Seasonal Depression

Aka: Seasonal Depression, Seasonal Affective Disorder

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II. Definitions

  1. Seasonal Affective Disorder
    1. Depressed mood that occurs within a specific time window of the year (typically fall-winter)

III. Epidemiology

  1. Annual Incidence in United States: <5%
  2. Lifetime Prevalence: 0.5 to 2.4%
  3. Of those with Major Depression, 10-20% have a seasonal pattern to their Major Depression
  4. Peak Incidence
    1. Fall and winter (October to February)
    2. Variation occurring Spring-Summer is less common
  5. Gender
    1. Female more than Male by factor of 4
  6. Age
    1. Uncommon under age 15 years
    2. Uncommon in elderly
  7. Family History
    1. Identical twin studies suggest a genetic predisposition
      1. Madden (1996) Arch Gen Psychiatry 53(1): 47-55 [PubMed]

IV. Symptoms

  1. See Major Depression Diagnosis Criteria

V. Diagnosis: DSM V Criteria (all must be present)- Variant of Major Depression

  1. Regular temporal relationship of Major Depression onset
    1. Occurs at the same time every year
    2. Usually occurs in fall or winter
    3. Unrelated to seasonal life stressors
  2. Full remission occurs at a specific time of year
  3. Two Seasonal Major Depression episodes in last 2 years
  4. No Non-seasonal episodes of Major Depression in 2 years
  5. Seasonal Depression episodes outnumber non-seasonal

VI. Diagnosis: Instruments

  1. Standard depression tools may be used to diagnosis presence and severity of Major Depression
  2. Patient Health Questionaire 9 (PHQ-9)
  3. Zung Self-Rating Depression Scale
  4. Beck Depression Inventory
  5. Hamilton Depression Scale
  6. Avoid SPAQ for clinical diagnosis (intended for research settings, and variable efficacy in practice)

VII. Associated conditions

  1. Generalized Anxiety Disorder
  2. Panic Disorder
  3. Bulimia Nervosa
  4. Premenstrual Syndrome
  5. Chronic Fatigue Syndrome
  6. Seasonal Alcohol Abuse
  7. Attention Deficit Disorder

VIII. Management

  1. Light Therapy (preferred therapy)
    1. Timing
      1. Start therapy in early fall and continue until spring
      2. Light exposure early in day
        1. Synchronizes with circadian rhythm
        2. Terman (2001) Arch Gen Psychiatry 58:69-75 [PubMed]
    2. Dose and Duration (white fluorescent light with UV wavelengths filtered out)
      1. Exposure to 10,000 lux for 30 minutes per morning (Preferred) or
      2. Exposure to 2500 lux for 2 hours per morning (Dawn simulation at end of sleep cycle and early in day)
      3. Contrast with mid-day sun intensity (50,000 to 100,000 lux)
    3. Technique
      1. Keep eyes open during this time
      2. Do not need to stare at the light
  2. Cognitive behavior therapy
    1. Cognitive Behavioral Therapy is associated with significant improvements in the short and longterm
    2. Rohan (2009) Behav Ther 40(3): 225-238 [PubMed]
    3. Rohan (2015) Am J Psychiatry 172(9):862-9 [PubMed]
    4. Rohan (2016) Am J Psychiatry 173(3): 244-51 [PubMed]
  3. Pharmacotherapy
    1. Indications
      1. High Suicide Risk
      2. Significant functional Impairment
      3. Recurrent moderate to severe Major Depression
      4. Patient preference
      5. Failure to respond to Light Therapy, Psychotherapy
    2. Agents
      1. Selective Serotonin Reuptake Inhibitor (SSRI)
        1. Fluoxetine (Prozac) and Sertraline (Zoloft) have been most studied (limited evidence)
        2. Thaler (2011) Cochrane Database Syst Rev (12):CD008591 [PubMed]
        3. Moscovitch (2004) Psychopharmacology 171(4):390-7 [PubMed]
      2. Bupropion
        1. Specifically FDA labeled for preventing Seasonal Affective Disorder
        2. Effective when started September to November before the onset of SAD symptoms
          1. Gartlehner (2019) Cochrane Database Syst Rev (3): CD011268 [PubMed]
    3. Other medications
      1. Insufficient evidence to support Vitamin D Supplementation
  4. Adjunctive measures
    1. Exercise
    2. Sleep Hygiene
    3. Avoid prolonged Screen Time before bed
    4. Maintain a regular sleep-wake cycle
    5. Stress management and Relaxation Techniques
    6. Daytime outdoor activity during seasons with shorter day lengths
    7. Increased overall lighting in the home

IX. Resources

  1. Canadian Consensus Guidelines For Treating Seasonal Affective Disorder (1999)
    1. http://www.ubcmood.ca/sad/CCG%20SAD%201999.pdf

X. References

  1. Zal (March 1997) Consultant, 641-9
  2. APA (1994) DSM IV, APA, p. 317-91
  3. (2021) Presc Lett 28(12): 69
  4. Galima (2020) Am Fam Physician 102(11): 668-72 [PubMed]
  5. Kurlansik (2012) Am Fam Physician 86(11): 1037-41 [PubMed]
  6. Lurie (2006) Am Fam Physician 74:1521-24 [PubMed]
  7. Partonen (1998) Lancet 352:1369-74 [PubMed]
  8. Saeed (1998) Am Fam Physician 57(6): 1340-6 [PubMed]

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Ontology: Seasonal Affective Disorder (C0085159)

Definition (MEDLINEPLUS)

Some people experience a serious mood change during the winter months, when there is less natural sunlight. This condition is called seasonal affective disorder, or SAD. SAD is a type of depression. It usually lifts during spring and summer.

Not everyone with SAD has the same symptoms. They include

  • Sad, anxious or "empty" feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness or helplessness
  • Irritability, restlessness
  • Loss of interest or pleasure in activities you used to enjoy
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Difficulty sleeping or oversleeping
  • Changes in weight
  • Thoughts of death or suicide

SAD may be effectively treated with light therapy. But nearly half of people with SAD do not respond to light therapy alone. Antidepressant medicines and talk therapy can reduce SAD symptoms, either alone or combined with light therapy.

NIH: National Institute of Mental Health
Definition (MSH) A syndrome characterized by depressions that recur annually at the same time each year, usually during the winter months. Other symptoms include anxiety, irritability, decreased energy, increased appetite (carbohydrate cravings), increased duration of sleep, and weight gain. SAD (seasonal affective disorder) can be treated by daily exposure to bright artificial lights (PHOTOTHERAPY), during the season of recurrence.
Definition (CSP) specific disorder usually appearing in the second or third decade, characterized by symptoms of depression between late fall and early spring, sometimes followed by mania or hypomania; intense light is reportedly therapeutic.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D016574
SnomedCT 191655007, 192374007, 154969002, 154876006, 247803002
English Affective Disorder, Seasonal, Affective Disorders, Seasonal, Disorder, Seasonal Affective, Disorder, Seasonal Mood, Disorders, Seasonal Affective, Disorders, Seasonal Mood, Mood Disorder, Seasonal, Mood Disorders, Seasonal, Seasonal Affective Disorder, Seasonal Affective Disorders, Seasonal Mood Disorder, Seasonal Mood Disorders, seasonal affective disorder, SAD - Seasonal affect disorder, SAD, SEASONAL AFFECTIVE DISORDER, SEASONAL AFFECTIVE DIS, depression in a seasonal pattern, seasonal depression (symptom), depression seasonal pattern (diagnosis), seasonal depression, depression seasonal pattern, seasonal pattern depression, Seasonal Affective Disorder [Disease/Finding], seasonal affective disorder (SAD), seasonal affective disorders, Seasonal mood disorder, [X]Seasonal depressive disorder, [X] Seasonal depressive disorder, [X]SAD - Seasonal affective disorder, seasonal affective disorder (diagnosis), SAD - Seasonal affective disorder, Seasonal affective disorder, Seasonal affective disorder (disorder), depression; seasonal, seasonal; depression, Seasonal depression
Dutch seizoensgebonden depressie, depressie; seizoengebonden, seizoengebonden; depressie, seizoensgebonden affectieve stoornis, Stemmingsstoornis met seizoengebonden patroon, Stemmingsstoornis, seizoensgebonden
German Saisonabhaengige Depression, saisonale affektive Stoerung, Jahreszeitbedingte Verstimmung, Saisonale affektive Störung
Italian Depressione stagionale, Disturbi affettivi stagionali, Disturbo affettivo stagionale
Portuguese Depressão sazonal, Transtorno Afetivo Sazonal, Transtorno de Humor Sazonal, Perturbação afectiva sazonal
Spanish Depresión estacional, trastorno afectivo estacional (trastorno), trastorno afectivo estacional, Trastorno afectivo estacional, Trastorno Afectivo Estacional, Trastorno de Ánimo Estacional
Russian АФФЕКТИВНЫЕ РАССТРОЙСТВА СЕЗОННЫЕ, ЭМОЦИОНАЛЬНЫЕ РАССТРОЙСТВА СЕЗОННЫЕ, AFFEKTIVNYE RASSTROISTVA SEZONNYE, NASTROENIIA SEZONNOE NARUSHENIE, EMOTSIONAL'NYE RASSTROISTVA SEZONNYE, SEZONNOE NARUSHENIE NASTROENIIA, SEZONNYE AFFEKTIVNYE RASSTROISTVA, НАСТРОЕНИЯ СЕЗОННОЕ НАРУШЕНИЕ, СЕЗОННОЕ НАРУШЕНИЕ НАСТРОЕНИЯ, СЕЗОННЫЕ АФФЕКТИВНЫЕ РАССТРОЙСТВА
Japanese 季節性うつ病, ｷｾﾂｾｲｶﾝｼﾞｮｳｼｮｳｶﾞｲ, ｷｾﾂｾｲｳﾂﾋﾞｮｳ, 感情障害-季節性, 季節的情動障害, 季節的気分障害, 季節性感情障害, 情動障害-季節的, 気分障害-季節的
Swedish Årstidsbundna affektiva störningar
Czech nálada - sezónní porucha, Sezónní deprese, Sezónní afektivní porucha, afektivní porucha sezónní, sezónní afektivní porucha
Finnish Vuodenaikamasennus
Croatian SEZONSKI AFEKTIVNI POREMEĆAJ
Polish Sezonowe zaburzenie afektywne, Zaburzenia nastroju sezonowe, Zaburzenie afektywne sezonowe, Choroba afektywna sezonowa
Hungarian Szezonális depressio, Szezonális érzelmi-indulati zavar
Norwegian Vinterdepresjon, Årstidsbestemt stemningsforstyrrelse
French Trouble affectif saisonnier, Dépression saisonnière, Trouble affectif saisonnier (TAS), Trouble dépressif saisonnier
Derived from the NIH UMLS (Unified Medical Language System)

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