What is Seasonal Affective Disorder (SAD)?
Seasonal Affective Disorder (SAD), also known as winter depression or winter blues, is a subtype of mood disorder consists of recurrent major depressive episodes of varying severity, that occur with a seasonal pattern. The most common type of SAD is winter depression with symptoms from the fall and winter. This is followed by a complete remission or hypomanic states (mild state of mania) during the spring and summer following. A rare form of SAD occurs during the summer. SAD is generally characterized by four central elements;
1. Recurrent major depressive episodes, which begin at the same time each year, e.g. September to October, and end around the same time each year, for example, from March to April
2. Complete remission of symptoms during the time allocated for the year, for example, from May to August,
3. Relatively more seasonal depressive episodes than non-seasonal episodes in the life course of the disease,
4. Seasonal depressive episodes occur in at least 2 consecutive years.
Subsyndromal SAD is a disorder with symptoms similar but milder to the CAS, which do not affect the patient’s ability to function. It was reported that there is a lack of information about the incidence and detection of seasonal depression. Prevalence rates suggested by the studies ranged from 1 to 12% depending on diagnostic criteria. The overall incidence of SAD life is said to range from 0 to 9.7%, depending on the specific study population and how it is diagnosed. The prevalence of SAD may be higher in northern latitudes than southern latitudes and may vary among ethnic groups at the same latitude. It was reported that the risk of SAD probably increases if people move to live farther from the equator. Almost all studies of the impact of the report of sad that women are more likely to suffer from SAD. The average ratio of women to men in all studies is 1.8 to 1.2 during the childbearing years, women with prevalent, but a reduced incidence and a narrowing of the gender gap is seen in old age.
With regard to age, studies indicate that the incidence increases the lifetime of SAD with age up to 60 years. After the age of 50-54 years, it is reported that the incidence decreased significantly and, as such, more than 65 years, the incidence of SAD is very low. Apart from that, however, patients over 65 may still present to the hospital for treatment. It was suggested that the response of patients over 65 to be treated no different from that of younger patients with SAD. It should be noted that the low incidence of seasonal depression in the elderly may be the result of misdiagnosis as physicians may consider the symptoms experienced by these people as being down to old age and not sad. Children also suffer from seasonal depression, although it is rare that children are more likely than adults to play and interact outside exposing them to more sun and the removal of any of these possible triggers SAD, but the incidence increases at puberty. Severity of SAD can be mild, moderate or severe.
Cause of SAD
The cause of SAD is unknown. However, it is thought that in people predisposed to winter SAD, decreasing daylight period as winter approaches is thought to be a trigger. Essentially, the onset of SAD is thought to be associated with a seasonal reduction in daylight, and to surrender that followed the seasonal increase in daylight.
Symptoms of SAD include
1. Hypersomnia (excessive sleeping)
2. Chocolate / carbohydrate thirsty
3. Impaired concentration
5. Weight gain
6. Decreased libido
7. Anhedonia (lack of pleasure or the ability to experience)
8. Low mood, which is often worse in the morning
9. Loss of interest
10. Lack of motivation
12. Anergy (lack of energy)
13. Social withdrawal
14. In children, symptoms may also include grades falling in the winter and higher in the spring, or poor relations at the school during the winter
Patients sad winter can be a reversal of their winter symptoms in summer, that is, elevated mood, increased libido, social activity and energy, reduce the need for sleep, appetite and mild hypomania (mild state of mania).
Several conditions have been reported to be associated with SAD because they share similar mechanisms. These include,
1. Panic disorder
2. Social phobia
4. Chronic Fatigue Syndrome
5. Premenstrual syndrome
6. Can also be associated with attention deficit hyperactivity disorder (ADHD)
7. A model of seasonal alcohol use may be associated with SAD
Treatment options for SAD include
1. Regular exposure to the outside natural light (sunlight therapy) as much as possible in autumn and winter, especially in the morning. This is recommended for milder symptoms and in conjunction with other therapies in severe cases.
2. Continuing regular exercise. It is antidepressant in itself and helps to reduce weight gain and promote a sense of control. Outdoor exercise (walking or light jogging) is even more beneficial by simultaneous exposure to light. It should also be used in conjunction with other therapies.
3. Light therapy, which has been recommended as first-line treatment for SAD. This includes the use of light boxes. Alternatives include light sources suitable for the workplace (such as desk lamps or mounts over computer screens), rechargeable light visors and dawn simulating alarm clocks (clock). Both sad and full-syndromic subsyndromal can respond to light therapy.
4. Cognitive-behavioral therapy. This has some effectiveness in improving dysfunctional automatic thoughts and attitudes, behaviors, withdrawal and low rates of positive reinforcement. When used in combination with light therapy, cognitive behavioral therapy was found to be effective in the treatment and prevention against the recurrence of SAD.
5. Pharmacotherapy (antidepressants such as fluoxetine and sertraline). They are often used in moderate to severe cases, alone or in conjunction with light therapy.
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