Seasonal Affective Disorder

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Seasonal affective disorder (SAD) refers to episodes of depression that generally occur at a certain time of the year, typically during the winter months. There is also a less common form of SAD that involves episodic depression during the summer months. Individuals who live in places where the winter nights are long, such as the northern latitudes, are at an increased risk for SAD. SAD is more common in women than in men, and the onset may begin as early as the teenage years. Additional factors that may influence the development of SAD include the amount of light an individual is exposed to, as well as body temperature, genetic factors (i.e., family history of SAD), and levels of certain hormones, such as melatonin (which regulates sleep patterns and mood). In addition, decreased sunlight can cause levels of the neurotransmitter serotonin to drop, which may also trigger the onset of depression.

The symptoms associated with SAD generally arise slowly during the course of the late autumn and early winter months, and are the same as those that are associated with major depression: decreased energy and loss of concentration in the afternoon hours, loss of interest in work and other activities, lethargy, social withdrawal and isolation, anxiety, and general unhappiness. Contrary to other forms of depression, winter-onset SAD often results in increased appetite and weight gain, as well as increased sleep and daytime sleepiness. Summer-onset SAD is more often characterized by anxiety, insomnia, irritability, agitation, weight loss, decreased appetite, and increased sex drive. In addition, the spring and summer months can also affect individuals who suffer from bi-polar disorder, by initiating symptoms of mania. When this occurs, it is referred to as reverse seasonal affective disorder. Symptoms of this variant include a continuously elevated mood, hyperactivity, agitation, enthusiasm that is disproportionate to given situations, and rapid speech and thinking.

The diagnosis of SAD is generally based on an examination of the patient’s symptoms and history, however certain blood tests and other examinations may be useful to help rule out other disorders with similar symptoms. Antidepressant medications as well as talk therapy are effective forms of treatment for SAD. The most common antidepressant medications used to treat SAD include paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac, Sarafem), and venlafaxine (Effexor). Extended-release bupropion (Wellbutrin XL) may also help prevent recurrence of depression in individuals with a history of SAD.  In addition, increased exposure to sunlight by way of increased outdoor activity, particularly exercise, can also help improve symptoms. Environmental changes, such as opening blinds and trimming tree branches to allow more light to enter windows can also be beneficial. Some people have also received benefit from light therapy. Light therapy involves sitting near a special lamp with an extremely bright fluorescent light for a period of time each day, usually in the early morning. If it is beneficial, the effects of light therapy will generally be realized within a month. With appropriate treatment, many individuals can successfully manage their SAD, however others may have the disorder throughout their lifetime. In addition, SAD can sometimes develop into chronic depression or bi-polar disorder.

Seasonal Affective Disorder and Fibromyalgia

An estimated 30% of all fibromyalgia patients have clinically significant depression at the time they are diagnosed. Depressed individuals frequently modify their behaviors as a result of their depression, including limiting their time spent with friends, and self-imposed isolation in their homes. Decreased physical activity is also common, both as a result of the depression and due to the painful fibromyalgia symptoms. This can all culminate in increased time spent indoors and decreased exposure to sunlight. The scientific literature pertaining to SAD in fibromyalgia patients specifically is scarce; nevertheless, the increased risk of depression among fibromyalgia patients makes SAD a particular topic of interest. It is important for fibromyalgia patients who suffer from depression to pay attention to any seasonal changes in their symptoms, which may lead to a better understanding of the nature of their depression, as well as better options for management.

Fibromyalgia and SAD Research

One study has addressed SAD in individuals with fibromyalgia. Hawley et al. assessed patients with what they collectively described as rheumatic diseases to determine the seasonal nature and prevalence of their symptoms, as well as between-disease differences. In total, the study surveyed 614 patients with rheumatoid arthritis, 375 with osteoarthritis, and 435 with fibromyalgia. All of the patients were participants in a long-term rheumatic disease outcome study and had previously completed a Seasonal Pattern Assessment Questionnaire (SPAQ) in 1991. The SPAQ is a frequently used screening tool for SAD. All patients had also been followed over a 24 year period, and their corresponding clinical data from the visit closest in time to when they completed the SPAQ was collected and used for comparison to their survey responses. In addition, each patient also completed various questionnaire-based assessments of health status, disability, arthritis, anxiety, depression, pain severity and overall functioning at each clinic visit. Following their data analysis, the researchers found that 23% of the fibromyalgia patients exhibited a high seasonal variations of  depression symptoms, based on their responses to the SPAQ. This was the highest rate among the three groups of patients. However, the researchers found no correlation between season and actual pain severity measurements, despite the fact that patients reported increased symptoms severity on their self-reported SPAQ. The authors concluded that although patients frequently reported seasonal variations in symptoms and symptom severity, these self-reports were not confirmed by corresponding clinical data (Hawley et al., 2001).

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References

1.        Seasonal affective disorder. U.S. National Library of Medicine; PubMed Health.  Last reviewed March 6, 2011; Accessed April 24, 2012.

2.        Seasonal affective disorder (SAD). Mayo Clinic.  http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195  June 9, 2011; Accessed April 24, 2012.

3.        Hawley DJ, Wolfe F, Lue FA, Moldofsky H. Seasonal symptom severity in patients with rheumatic diseases: a study of 1,424 patients. J Rheum. 2001;28:1900-1909.

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