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Last Updated: 11/20/2017
 

Disability Information - Seasonal Affective Disorder (SAD)

 

General Information

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 General Information

For more information, visit http://www.sunbox.com or read the National Mental Health Association's Fact Sheet located at http://www.nmha.org/infoctr/factsheets/27.cfm.

 

WHAT IS SAD?
Seasonal Affective Disorder (SAD) is a specific type of recurring depressive illness that manifests in an annual pattern, usually from early-to-late fall and subsiding with the longer, sunnier days of spring.1 Some people have the milder form, called Subsyndromal-SAD (S-SAD), also called Winter Blues, which causes minor problems in their lives but not the total disruption that full-blown SAD causes.

 

This is the Winter-SAD subtype; another subtype is Summer-SAD, which occurs in the spring & summer months. Summer-SAD is much rarer than Winter-SAD, is less well researched, and its cause is undetermined. Throughout this website, unless otherwise noted, the term "SAD" refers specifically to Winter-SAD.


Researchers have confirmed that specific biological changes within the brain occur in response to different levels of bright light exposure, and that these biochemical changes affect hormones and neurotransmitters responsible for regulating our mood, energy, sleep and appetite. In the majority of the population, these changes are not troublesome; they simply cause minor variations in their annual rhythms. For those with SAD, though, these changes are profound enough to cause significant disruption to their lives.

 

WHO GETS IT?
SAD affects both genders, and people of all ages. A small but significant percentage of children are affected, with the female-male ratio being about equal among this age group. In the 15-43 age group, however, women outnumber men by nearly 3.5 to 1. After age 44, the number of women starts to decline and the gender ratio again equalizes.2

The effect of latitude on the incidence of SAD has not been determined conclusively. Numerous studies indicate that incidence increases with higher latitude, but some other studies have either failed to show any correlation or shown an opposite trend.3

Anyone deprived of regular sunlight exposure or adequate indoor lighting can suffer from SAD symptoms. A series of rainy, overcast days can trigger SAD even in the summertime.4

 

WHAT ARE THE SYMPTOMS?
SAD manifests itself in different ways in different people. The typical symptoms include decreased mood and energy level, social withdrawal, reduction in sex drive, anxiety, irritability, and difficulty concentrating or being productive at work. The "classic" SAD symptoms, which are considered atypical symptoms of nonseasonal depression, are changes in sleeping patterns (oversleeping and having poor sleep) and appetite changes (increased appetite, carbohydrate cravings, and subsequent weight gain).5

In children and teenagers, the symptoms are slightly different from those for adults. These symptoms include irritability, crying spells, anxiety, fatigue, difficulty in getting out of bed for school, and a lowering of grades and self-esteem. Because these symptoms mirror the symptoms of laziness, Attention Deficit Disorder (ADD), learning disabilities, or the stereotypical behavior of teenagers, it is important for parents to note whether these symptoms recur year after year during the fall and winter months, and whether they go away in the spring.6

 

WHAT CAUSES IT?
Researchers aren't sure what causes SAD. Three main theories have been put forth, and there is contrasting evidence both for and against each of these theories: the Melatonin Hypothesis, the Phase Shift Hypothesis, and the Serotonin Hypothesis.

The Melatonin Hypothesis argues that SAD is due to too much melatonin being secreted in response to the long, dark days of winter.7 Some studies have supported this theory, while others have disputed it.8

Advocates of the Phase Shift Hypothesis, proposed in 1986, contend that in patients with SAD, circadian rhythms [see Sleep & Circadian Rhythm Disorders section] have been desynchronized to the light-dark cycle, and that appropriately timed bright light reverses SAD symptoms by realigning these rhythms. Again, there is evidence on either side of the debate.9

In the Serotonin Hypothesis, the idea is that serotonin levels in the brain are much lower during the winter months in patients with SAD than they are either in people without SAD or in SAD patients during the spring and summer months. This hypothesis came about from researchers observing that SAD patients tend to feel energized after carbohydrate consumption (which increases serotonin levels), whereas people without SAD generally feel more lethargic after eating carbohydrates.10 Whether serotonin is 'the cause' of SAD or not, there is currently a wide body of evidence to suggest that it does play a major role in the disorder.11

Other neurotransmitters (dopamine and noradrenaline, for example) may also be involved, as well as other hormones (thyroid, corticotrophin-releasing hormone). The role of these other neurotransmitters and hormones, though, requires further research.12

 

HOW IS IT TREATED?
Bright light is highly effective in treating SAD. According to the Journal of the American Medical Association, "Treatment [for SAD] with bright environmental light is generally a first-line therapeutic approach."13 Four out of five people with seasonal difficulties (either SAD or S-SAD) should expect to benefit from bright light treatment.14

"Several qualitative review of the literature...have concluded that light therapy, administered by fluorescent light boxes...is an effective treatment for SAD, with response rates of 60% to 90%."15 According to Norman Rosenthal, former Chief of Clinical Psychobiology at the National Institute of Mental Health, "The most effective, practical, and best-studied way of enhancing your environmental light is by means of a special light fixture or light box, the most commonly used method for administering light therapy.16

Other treatments that may be helpful include changes in diet and exercise, stress management, sleep restriction, psychotherapy, and antidepressant medications.17

 

1 Wesson, VA & AJ Levitt: Light treatment for seasonal affective disorder. In: Seasonal Affective Disorder and Beyond: Light Treatment for SAD and Non-SAD Conditions. Edited by Lam, RW. Washington, DC: American Psychiatric Press, 1998, p 45.

2 Eagles, JM: Sociodemographic aspects. In: Seasonal Affective Disorder. Practice and Research. Edited by Partonen, T & A Magnusson. New York: Oxford University Press, 2001, pp 34-37.

3 Mersch, PPA: Prevalence from population surveys. In: Seasonal Affective Disorder. Practice and Research. Edited by Partonen, T & A Magnusson. New York: Oxford University Press, 2001, pp 133-134.

4 Rosenthal, NE: Winter Blues: Seasonal Affective Disorder - What It Is and How to Overcome It. (rev. ed.) New York: Guilford Press, 1998, p 51.

5 Partonen, T & N Rosenthal: Symptoms and course of illness. In: Seasonal Affective Disorder. Practice and Research. Edited by Partonen, T & A Magnusson. New York: Oxford University Press, 2001, p 13.

6 Rosenthal, NE, CJ Carpenter, SP James et al.: Seasonal affective disorder in children and adolescents. Am J Psychiatry, 143(3): pp 356-358, 1986.

7 Rosenthal, 1998, p 249.

8 Lam, RW & AJ Levitt (eds.): Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder. Canada: Clinical & Academic Publishing, 1999, pp 42-43.

9 ibid, pp 43-45.

10 Rosenthal, 1998, p 251.

11 Lam, p 46.

12 ibid, pp 46-47 & 51.

13 Rosenthal, NE: Diagnosis and treatment of seasonal affective disorder. JAMA, 270(22): p 2719, 1993(a).

14 Rosenthal, NE: Winter Blues: Seasonal Affective Disorder - What It Is and How to Overcome It. New York: Guilford Press, 1993(b), p 108.

15 Lam, p 65.

16 Rosenthal, 1998, p 105.

17 Rosenthal, 1998, pp 144-204.

 

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 Education & Classroom Accommodations

 

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 Michigan Resources, Support Groups, Listservs & Websites

 

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 National Resources & Websites

Contact your local Mental Health Association, community mental health center, or:

 

National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959

 

Society for Light Treatment and Biological Rhythm
P.O. Box 591687
174 Cook Street
San Francisco, CA 94159-1687
www.websciences.org/sltbr

 

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 Articles Related to this Disability

A three part article on About.com about SAD by Dr. Terman and Mr. Jamie Rifkin. You can click on the first link and then click on Part 2 and 3 from that window or go to each section from our website.

Part 1: Symptoms of SAD
http://depression.about.com/library/weekly/aa120798.htm?once=true

Part 2: Treatment of SAD
http://depression.about.com/library/weekly/aa121498.htm

Part 3: Disorders Beyond SAD (discusses other conditions light therapy might be useful for)
http://depression.about.com/library/weekly/aa122198.htm

 

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 Medical Information

Phototherapy or bright light therapy has been shown to suppress the brainís secretion of melatonin. Although, there have been no research findings to definitely link this therapy with an antidepressant effect, many people respond to this treatment. The device most often used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen. For mild symptoms, spending time outdoors during the day or arranging homes and workplaces to receive more sunlight may be helpful. One study found that an hourís walk in winter sunlight was as effective as two and a half hours under bright artificial light. If phototherapy doesnít work, an antidepressant drug may prove effective in reducing or eliminating SAD symptoms, but there may be unwanted side effects to consider. Discuss your symptoms thoroughly with your family doctor and/or mental health professional.

 

Click here for information on "Bright Light" treatment.

 

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