Seasonal Affective Disorder
Kenneth R. Yeager PhD
SAD Definition
• Seasonal Affective Disorder (SAD) is
a recurrent major depression which generally
results in lethargy and depression symptoms
during the Fall and Winter seasons
– Measure with Global Seasonality Score (GSS) from
the Seasonal Pattern Assessment Questionnaire
(SPAQ). (Rosenthal, 1987)
– Diagnostic and Statistical Manual of Mental
Disorders, 4th edition (DSM-IV) (APA, 2000)
SAD Definition
– Structured Interview Guide for the Hamilton
Depression Rating Scale: Seasonal Affective
Disorder Version (SIGH-SAD) (Williams, 1988)
– WHO “ICD-10 Classification of Mental and
Behavioral Disorders” (WHO, 1992)
• SAD epidemiology favors age (young), gender
(female), and latitude (far from equator), but
not race or ethnicity (Sher, 2001; Boehnert, 2003;
Magnusson, 2000; Eagles, 2003 )
SAD Mechanisms
• Melatonin Dysregulation (Malhotra, 2004; Arnedt, 2003; Lam,
2000; Wehr, 2001)
– Secretion is longer than normal in winter
• Serotonin Deficiency (Sher, 2001)
– L-tryptophan is a precursor of serotonin
• Genetic Abnormalities (Sher, 2004; Ebisawa, 2007)
– Based on epidemiology studies; serotonin transporter or
clock gene defects
Comorbidity
• SAD also frequently found with
– Bulimia nervosa (Levitan, 2004; Eagles, 2003)
– Premenstrual dysphoric disorder (Portella, 2006)
– Alcohol dependence (Sher, 2004)
• No diurnal preference (morningness vs
eveningness) (Natale, 2005; Bernert, 2005)
SAD Symptoms
• A distinct seasonal pattern to your mood (i.e.,
very little or no depression symptoms during
spring or summer months, when the days are
longer)
• A recurrent pattern of decreased energy and
activity levels you usually enjoy during the
winter months
• Improved mood if you are in a sunnier climate
during the usual "high risk" winter months
SAD Symptoms
• Persistently low, depressed mood that lasts for usually
two to three months during winter months. November
to February are the peak months.
• Depression symptoms such as:
– low mood,
– changes in appetite or weight,
– decreased energy or fatigue,
– sleep changes,
– avoidance of social situations) in the absence of
other identifiable triggers or causes
Reduce SAD Symptoms
• There are a number of very effective strategies that can help
lessen the impact of SAD:
– Make a point to spend more time outdoors during peak
light hours (10am to 2pm), even if it's only for 10 to 15
minutes during a coffee or lunch break.
– Arrange your home and work environments (if possible) to
maximize your exposure to direct sunlight: Leave blinds
and curtains open and try to be around windows that
allow in natural light.
Reduce SAD Symptoms
– Avoid sedentary activities, turn off your
television and stay off your couch
– Engage in activities that while indoor engage your
brain and body. It’s a great time to do a home
project, work on that novel you have been
planning to write, hone your music talents
– Socialize, winter is a great time to reconnect with
friends, host gatherings, visit relatives
Reduce SAD Symptoms
– If you are going to be drinking while socializing
remember all things in moderation. Too much
alcohol can contribute to SAD symptoms.
– The grey months are also a time for keeping up
with vitamin supplements such as vitamin D, and
other ammine boosting supplements to keep
those winter sniffles at a distance
SAD Treatment
• If you find the above listed strategies are not
working for you consult your healthcare
provider. They may make additional
recommendations such as:
– Light therapy (Wirz-Justice, 2005; Golden, 2005)
– 2500 to 10,000 lux white light for 15-30 min
– Wake therapy? Controlled sleep deprivation
– SSRIs (Prozac, Zoloft) do as well as light (Blumberger,
2005)
Reduce SAD Symptoms
• By vigilant about taking care of yourself in the
fall and winter months, be sure you:
– exercise, take walks outdoors between 10:00 am
and 2:00
– eat a healthy diet
– socialize
– drink alcohol in moderation
– consider vitamin supplements such as vitamin D
Calculate Your Risk
• What is your gender?
___ M ___ F
• Are you above the age of 35
___ Yes ___ No
• Have you ever been diagnosed with Seasonal Affective
Disorder (SAD)?
___ Yes ___ No
• Have you ever been diagnosed with bulimia?
___ Yes ___ No
Calculate Your Risk
• Have you ever been diagnosed with premenstrual
dysphoric disorder (severe PMS)? ___ Yes ___ No
• Have you ever been diagnosed with an alcohol or drug
problem?
___ Yes ___ No
• Are you more sensitive to odors than others?
___ Yes ___ No
• Does anyone in your immediate family have seasonal
affective disorder?
___ Yes ___ No
Conclusion
• The total risk value from this brief survey is a
score of 8, it can help quantify the risk of having
SAD. If you are female you can begin by adding 1
point
• If you find your scores in the range of 1-3 you are
experiencing usual seasonal blues.
• If your score is 4-6 get moving and take your
supplements
• If your score is 7 or 8 ask your healthcare
professional about Seasonal Affective Disorder.
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