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Seasonal Affective Disorder
Source: VA Affair
Office
Posted on January 26, 2011 |
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Dr. Joseph Pace |
While
it may be just a temporary case of “winter blues” for
most people, for others the long cold days of winter can
be a serious psychological problem.
It’s
called Seasonal Affective Disorder — and never has an
acronym been more apropos: SAD.
According to Dr. Joseph V. Pace, Chief of Psychiatry at
the Alaska VA Medical Center, SAD is defined as
“recurring depression with seasonal onset and
remission.”
Two
seasonal patterns of SAD have been described: the
fall-onset SAD and the summer-onset SAD. The fall-onset
type, also known as “winter depression,” is most
recognized. In this subtype, major depressive episodes
begin in late fall to early winter and decrease during
summer months.
Dr.
Pace adds that some of the symptoms of SAD include
increased appetite, weight gain, sleep loss, decreased
energy and lack of motivation.
He
notes that, “Usually, we do not see pure seasonal
depression, but seasonal worsening of pre-existing
depression. Also, low vitamin D levels are common in our
Alaskan vets and can correlate with depression. We
screen for that and treat it.”
One of
the treatments he also recommends is aerobic exercise,
“which can sometimes help.”
The
cause of SAD is not well understood. It is believed that
the decreasing daylight available in fall and winter
triggers a depressive episode in people predisposed to
develop the disorder. However, no studies have
established a causal relationship between decreasing
daylight and the development of winter SAD.
One of
the most effective remedies for dealing with the
condition is light therapy. Light therapy has proven
effective in a limited number of small,
placebo-controlled studies.
The
usual dose is 10,000 lux (the intensity of light that
hits or passes through a surface) beginning with one
10-to-15 minute session per day, usually in the morning,
gradually increasing to 30-to-45 minutes per day,
depending upon response.
It may
take four- to- six weeks to see a response, although
some patients improve within days. Therapy is continued
until sufficient daily light exposure is available
through other sources, typically from springtime sun.
Light
therapy is considered first-line therapy in patients who
are not severely suicidal, have medical reasons to avoid
antidepressant drugs, have a history of a positive
response to light therapy, or if the patient
specifically requests it.
Medication is also an option in some cases. Drugs may be
a better option in patients with significant functional
impairment or who are at high suicide risk, for patients
with a history of moderate to severe recurrent
depression and for patients who have had a prior
positive response to antidepressants or mood stabilizers
or who have failed other therapies.
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