Seasonal Affect Disorder (SAD) By, Leah Wasicka

Transcription

1 Seasonal Affect Disorder (SAD) By, Leah Wasicka

2 What is SAD? A pattern of major depressive episodes that occur and remit with changes in seasons Winter SAD Late Autumn through Winter Summer SAD July and August A dip in mood associated with a lack of light at Northern latitudes

3 SAD: A Subtype of Depression SAD is a specifier of either bipolar or recurrent major depressive disorder, with a seasonal pattern of major depressive episodes (DSM IV) All depression that occurs during winter months is not necessarily SAD Winter blues = low grade of SAD SAD symptoms are atypical of depression Light therapy does not benefit nonseasonal depressive patients

4 Summer SAD Triggered by heat More similar to depression Eat less Sleep less Lose weight More suicidal thoughts

5 Summer SAD con t Treatment Keep cool Regular aerobic exercise Antidepressant drugs Prozac Zoloft

6 Winter SAD: Symptoms Hypersomnia Feelings of sadness, anxiety, fatigue Cravings for sweet or starchy foods Big weight gain Overeating Headaches Difficulty awakening in morning Daytime drowsiness

7 Summer vs. Winter SAD Sleep Increase Sleep Decrease Summer Winter

8 Summer vs. Winter SAD con t Appetite Decrease Weight Loss Appetite Increase Carbo Craving Weight Gain Summer Winter

9 Summer vs. Winter SAD con t Influenced more by Temp Influenced more by Light Summer Winter

10 Seasonal Pattern Assessment Questionnaire (SPAQ) Used for population surveys Not used as a diagnostic test After taking SPAQ: cannot conclude if you have SAD, need to go for a detailed clinical evaluation

11 How to Score the SPAQ 1. Establishing your pattern of seasonality: No time of year generally feel best or worst = non seasonal pattern Feel worst in Dec, Jan or Feb = winter seasonal pattern Feel worst in July or August = summer seasonal pattern Can have combo of winter and summer seasonal pattern 2. Degree of seasonality

12 Score SPAQ con t 3. Determining whether seasonal changes are a problem for you, and if so to what degree 4. Evaluating other information (not for scoring purposes) Interest to clinicians and researchers who treat SAD

13 How to Interpret SPAQ Scores 1. Establishing pattern of seasonality Almost 50% of people in Northern US report feeling worst during winter Report eating, sleeping more and weight gain most in winter months Report eating, sleeping less, and weight loss in summer months 2. Degree of seasonality 4-7 points = average overall score 8-10 points = Winter Blues 11+ points = SAD

14 Interpreting SPAQ Scores con t Higher seasonality scores: See changing seasons as a problem (Q 3) Show greater changes in weight and total numbers of hours they sleep per day during different seasons (Q 4 & 5) Report seasonal changes in food preference (Q 6) 3. Seasonal changes a problem for you? 25% people in Northern US report yes Higher score more likely SAD is a problem

15 Treatment for SAD Bright light Tx Needs to be at least 2,500 lux at eye level House light = 100 lux or less Workplace = lux Outdoors = 2,000-10,000 lux 40% respond fully to bright light Tx Antidepressants have been shown as effective Need more research Not Tx of choice

16 How Light Tx Works No one really knows Light constantly stimulates a region on the retina Too much light, light at wrong intensities or light administered at wrong time of day can cause symptoms to worsen Too much light can induce a swing to hypomania or mania Light Tx given too late in day produces insomnia

17 Side Effects of Light Tx Headaches Fatigue Irritability Hypomania Insomnia Possible retinal damage

18 Study: 3 Weeks of Bright Light Therapy Will Lift Winter SAD 6 weeks 96 patients with SAD Randomly assigned to one of three groups Morning light 6:00 AM Evening light 9:00 PM Morning placebo 6:00 AM Tx lasted for 90 minutes Tx boxes produced 6,000 lux Placebo box produced negative ions

19 Study con t Results: All 3 Tx greatly reduced SAD By week 4 responses were: 61% morning light group 50% evening light group 32% placebo group Conclusions Bright light Tx had specific antidepressant effects beyond placebo effect Took 3 weeks for a significant effect to develop

20 Prevalence of SAD 10 million Americans 1 in 10 people in Alaska and other Northern regions 1 in 100 people in Florida 25 million Americans have Winter Blues Lifetime prevalence 8%

21 Risk and Onset of SAD Risk 1.2% of general population Mostly adults (age 20-40) Percent of adults with SAD report onset of symptoms: Prior to age 11 = 9% Prior to age 19 = 33% Average age onset % of SAD patients are 4th-6th graders; 3% HS

22 Susceptibility to SAD Light depravation Live in Northern regions (higher latitude) Time of year Women (4:1) Young Stress Family history