Seasonal affective disorder

Seasonal affective disorder (SAD) is a mood disorder.

Its symptoms of it mimic those of dysthymia or even major depressive disorder. 



Patients with SAD  have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year, most commonly in winter



Common symptoms of SAD include:  sleeping too much, having little to no energy, and overeating.



Summer SAD can include heightened anxiety.



Additional names for the disorder: Depressive disorder with seasonal pattern, winter depression, winter blues, summer depression, seasonal depression.



Bright light therapy is a common treatment for seasonal affective disorder.



It is a common disorder.



Its prevalence varies with geographic location: affects from 1.4% in Florida to 9.9% in Alaska.



6.1% of the population experiences seasonal affective disorder.



There is a connection between mood, energy level, and the seasons.



SAD may lower the likelihood of risky behavior, and those affected are more likely to opt for conservative activities.



Individuals with SAD may exhibit depressive symptoms: hopelessness and feelings of worthlessness, suicide ideation , loss of interest in activities, withdrawal from social interaction, sleep and appetite problems, difficulty with concentrating and making decisions, decreased libido, a lack of energy, agitation, oversleeping or difficulty waking up in the morning, nausea, and a tendency to overeat, often with a craving for carbohydrates, which leads to weight gain.



It  is typically associated with winter depression, but an association with springtime lethargy or other seasonal mood patterns occur.



Patients who experience spring and summer depression are more likely to experience:  insomnia, decreased appetite, weight loss, agitation or anxiety.



While most people with SAD experience major depressive disorder, but as many as 20% may have a bipolar disorder. 



Around 25% of patients with bipolar disorder present with a depressive seasonal pattern.



Depressive seasonal pattern is associated with bipolar II disorder, rapid cycling, eating disorders, and more depressive episodes.



In seasonal pattern presentation males present with more Bipolar II disorder and a higher number of depressive episodes, and females with rapid cycling and eating disorders.


Seasonal affective disorder (SAD) is most prevalent in patients with early-onset bipolar II disorder, compared with other early-onset mood disorders and healthy control subjects.

Seasonal impairment is greater in patients with mood disorders compared with healthy controls.

Among patients with mood disorders, those with bipolar II disorder had the highest prevalence of SAD.

SAD affects 23% of participants with bipolar II disorder, compared with approximately 10% of participants with major depressive disorder and bipolar I disorder and just 6% of healthy controls. 



Various causes have been proposed but SAD’s explanation remains obscure: lack of serotonin, and serotonin, lack of sunlight, polymorphisms, could play a role in SAD.



Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland.



Certain personality traits, neuroticism, agreeableness, openness, and an avoidance-oriented coping style, appeared to be common in those with SAD.



Seasonal mood variations are believed to be related to light.



An argument for this view is the effectiveness of 



Bright-light therapy is effective management of SAD associated delay in circadian rhythm.



At latitudes in the Arctic region,  the rate of SAD is 9.5%.



SAD negative affects include cloud cover.



SAD has the potential risk of suicide.



6–35% of sufferers of SAD required


 hospitalization during one period of illness.



Patients may lack energy to perform everyday activities.



Subsyndromal Seasonal Affective Disorder (SSAD) is a milder form of SAD.



SSAD is experienced by an estimated 14.3%  of the U.S. population, vs. 6.1% SAD.



The depressive symptoms in SAD and SSAD sufferers can be improved by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure.



 Mood and energy levels vary by season.



Seasonal affective disorder criteria: 



depressive episodes at a particular time of the year



remissions or mania/hypomania at a characteristic time of year



these patterns must have lasted two years with no nonseasonal major depressive episodes during that same period



Seasonal depressive episodes outnumber other depressive episodes throughout the patient’s lifetime. 



Treatments for winter-based seasonal affective disorder include:  light therapy, medication, ionized-air administration, cognitive-behavioral therapy and supplementation melatonin.



This suggests that light therapy may be an effective treatment for SAD.



Light therapy uses a lightbox.


with the patient sitting a prescribed distance, commonly 30–60 cm, in front of the box with eyes open but not staring at the light source for 30–60 minutes. 



Dawn simulation is also effective, and has up to 83% better response when compared to other bright light therapy.



Light therapy can also consist of exposure to sunlight, either by spending more time outside.



Selective serotonin reuptake inhibitor antidepressants are effective in treating SAD: 67% effective in treating SAD.



Light therapy  shows earlier clinical improvement, generally within one week.



Bupropion prevents SAD  in 25% of people.



Modafinil is effective  in patients with seasonal affective disorder.



Negative air ionization, thatis releasing charged particles into the sleep environment, id effective with a 47.9% improvement if the negative ions are in sufficient quantity.



Physical exercise is an effective form of depression therapy, 



The addition of multiple  forms of treatment for SAD increases efficacy.



Evidence for cognitive behavior therapy  or any of the psychological therapies aimed at preventing SAD remains inconclusive.



Winter depression is common in most of the Nordic countries. 



Iceland, however, seems to be an exception, with the prevalence of seasonal affective disorder and seasonal changes in anxiety and depression to be unexpectedly low in both sexes.



Propensity for SAD may differ due to some genetic factor within the Icelandic population, while others suggest that this may be attributed to the large amount of fish traditionally eaten by Icelandic people.



In Alaska the SAD rate is 8.9%, and an even greater rate of 24.9% for subsyndromal SAD.



Around 20% of the inhabitants of Ireland are affected by SAD.



Women are more likely to be affected by SAD than men.



An estimated 3% of the population in the Netherlands suffer from winter SAD.


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