SEASONAL AFFECTIVE DISORDER

General Information

DEFINITION--A seasonal disruption of mood that occurs during the winter months and ceases with the advent of spring. Symptoms usually begin in September when days begin to shorten, and last through the winter into March when the days begin to lengthen again. Light plays a big part in its origin and in its treatment. In rarer instances, the seasonal disorder symptoms occur in the summer months and may be caused by an intolerance to heat.

BODY PARTS INVOLVED--Nervous.

SEX OR AGE MOST AFFECTED--Adults and children and is more common in women.

SIGNS & SYMPTOMS

Experienced at the start of winter:

• Depression; tiredness; sluggishness.
• Increased appetite (especially for carbohydrates); weight gain.
• Irritability; needing more sleep; feeling less cheerful; socializing less.
• Difficulty in coping with life as a result of these changes.

CAUSES--The pineal gland (one of the body's clocks) in the brain releases a hormone called melatonin that can adversely affect our moods. Very little melatonin is secreted in light (daytime) and its peak production is usually at night, between 2 and 3 a.m. Winter months (with their longer nights) cause extra production of melatonin, so the level in the body is increased. The average nighttime illumination in homes or offices is not adequate to counteract this affect.

RISK INCREASES WITH

• Geographical location (people in northern latitudes more susceptible).
• Other depressive illness.

HOW TO PREVENT--No measures known.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Diagnosis can be difficult. The same symptoms can arise from other types of depression. Laboratory blood studies may be done to rule out other medical disorders. Diagnosis usually requires a three-year mood disturbance pattern, with the onset occurring in the autumn and a remission in the spring.

APPROPRIATE HEALTH CARE

Self-care. Doctor's treatment. Therapies continue to evolve for treatment of people with moderate to severe symptoms, but they usually involve extending the day artificially in various ways with light therapy (phototherapy). Duration and intensities of the therapy may vary for individuals and they need to be worked out with you and your medical team. Even though these light sources are commercially available, it is recommended that they not be used without medical advice. Examples include:

Sitting in a very bright light (equivalent to 10 100 watt bulbs or more) for an hour in the morning and evening. Installing a computerized system of lighting in a patient's bedroom that creates an artificial dawn. The light goes from very dim to bright like a sunrise. Wearing a visor cap with small battery-powered lights that provide illumination falling directly on the eyes.

• For some patients the light therapy doesn't work and they may require other forms of treatment such as drugs or psychotherapy.

PROBABLE OUTCOME--With correct diagnosis and treatment, symptoms can be minimized.

POSSIBLE COMPLICATIONS--Continuation of the symptoms and lifestyle disruptions.

How To Treat

GENERAL MEASURES--

• Mild symptoms may be resolved with simple measures: keep drapes and blinds open in your house; sit near windows and gaze outside frequently; turn on bright lights on cloudy days; keep a diary or journal of your mood changes so that any changes or patterns can be evaluated; don't isolate yourself (visit friends, see shows, etc.).
• See Resources for Additional Information.

MEDICATION--Antidepressants may be prescribed for patients who do not respond to other forms of therapy.

ACTIVITY--

• Stay as active as your energy permits. Physical activity is usually always therapeutic for mood disorders.
• Get outside as much as possible, especially in the early morning light.
• Try to take a vacation in the winter months instead of the summer.

DIET--No special diet.

Call Your Doctor If

Symptoms continue or worsen despite treatment.