” depressive symptoms such as excessive sleep, lethargy, carbohydrate cravings, overeating, and weight gain. The symptoms usually occur the same time of year, typically fall and winter, and disappear with the onset of spring and summer.

Light exposure research and treatment measures in “lux” units. For example, the intensity of light on a high mountain at the equator at midday is greater than 100,000 lux, compared with less than 11 lux generated by a moonlit night. A well-lit kitchen or office may be around 500 lux.

Other Therapies

Treatment includes daily exposure to bright light, often 2,500 lux administered in two-hour increments. Individuals with SAD should spend as much time as possible outside during the day. Use of a “dawn simulator,” a light programmed to slowly increase in intensity in the morning, is also recommended. Some healthcare providers might also recommend aerobic exercise under bright lights.

References

1. Neumeister A, Konstantinidis A, Praschak-Rieder N, et al. Monoaminergic function in the pathogenesis of seasonal affective disorder. Int J Neuropsychopharmacol 2001;4:409-20.

2. Van der Does AJ. The effects of tryptophan depletion on mood and psychiatric symptoms. J Affect Disord 2001;64:107-19.

3. Levitt AJ, Brown GM, Kennedy SH, Stern K. Tryptophan treatment and melatonin response in a patient with seasonal affective disorder. J Clin Psychopharmacol 1991;11:74-5.

4. Lam RW, Levitan RD, Tam EM, et al. L-tryptophan augmentation of light therapy in patients with seasonal affective disorder. Can J Psychiatry 1997;42:303-6.

5. Ghadirian AM, Murphy BE, Gendron MJ. Efficacy of light versus tryptophan therapy in seasonal affective disorder. J Affect Disord 1998;50:23-7.

6. McGrath RE, Buckwald B, Resnick EV. The effect of L-tryptophan on seasonal affective disorder. J Clin Psychiatry 1990;51:162-3.

7. Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Alternative Med Rev 1998;3:271-80.

8. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500-4.

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10. Martinez B, Kasper S, Ruhrmann S, Moller HJ. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatry Neurol 1994;7:S29-33.

11. Wheatley D. Hypericum in seasonal affective disorder (SAD). Curr Med Res Opin 1999;15:33-7.

12. Stumpf WE, Privette TH. Light, vitamin D and psychiatry. Role of 1,25 dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other mental processes. Psychopharmacology (Berl) 1989;97:285-94 [review].

13. Gloth FM III, Alam W, Hollis B. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging 1999;3:5-7.

14. Frandsen TB, Pareek M, Hansen JP, Nielsen CT. Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: a double-blind randomised placebo-controlled trial. BMC Res Notes 2014;7:528.

15. Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Alternative Med Rev 1998;3:271-80.

16. Lee TM, Chan CC. Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand 1999;99:315-23 [review].

17. Lewy AJ, Bauer VK, Cutler NL, et al. Morning vs evening light treatment of patients with winter depression. Arch Gen Psychiatry 1998;55:890-6.

18. Eastman CI, Young MA, Fogg LF, et al. Bright light treatment of winter depression: a placebo-controlled trial. Arch Gen Psychiatry 1998;55:883-9.

19. Lingjaerde O, Foreland AR, Dankertsen J. Dawn simulation vs. lightbox treatment in winter depression: a comparative study. Acta Psychiatr Scand 1998;98:73-80.

20. Vasile RG, Sachs G, Anderson JL, et al. Changes in regional cerebral blood flow following light treatment for seasonal affective disorder: responders versus nonresponders. Biol Psychiatry 1997;42:1000-5.

21. Partonen T, Lonnqvist J. Prevention of winter seasonal affective disorder by bright-light treatment. Psychol Med 1996;26:1075-80.

22. Lee TM, Chan CC, Paterson JG, et al. Spectral properties of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand 1997;96:117-21 [review].

23. Kogan AO, Guilford PM. Side effects of short-term 10,000-lux light therapy. Am J Psychiatry 1998;155:293-4.

24. Terman M, Terman JS. Treatment of seasonal affective disorder with a high-output negative ionizer. J Altern Complement Med 1995;1:87-92.

25. Terman M, Terman JS, Ross DC. A controlled trial of timed bright light and negative air ionization for treatment of winter depression. Arch Gen Psychiatry 1998;55:875-82.

26. Krauchi K, Reich S, Wirz-Justice A. Eating style in seasonal affective disorder: who will gain weight in winter? Compr Psychiatry 1997;38:80-7.

27. Krauchi K, Keller U, Leonhardt G, et al. Accelerated post-glucose glycaemia and altered alliesthesia-test in Seasonal Affective Disorder. J Affect Disord 1999;53:23-6.

28. Danilenko KV, Putilov AA, Russkikh GS, et al. Diurnal and seasonal variations of melatonin and serotonin in women with seasonal affective disorder. Arctic Med Res 1994;53:137-45.

29. Blum I, Vered Y, Graff E, et al. The influence of meal composition on plasma serotonin and norepinephrine concentrations. Metabolism 1992;41:137-40.

30. Christensen L. Effects of eating behavior on mood: a review of the literature. Int J Eat Disord 1993;14:171-83 [review].

31. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999;159:2349-56.

32. Martinsen EW, Hoffart A, Solberg O. Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Compr Psychiatry 1989;30:324-31.

33. Groom KN, O'Connor ME. Relation of light and exercise to seasonal depressive symptoms: preliminary development of a scale. Percept Mot Skills 1996;83:379-83.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.

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