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Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression that typically occurs most often during the fall or winter and then subsides in the spring. It tends to be more common in areas that have fewer sunny days. It sometimes is called the ?winter blues? because most people with seasonal affective disorder have an episode of depression during the winter months, although it is possible to experience SAD during summer months. A diagnosis of SAD is made when a pattern of depression and remission from depression is present for at least two consecutive years. This should be differentiated from the typical ?blue? feeling that people seem to experience when Fall arrives. Many people become more sad when the shorter and darker days are nearing.

There are four main features of SAD:

Recurring major depressive episodes that begin around the same time each year (usually in September or October) and end around the same time each year (usually in April or May)
Full recovery from the symptoms during ?nonseasonal? months
Depressive episodes occurring during the same time of year for 2 consecutive years
Over the lifetime course of the illness, more depressive episodes during winter months than summer months
The specific cause of SAD is not well known. However, it is believed that a lack of sunlight caused by the shorter and darker days of winter, darkened or indoor workplaces, and long cloudy spells have been linked to episodes of SAD. Many experts hypothesize that SAD may be related to a disturbance in the body's natural biological clock (circadian rhythms) or problems with the regulation of a brain chemical serotonin. Many of the commonly used anti-depressant medicines affect the re-uptake of serotonin in the brain (essentially reduces the uptake so there is more seretonin).

Women are more apt to be affected then Men (women make up ~ 60-90% of those with SAD). The risk of developing SAD for the first time decreases as you grow older and younger individuals are at higher risk for winter depressive episodes. People who live in the northern hemisphere develop seasonal affective disorder more often, although you can develop SAD no matter where you live. Working environments that keeps you out of sunlight (such as working at night and sleeping during the daylight hours)will increase the likelihood of experiencing SAD.

Your health professional can diagnose SAD through a combination of a physical examination, medical history, and possibly a mental health assessment or questionnaire that helps identify symptoms of SAD. A family history of SAD increases your risk of developing SAD. In some situation, SAD can be difficult to distinguish from major depression.

There is no known cure for SAD, but the depressive episodes of SAD can be managed effectively with medications, counseling, light therapy, or a combination of these treatments.

Although light therapy is effective for SAD, scientists do not fully understand how the light works and what is the best method for light therapy. There are now many light therapy devices available on the market that make claims about light treatment. When seeking out an effective light source be sure to consider the following: 1) the light device should be clinically tested and its efficacy should be validated, 2) the light device should filter the harmful ultraviolet rays, 3) the light device company should have a track record of reliability.

Typically it is recommended that the light source be either a 10,000 lux light box or a light visor because they have been extensively tested in scientific studies. These devices fullfill all the criteria above. BLV Co has no financial interest in the companies recommended below.

Medic-Light 10,000 Light Box
Medic-Light, Inc.
Yacht Club Drive
Lake Hopatcong, NJ 07849

SunRay I Light Box
SunBox Company
19217 Orbit Drive
Gaithersburg, MD 20879-4149

Light Visor
BioBrite, Inc.
7315 Wisconsin Avenue, Suite 900E
Bethesda, MD 20814-3202

S-adenosylmethionine (SAMe)
Claims:Anti-depression, (more effective than prescription anti-dep 38% to 20%-Bressa 1994) arthritis and liver problems
Actions: From methionine and ATP, synthesis of hormones, neurotransmitters, nucleic acids and proteins. Enhances DA and seretonin fxn in brain
CI: When methyl group lost SAM converts to homocysteine (dangerous to CVS), B6, B12 and folate will convert homocysteine to glutathione
Side effects: Manic episode in bipolar disease, mild GI prob
Interactions: Do not use with MAOI
Dosage: Depression-200-400 mg/day; Arthritis 600-1200/day

Essential Fatty Acids:

-Low levels of EFAs have been linked to depression

-Fish oil supplementation may be a promising alternative to standard antipsychotic drugs used in schizophrenic patients (Joy, C. et al. Cochrane Data Sys Rev, 2000)

-Omega 3 deficiency was prevalent in patients with minor and major depression, indicating an abnormal intake or skewed metabolism of EFAs in major depression (Maes, M. et al. J Affect Disord, 1996)

-Deficiency of omega 3 fatty acids has been linked to behavior and sleep problems in children between ages 6 to 12 years (Stevens, S. et al. Physiol Behav, 1996)

5-Hydroxytryptophan (5-HTP)
Claims: Raises CNS serotonin levels, balances mood (bipolar), cuts time to fall asleep in 1/2, reduces appetite, reduces Parkinsons and Migraine sx
Actions: Precursor to L-tryptophan and serotonin, increases beta-endorphin release
CI: Don?t take with MAO inhib
Side effects: Doses above 6 gm can harm liver, an impurity ?peak X? assoc with 1500 cases of eosinophilia-myalgia syndrome-linked to L-tryp supplied from Japan has been reported
Interactions: Avoid high protein close to taking 5-HTP (reduces assimilation), supp with B3 prevents breakdown to niacinamide
Dosage: Take two hrs before or after meals, take with high CHO snack or liquid 100 mg/day max 600-1000 mg/d

St. John?s Wort (hypericum perforatum)
Claims: Mild to moderate depression, viral infections, wound healing
Actions: Antidepressant (weak MAOI, SSRI and DA agonist), Antiviral
CI: Do not take with MAOI, antidepressants, antiseizure medications; Do not take while pregnant
Side effects: Photosensitivity
Interactions: Antidepressants, Mono Amine Oxidase Inhibitors
Dosage: 300 mg TID with food (should say 0.3%hypericin)
(Has IND status by FDA-VIMRxyn for AIDS tx) (more than 23 controlled trials show SJW to be more effective than placebo)

Folic acid
Folate and vitamin B6 supplementation reduces risk of heart disease (Study of 80,082 women)
-Combining with one drink/day further reduces risk
-Low intake of Folate and B6 lead to high levels of homocysteine which leads to increase in heart disease
-Recommended Dietary Allowance: 400 micrograms
-Coenzyme for AA metabolism and nucleic acid synthesis folate may be low in patients with mild to moderate depression
Folate RDA:180 ug (recommend: 300-600 ug)
Vitamin B6 RDA: 1.6 mg (recommend: 3-10 mg)

Rimm et al 1998

Seasonal Affective Disorder And Light Therapy References
Journal Articles

Lam RW, Fleming JAE, Buchanan A, Remick RA: Seasonal affective disorder.
Canadian Family Physician 1990; 36:1162-1166.

Blehar MC, Lewy AJ: Seasonal mood disorders: concensus and controversy.
Psychopharmacology Bulletin 1990; 26:465494.

Lam RW, Kripke DF, Gillin JC: Phototherapy for depressive disorders: a review.
Canadian Journal of Psychiatry 1989; 34:140-147.

Wehr TA, Rosenthal NE: Seasonality and affective illness.
American Journal of Psychiatry 1989; 146:829-839.

Lewy AJ, Sack RL, Singer CM, et al: Winter depression and the phase shift hypothesis for bright light's therapeutic effects: history, theory, and experimental evidence.
Journal of Biological Rhythms 1988; 3:121-134.

Rosenthal NE, Sack DA, Gillin IC, et al: Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy.
Archives of General Psychiatry 41 :72-80, 1984

Books and Book Chapters

Rosenthal NE, Blehar M (eds): Seasonal Affective Disorders and Phototherapy. New York, Guilford Press, 1989.

Thompson C, Silverstone T (eds): Seasonal Affective Disorder. London, CNS (Clinical Neuroscience) Publishers, 1989.

Patient Education

Seasons of the Mind, by Dr. Norman Rosenthal. New York, Bantam Books, 1989, about $13.00.

Winter Depression, by Angela Smyth in consultation with Professor Chris Thompson. London, Unwin Paperbacks, 1990, about 13.00.

The Light Book, by Jane Wegscheider Hyman. Toronto, Random House, 1990, about $7.00.
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