Depress

Seasonal Depression

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Seasonal Depression, Seasonal Affective Disorder

  • Epidemiology
  1. Annual Incidence in United States: 5%
  2. Peak Incidence
    1. Fall and winter (October to February)
  3. Gender
    1. Female more than Male by factor of 4
  4. Age
    1. Uncommon under age 15 years
    2. Uncommon in elderly
  • Symptoms
  • Diagnosis
  • DSM IV Criteria (all must be present)
  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
  • Diagnosis
  • Instruments
  • 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
    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. 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)
  4. Adjunctive measures
    1. Exercise
    2. Stress management and Relaxation Techniques
    3. Daytime outdoor activity during seasons with shorter day lengths
    4. Increased overall lighting in the home
  • Resources
  1. Canadian Consensus Guidelines For Treating Seasonal Affective Disorder (1999)
    1. http://www.ubcmood.ca/sad/CCG%20SAD%201999.pdf