Seasonal Affective Disorder

Kenneth R. Yeager PhD

SAD Definition• Seasonal Affective Disorder (SAD) is

a recurrent major depression which generally results in lethargy and depression symptoms during the Fall and Winter seasons – Measure with Global Seasonality Score (GSS) from

the Seasonal Pattern Assessment Questionnaire (SPAQ). (Rosenthal, 1987)

– Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (APA, 2000)

SAD Definition

– Structured Interview Guide for the Hamilton Depression Rating Scale: Seasonal Affective Disorder Version (SIGH-SAD) (Williams, 1988)

– WHO “ICD-10 Classification of Mental and Behavioral Disorders” (WHO, 1992)

• SAD epidemiology favors age (young), gender (female), and latitude (far from equator), but not race or ethnicity (Sher, 2001; Boehnert, 2003;

Magnusson, 2000; Eagles, 2003 )

SAD Mechanisms• Melatonin Dysregulation (Malhotra, 2004; Arnedt, 2003; Lam,

2000; Wehr, 2001)

– Secretion is longer than normal in winter

• Serotonin Deficiency (Sher, 2001) – L-tryptophan is a precursor of serotonin

• Genetic Abnormalities (Sher, 2004; Ebisawa, 2007) – Based on epidemiology studies; serotonin transporter or

clock gene defects

Comorbidity

• SAD also frequently found with – Bulimia nervosa (Levitan, 2004; Eagles, 2003) – Premenstrual dysphoric disorder (Portella, 2006) – Alcohol dependence (Sher, 2004)

• No diurnal preference (morningness vs eveningness) (Natale, 2005; Bernert, 2005)

SAD Symptoms • A distinct seasonal pattern to your mood (i.e.,

very little or no depression symptoms during spring or summer months, when the days are longer)

• A recurrent pattern of decreased energy and activity levels you usually enjoy during the winter months

• Improved mood if you are in a sunnier climate during the usual "high risk" winter months

SAD Symptoms • Persistently low, depressed mood that lasts for usually

two to three months during winter months. November to February are the peak months.

• Depression symptoms such as:– low mood, – changes in appetite or weight, – decreased energy or fatigue, – sleep changes, – avoidance of social situations) in the absence of

other identifiable triggers or causes

Reduce SAD Symptoms• There are a number of very effective strategies that can help

lessen the impact of SAD:– Make a point to spend more time outdoors during peak

light hours (10am to 2pm), even if it's only for 10 to 15 minutes during a coffee or lunch break.

– Arrange your home and work environments (if possible) to maximize your exposure to direct sunlight: Leave blinds and curtains open and try to be around windows that allow in natural light.

Reduce SAD Symptoms

– Avoid sedentary activities, turn off your television and stay off your couch– Engage in activities that while indoor engage your

brain and body. It’s a great time to do a home project, work on that novel you have been planning to write, hone your music talents

– Socialize, winter is a great time to reconnect with friends, host gatherings, visit relatives

Reduce SAD Symptoms

– If you are going to be drinking while socializing remember all things in moderation. Too much alcohol can contribute to SAD symptoms.

– The grey months are also a time for keeping up with vitamin supplements such as vitamin D, and other ammine boosting supplements to keep those winter sniffles at a distance

SAD Treatment• If you find the above listed strategies are not

working for you consult your healthcare provider. They may make additional recommendations such as:– Light therapy (Wirz-Justice, 2005; Golden, 2005) – 2500 to 10,000 lux white light for 15-30 min– Wake therapy? Controlled sleep deprivation – SSRIs (Prozac, Zoloft) do as well as light (Blumberger,

2005)

Reduce SAD Symptoms

• By vigilant about taking care of yourself in the fall and winter months, be sure you: – exercise, take walks outdoors between 10:00 am

and 2:00 – eat a healthy diet – socialize– drink alcohol in moderation– consider vitamin supplements such as vitamin D

Calculate Your Risk • What is your gender?

___ M ___ F• Are you above the age of 35 ___ Yes

___ No• Have you ever been diagnosed with Seasonal

Affective Disorder (SAD)? ___ Yes ___ No

• Have you ever been diagnosed with bulimia?

___ Yes ___ No

Calculate Your Risk

• Have you ever been diagnosed with premenstrual dysphoric disorder (severe PMS)? ___ Yes ___ No

• Have you ever been diagnosed with an alcohol or drug problem?

___ Yes ___ No• Are you more sensitive to odors than others?

___ Yes ___ No

• Does anyone in your immediate family have seasonal affective disorder? ___ Yes ___ No

Conclusion• The total risk value from this brief survey is a score

of 8, it can help quantify the risk of having SAD. If you are female you can begin by adding 1 point

• If you find your scores in the range of 1-3 you are experiencing usual seasonal blues.

• If your score is 4-6 get moving and take your supplements

• If your score is 7 or 8 ask your healthcare professional about Seasonal Affective Disorder.

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