Transcript Yeager`s powerpoint presentation

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.
References
• (APA, 2000) American Psychiatric Association. (2000) Diagnostic and
Statistical Manual of Mental Disorders, 4th edition, text revision (DSMIVTR). Washington, DC: American Psychiatric Press.
• (Arendt, 2003) J. Arendt (2003) Importance and Relevance of Melatonin
to Human Biological Rhythms. Journal of Neuroendocrinology, Vol. 15,
427–431.
• (Barinaga, 2002) Marcia Barinaga (8 Feb 2002) Circadian Clock: How the
Brain's Clock Gets Daily Enlightenment. Science Vol. 295. no. 5557, pp.
955–957.
• (Bernert, 2005) Rebecca A. Bernert (2005) A Circadian Vulnerability For
Depression: Eveningness And Sleep Variability. Master’s thesis for Florida
State University.
• (Bhatia, 2007) Subhash C. Bhatia, Shashi K. Bhatia. Diagnosis and
Treatment of Premenstrual Dysphoric Disorder. Downloaded on 6/5/2007
from http://www.aafp.org/afp/20021001/1239.html.
References
• (Bierman, 2005) Andrew Bierman, Terence R Klein and Mark S Rea (2005)
The Daysimeter: a device for measuring optical radiation as a stimulus for
the human circadian system. Meas. Sci. Technol. (16) 2292–2299.
• (Blumberger, 2005) Daniel M. Blumberger, M.D., and Anthony J. Levitt
(Oct 2005) The Light-er Side of Treating Seasonal Affective Disorder.
Psychiatric Times Vol. 22 Issue 11.
• (Boehnert, 2003) Caryl E. Boehnert, Robert A. Alberts (Jan 2003) Seasonal
Affective Disorder in Women How to identify and treat. Women’s Health
in Primary Care. Vol. 6, No. 1.
• (Eagles, 2003) John M. Eagles (2003) Seasonal affective disorder. British
Journal of Psychiatry 182, 174-176.
• (Ebisawa, 2007) Takashi Ebisawa (2007) Circadian Rhythms in the CNS and
Peripheral Clock Disorders: Human Sleep Disorders and Clock Genes. J
Pharmacol Sci 103, 150 – 154.
References
• (Golden, 2005) Robert N. Golden, Bradley N. Gaynes, R. David Ekstrom,
Robert M. Hamer, Frederick M. Jacobsen, Trisha Suppes, Katherine L.
Wisner, Charles B. Nemeroff, (2005) The Efficacy of Light Therapy in the
Treatment of Mood Disorders: A Review and Meta-Analysis of the
Evidence. Am J Psychiatry; 162, 656–662.
• (Horne, 1976) Horne, J.A., & Östberg, O. (1976). A self-assessment
questionnaire to determine morningness-eveningness. International
Journal of Chronobiology, 4, 97-110.
• (Keller, 2004) Matthew C. Keller, Barbara L. Fredrickson, Oscar Ybarra,
Stephane Cote, Kareem Johnson, Joe Mikels, Anne Conway, Tor Wager
(2004) A Warm Heart and a Clear Head The Contingent Effects of
Weather on Mood and Cognition. Psychological Science (16) 9, 724-731.
• (Lam, 2000) Raymond W. Lam, Robert D. Levitan (2000) Pathophysiology
of seasonal affective disorder: a review. J Psychiatry Neurosci 25(5) 46980.
References
•
•
•
•
(Levitan, 2004) Robert D. Levitan, Mario Masellis, Vincenzo S. Basile, Raymond W.
Lam, Allan S. Kaplan, Caroline Davis, Pierandrea Muglia, Bronwyn Mackenzie, Subi
Tharmalingam, Sidney H. Kennedy, Fabio Macciardi, James L. Kennedy (2004) The
Dopamine-4 Receptor Gene Associated with Binge Eating and Weight Gain in
Women with Seasonal Affective Disorder: An Evolutionary Perspective. Biol
Psychiatry 56:665–669.
(Lewy, 1989) Lewy, A.J., Sack, R.L., Singer, C.M., White, D.M., Hoban, T.M., 1989.
Winter depression and the phase-shift hypothesis for bright light’s therapeutic
effects: history theory and experimental evidence. In: Rosenthal, N.E., Blehar, M.C.
(Eds.), Seasonal Affective Disorders and phototherapy. Guilford Press, New York, pp.
295–310.
(Lewy, 2006) Alfred J. Lewy, Bryan J. Lefler, Jonathan S. Emens, and Vance K.
Bauer.(2006) The circadian basis of winter depression. PNAS; 103; 7414-7419.
(Magnusson, 2000) Magnusson A. (2000) An overview of epidemiological studies
on seasonal affective disorder. Acta Psychiatr Scand 101: 176-184.
References
• (Malhotra, 2004) Samir Malhotra, Girish Sawhney, Promila Pandhi (2004)
The Therapeutic Potential of Melatonin: A Review of the Science.
MedGenMed. 6 (2): 46.
• (McCarthy, 2002) E. McCarthy, N. Tarrier, L. Gregg (2002) The nature and
timing of seasonal affective symptoms and the influence of self-esteem
and social support: a longitudinal prospective study. Psychological
Medicine, 32, 1425–1434.
• (Murray, 2006) Greg Murray, Erin E. Michalak, Anthony J. Levitt, Robert D.
Levitan, Murray W. Enns, Rachel Morehouse, Raymond W. Lam. (2006) O
sweet spot where art thou? Light treatment of Seasonal Affective Disorder
and the circadian time of sleep. Journal of Affective Disorders (90) 227–
231.
• (Natale, 2005) Vincenzo Natale, Ana Adan, Paolo Scapellato (2005) Are
seasonality of mood and eveningness closely associated? Psychiatry
Research (136) 51– 60.
References
•
•
•
•
•
(NINDS, 2007) National Institute of Neurological Disorders and Stroke, NINDS
Hypersomnia Information Page, downloaded on 6/3/2007 from
http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm.
(Portella, 2006) Portella, Amy T. Nguyen; Haaga, David A. F.; Rohan, Kelly J. (Nov
2006) The Association Between Seasonal and Premenstrual Symptoms Is
Continuous and Is Not Fully Accounted for by Depressive Symptoms. Journal of
Nervous & Mental Disease. 194 (11) 833-837.
(Postolache, 2002) Postolache, TT, Wehr, TA, Doty, RL, Sher, L, Turner, EH, Bartko, JJ,
Rosenthal, NE. (2002) Patients with Seasonal Affective Disorder have Lower Odor
Detection Thresholds than Control Subjects. Arch Gen Psychiatry (59) 1119-1122.
(Rosenthal, 1984) Rosenthal, N.E., Sack, D.A., Gillin, C., Lewy, A.J., Goodwin, F.K.,
Davenport, Y., Mueller, P.S., Newsome, D.A., Wehr, T.A., 1984. Seasonal Affective
Disorder: a description of the syndrome and preliminary findings with light therapy.
Arch. Gen. Psychiatry 41,
72–80.
(Rosenthal, 1987) Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern Assessment
Questionnaire. Washington, DC: National Institute of Mental Health; 1987.
References
• (Sher, 2001) Leo Sher (2001) Genetic Studies of Seasonal Affective
Disorder and Seasonality. Comprehensive Psychiatry, Vol. 42, No. 2
(March/ April): pp 105-110.
• (Sher, 2004) Leo Sher (Jan/Feb 2004) Alcoholism and Seasonal Affective
Disorder. Comprehensive Psychiatry, Vol. 45, No. 1: pp 51-56.
• (Terman, 2006) Michael Terman, Jiuan Su Terman (Dec 2006) Controlled
Trial of Naturalistic Dawn Simulation and Negative Air Ionization for
Seasonal Affective Disorder. Am J Psychiatry 163:2126-2133.
• (Tsuno, 2005) Tsuno, N, Besset, A, Ritchie, K (2005) Sleep and Depression.
J Clin Psychiatry (66) 1254-1269.
• (Vieth, 2004) Reinhold Vieth, Samantha Kimball, Amanda Hu, Paul G
Walfish (2004) Randomized comparison of the effects of the vitamin D3
adequate intake versus 100 mcg (4000 IU) per day on biochemical
responses and the wellbeing of patients. Nutrition Journal, 3:8.
References
•
•
•
•
•
(Wehr, 2001) Wehr, TA, Duncan, WC Jr, Sher, L, Aeschbach, D, Schwartz, PJ, Turner,
EH, Postolache, TT, Rosenthal, NE (2001) A Circadian Signal of Change of Season in
Patients with Seasonal Affective Disorder. Arch Gen Psychiatry. (58) 1108-1114.
(WHO, 1992) World Health Organization. (1992) The ICD-10 Classification of
Mental and Behavioral Disorders. Diagnostic Criteria for Research. Geneva,
Switzerland: World Health Organization.
(Williams, 1988) Williams, J. B. W., Link, M. J., Rosenthal, N. E. & Terman, M. (1988)
Structured Interview Guide for the Hamilton Depression Rating Scale: Seasonal
Affective Disorder Version (SIGH-SAD) (New York State Psychiatric Institute, New
York).
(Winkler, 2005) D. Winkler, S. Kasper. (2005) Seasonal affective disorder: from
diagnosis to treatment. Medicographia, Vol 27, No. 3.
(Wirz-Justice, 2005) Anna Wirz-Justice, Francesco Benedetti, Mathias Berger,
Raymond W. Lam, Klaus Martiny, Michael Terman, Joseph C. Wu (2005)
Chronotherapeutics (light and wake therapy) in affective disorders. Psychological
Medicine, 35, 939–944.