Sad feelings come and go following bad news, disappointments, financial losses, rejections, health failures, job losses, relationship failures, etc. But when we get SAD during the fall and winter months, we are diagnosed with seasonal affective disorder or SAD Time Blues. This is one of the six recognized types of clinical depression, differing mainly in its timing. It has been associated with the sudden switch from longer summer days to shorter fall and winter days in temperate regions of the world.
Day light entering the eyes helps the hypothalamus in the brain to maintain the normal sleep - wake cycle or circadian rhythm. The light stimulates the pituitary, and pineal glands to release hormones that stimulate the ascending reticulated activating system (ARAS) to keep us awake. The same light normally suppresses the release of serotonin from the enterochromaffine cells of the raffle nuclei of the brain. Thus with sudden drop of light supply during the fall and winter months, the blood level of serotonin rises dramatically causing increased sleepiness, tiredness, irritability and ultimately depression. Severe depression may lead to suicidal thoughts and suicide attempts, which also generally increase during the winter months.
Like other major depressions, SAD may present with, sadness and irritability, loss of interest in previously exciting activities, feeling of hopelessness, social isolation, excessive sleep, increased appetite and weight gain. The diagnosis is mostly clinical and therapeutic. Hormonal assays are mainly used to confirm the diagnosis and track clinical progress. With or without treatment, seasonal affective disorders tend to improve by the onset of spring season. This is what differentiates it from the other five forms of major depression.
Treatment modalities include, light therapy, cognitive therapy and antidepressants (when severe). Light therapy substitutes 10,000 Lux light for day light for the short fall in normal day light (Danilenko K. V.V et al). Cognitive therapy helps patients to actively substitute optimism for hopelessness, social involvement for social withdrawal, and thoughts of living for suicidal thoughts (Melrose Sherri, 2015). Both light therapy and cognitive therapy have been shown to be effective in the treatment of SAD (Rohan, K. J. et all, 2015). But patients treated with cognitive therapy have been also been shown to have lower recurrence rate in subsequent seasons because they have thought through their conditions and adopted positive interpretations (Sitnikov L. et al, 2013).
Social integration or outdoor treatment has the advantage of combining light therapy and cognitive therapy. 'Outdoor' here is relative to a patient's seclusion environment. Since most social environments like the malls tend to be well lit up, the SAD patient gets supplemental light while socializing. The outdoor patient also sees how other people are coping with shorter days and finds hope for making it through another winter. Seeing less privileged people in the community actively striving to survive also helps the SAD patient to switch from death wish to life wish. Volunteering in social recreational activities away from their homes may, therefore, be the easiest way for patients to take advantage of the outdoor Treatment for SAD.
Danilenko, K. V., and I. A. Ivanova. "Dawn simulation Vs. bright light in seasonal affective disorder: Treatment effects and subjective preference." Journal of affective disorders 180 (2015): 87-89.
Melrose, Sherri. "Seasonal affective disorder: an overview of assessment and treatment approaches." Depression research and treatment 2015 (2015).
Rohan, K. J., et al. "Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes." The American journal of psychiatry (2015): appiajp, 201514101293.
Sitnikov L, Rohan K. J, Evans M, Mahon J. N, Nillni Y. I."Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment." Behav Res Ther. 2013 Dec;51(12):872-81. doi: 10.1016/j.brat.2013.09.010. Epub 2013 Oct 17. PMID: 24211338
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