Seasonal Affective Disorder (SAD) is a form of depression that occurs due to a lack of daylight hours. SAD symptoms, like all symptoms of depression, range from mild to severe; however, unlike symptoms of other depressive disorders, they occur only during the winter months and recur in a seasonal pattern. SAD is of special interest to Alaskans, who only experience a few hours of daylight during the winter months.
Geography
SAD is common in geographic locations characterized by only a few daylight hours during winter months, and it is often a problem within the extreme southern and northern latitudes, from late fall until early spring. According to New York On-line Access to Health (NOAH), research has demonstrated that "The further a person lives from the equator, the more likely he or she is to develop SAD." Alaska Regional Hospital also reported findings of seven times greater rates of SAD among residents of New Hampshire, than among inhabitants of Florida.
Symptoms
The symptoms of SAD do not differ from those of other depressive disorders; they are simply present during specific seasons of the year, and absent during others. Symptoms of SAD include the following:
· Mood changes characterized by negative emotions such as sadness, hopelessness, feelings of failure, despair, worthlessness and low self esteem, for a period of at least two weeks.
· Inability to experience pleasure from, or interest in things normally enjoyed; dissatisfaction with one's work, performance or behavior, with accompanying tendencies towards dissatisfaction or guilt.
· Low energy levels, characterized by desire to sleep more often, and exhibit more sedentary life choices than normally selected, when awake.
· Changes in sleep patterns as demonstrated by tendencies to sleep more often, or awaken in the early morning hours, unable to return to sleep.
· Changes in eating patterns, often involving over-eating of comfort and junk food diets, sometimes resulting in unhealthy weight gain.
· Difficulty concentrating, focusing and remembering, accompanied by decreased motivation and procrastination of planned responsibilities and obligations.
· Less social, more withdrawn, with tendencies towards social isolation.
Vulnerable populations
SAD effects 6 percent of the general population and is most common in older teens and young adults reaching their early twenties, though it is also found in children, young teens and adults. Women, and people who have family histories of depression, are four times more likely to experience SAD. The tendency to suffer from SAD, and other depression, is closely related to one's personal biology, brain chemistry, family history, and environmental and life circumstances.
Causes
Researchers believe SAD is caused by the absence of daylight exposure; however, exactly why this occurs is uncertain. Theories exist linking SAD to two hormones, Melatonin and Serotonin.
Melatonin, a hormone related to sleep patterns, is more abundant during times when less daylight is present. Increased production of Melatonin, as is common during times of less sunlight, can cause low energy and drowsiness. According to The Alaska Regional Hospital's report, many scientists believe an over abundance of Melatonin causes the depressed symptoms of SAD.
Serotonin production, on the other hand, increases with exposure to sunlight. Since Serotonin tends to decrease the likelihood of depression, its absence during times when less exposure to daylight occurs would tend to increase symptoms of depression and SAD. The combination of increased levels of Melatonin, and decreased levels of Serotonin makes it even more likely that SAD and depression will develop during winter months.
Treatment
Treatment of SAD involves use of a light box, as well as prescribed medication. The obvious method for reduction of SAD symptoms is to expose the SAD sufferer to increased levels of light. The light box is a device used for the purpose of doing so. The light box produces light about 50 times as intense as normal indoor light. The client is positioned next to the light box for about 30 minutes per session, thus replacing the portion of natural light that is unavailable during winter months.
While light therapy is considered safe for most people, some individuals experience vision related side effects after its use. Side effects experienced include eyestrain, headaches, irritability, and insomnia. Most side effects related to light therapy are experienced by individuals already suffering from eye disorders before being subjected to light therapy.
Prescription medications are also available for the treatment of SAD, and belong to four general classes of drugs. Drugs used for the treatment of SAD are: Heterocyclic antidepressants (HCAs), such as amitriptyline (trade name Elavil); Selective Serotonin reuptake inhibitors (SSRIs), such as fluoxetine (trade name Prozac); Monoamine oxidase inhibitors (MAO inhibitors), such as phenelzine sulfate (trade name Nardil); and Lithium salts, such as lithium carbonate (trade name Eskalith), often used by people suffering from bipolar disorder.
Researchers are also considering the possibility of treating SAD through Melatonin injections to see if the hormone will enable the body to adjust to longer periods of darkness without the experience of SAD related symptoms.
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