Glenn Booker
BMES 531
June 7, 2007

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)
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– 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 )
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Phase Shift Hypothesis
(Lewy, 1989)
– Phase delay in body
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
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SAD also frequently found with
– Bulimia nervosa
(Levitan, 2004; Eagles, 2003)
– Premenstrual dysphoric disorder
(Portella, 2006)
– Alcoholism
(Sher, 2004)
– Increased odor sensitivity
(Postolache, 2002)
No diurnal preference (morningness vs eveningness)
(Natale, 2005; Bernert, 2005)
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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)
Dawn Simulators or Negative Ions
(Terman,
2006)
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Vitamin D improves mood
(Vieth, 2004)
Self-esteem and social support reduce symptoms’ severity
(McCarthy, 2002)
Good weather and being outside
(Keller, 2004)
– Measured time spent outdoors, outside temperature, and barometric pressure
BMES 531 Glenn Booker 7

Take all the previous information, and turn it into two checklists
– One for background information which isn’t likely to change often; call it the Personal
History Form
– One for information which may change frequently (location, weather, etc.) and call it the Recent Habits Survey
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What is your gender?
What is your birthday?
– Calculate age
Have you reached puberty yet? If you don’t know, say no.
Have you completed menopause?
Have you ever been diagnosed with
Seasonal Affective
Disorder (SAD)?
Have you ever been diagnosed with bulimia?
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Have you ever been diagnosed with premenstrual dysphoric disorder
(severe PMS)?
Have you ever been diagnosed as an alcoholic?
Are you more sensitive to odors than others?
BMES 531 Glenn Booker
Do you have a twin?
If yes, do they have
SAD?
Does anyone in your immediate family
(other than your twin, if you have one) have seasonal affective disorder?
10

What is your location?
– Use to get latitude, altitude, and weather
What is today’s date?
– Or get automatically
What vitamin supplements are you taking?
Do you feel good about yourself today?
Do you have friends you can talk to easily?
How much time per day have you spent outdoors during the daytime?
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From the Personal History Form and
Recent Habits Survey, calculate risk values from each answer
– Typically, “yes” means a risk value of 1, and “no” means a risk value of 0
– Add up the risk values for each form
– Possible range for the Personal History Form is 1 to +8 ½, whereas for the Recent Habits
Survey the possible range is -2 to +4
BMES 531 12 Glenn Booker

The total risk value for the Personal
History Form and Recent Habits Survey help quantify the risk of having SAD, and the likely severity of symptoms if it occurs
Can also help identify client actions to reduce symptoms, and point to effective treatments
BMES 531 Glenn Booker 13

(APA, 2000) American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision
(DSM-IVTR). Washington, DC: American Psychiatric Press.
(Arendt, 2003) J. Arendt (2003) Importance and Relevance of
Melatonin to Human Biological Rhythms. Journal of
Neuroendocrinology, Vol. 15 , 427 –431.
(Barinaga, 2002) Marcia Barinaga (8 Feb 2002) Circadian Clock:
How the Brain's Clock Gets Daily Enlightenment. Science Vol. 295 . no. 5557, pp. 955 –957.
(Bernert, 2005) Rebecca A. Bernert (2005) A Circadian Vulnerability
For Depression: Eveningness And Sleep Variability. Master’s thesis for Florida State University.
(Bhatia, 2007) Subhash C. Bhatia, Shashi K. Bhatia. Diagnosis and
Treatment of Premenstrual Dysphoric Disorder. Downloaded on
6/5/2007 from http://www.aafp.org/afp/20021001/1239.html
.
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(Bierman, 2005) Andrew Bierman, Terence R Klein and Mark S Rea
(2005) The Daysimeter: a device for measuring optical radiation as a stimulus for the human circadian system. Meas. Sci. Technol. (16)
2292 –2299.
(Blumberger, 2005) Daniel M. Blumberger, M.D., and Anthony J.
Levitt (Oct 2005) The Light-er Side of Treating Seasonal Affective
Disorder. Psychiatric Times Vol. 22 Issue 11.
(Boehnert, 2003) Caryl E. Boehnert, Robert A. Alberts (Jan 2003)
Seasonal Affective Disorder in Women How to identify and treat.
Women’s Health in Primary Care. Vol. 6 , No. 1.
(Eagles, 2003) John M. Eagles (2003) Seasonal affective disorder.
British Journal of Psychiatry 182 , 174-176.
(Ebisawa, 2007) Takashi Ebisawa (2007) Circadian Rhythms in the
CNS and Peripheral Clock Disorders: Human Sleep Disorders and
Clock Genes. J Pharmacol Sci 103 , 150 – 154.
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(Golden, 2005) Robert N. Golden, Bradley N. Gaynes, R. David
Ekstrom, Robert M. Hamer, Frederick M. Jacobsen, Trisha Suppes,
Katherine L. Wisner, Charles B. Nemeroff, (2005) The Efficacy of
Light Therapy in the Treatment of Mood Disorders: A Review and
Meta-Analysis of the Evidence. Am J Psychiatry; 162 , 656 –662.
(Horne, 1976) Horne, J.A., & Östberg, O. (1976). A self-assessment questionnaire to determine morningness-eveningness. International
Journal of Chronobiology, 4 , 97-110.
(Keller, 2004) Matthew C. Keller, Barbara L. Fredrickson, Oscar
Ybarra, Stephane Cote, Kareem Johnson, Joe Mikels, Anne Conway,
Tor Wager (2004) A Warm Heart and a Clear Head The Contingent
Effects of Weather on Mood and Cognition. Psychological Science
(16) 9, 724-731.
(Lam, 2000) Raymond W. Lam, Robert D. Levitan (2000)
Pathophysiology of seasonal affective disorder: a review. J
Psychiatry Neurosci 25 (5) 469-80.
BMES 531 16 Glenn Booker

(Levitan, 2004) Robert D. Levitan, Mario Masellis, Vincenzo S. Basile,
Raymond W. Lam, Allan S. Kaplan, Caroline Davis, Pierandrea Muglia,
Bronwyn Mackenzie, Subi Tharmalingam, Sidney H. Kennedy, Fabio
Macciardi, James L. Kennedy (2004) The Dopamine-4 Receptor Gene
Associated with Binge Eating and Weight Gain in Women with Seasonal
Affective Disorder: An Evolutionary Perspective. Biol Psychiatry 56 :665 –
669.
(Lewy, 1989) Lewy, A.J., Sack, R.L., Singer, C.M., White, D.M., Hoban, T.M.,
1989. Winter depression and the phaseshift hypothesis for bright light’s therapeutic effects: history theory and experimental evidence. In: Rosenthal,
N.E., Blehar, M.C. (Eds.), Seasonal Affective Disorders and phototherapy.
Guilford Press, New York, pp. 295
–310.
(Lewy, 2006) Alfred J. Lewy, Bryan J. Lefler, Jonathan S. Emens, and
Vance K. Bauer.(2006) The circadian basis of winter depression. PNAS;
103 ; 7414-7419.
(Magnusson, 2000) Magnusson A. (2000) An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand 101 : 176-184.
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(Malhotra, 2004) Samir Malhotra, Girish Sawhney, Promila Pandhi
(2004) The Therapeutic Potential of Melatonin: A Review of the
Science. MedGenMed. 6 (2): 46.
(McCarthy, 2002) E. McCarthy, N. Tarrier, L. Gregg (2002) The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: a longitudinal prospective study.
Psychological Medicine, 32 , 1425 –1434.
(Murray, 2006) Greg Murray, Erin E. Michalak, Anthony J. Levitt,
Robert D. Levitan, Murray W. Enns, Rachel Morehouse, Raymond
W. Lam. (2006) O sweet spot where art thou? Light treatment of
Seasonal Affective Disorder and the circadian time of sleep. Journal of Affective Disorders (90) 227 – 231.
(Natale, 2005) Vincenzo Natale, Ana Adan, Paolo Scapellato (2005)
Are seasonality of mood and eveningness closely associated?
Psychiatry Research (136) 51 – 60.
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(NINDS, 2007) National Institute of Neurological Disorders and Stroke,
NINDS Hypersomnia Information Page, downloaded on 6/3/2007 from http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm
.
(Portella, 2006) Portella, Amy T. Nguyen; Haaga, David A. F.; Rohan, Kelly
J. (Nov 2006) The Association Between Seasonal and Premenstrual
Symptoms Is Continuous and Is Not Fully Accounted for by Depressive
Symptoms. Journal of Nervous & Mental Disease. 194 (11) 833-837.
(Postolache, 2002) Postolache, TT, Wehr, TA, Doty, RL, Sher, L, Turner, EH,
Bartko, JJ, Rosenthal, NE. (2002) Patients with Seasonal Affective Disorder have Lower Odor Detection Thresholds than Control Subjects. Arch Gen
Psychiatry (59) 1119-1122.
(Rosenthal, 1984) Rosenthal, N.E., Sack, D.A., Gillin, C., Lewy, A.J.,
Goodwin, F.K., Davenport, Y., Mueller, P.S., Newsome, D.A., Wehr, T.A.,
1984. Seasonal Affective Disorder: a description of the syndrome and preliminary findings with light therapy. Arch. Gen. Psychiatry 41 ,
72 –80.
(Rosenthal, 1987) Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern
Assessment Questionnaire. Washington, DC: National Institute of Mental
Health; 1987.
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(Sher, 2001) Leo Sher (2001) Genetic Studies of Seasonal Affective
Disorder and Seasonality. Comprehensive Psychiatry, Vol. 42 , No. 2
(March/ April): pp 105-110.
(Sher, 2004) Leo Sher (Jan/Feb 2004) Alcoholism and Seasonal
Affective Disorder. Comprehensive Psychiatry, Vol. 45 , No. 1: pp
51-56.
(Terman, 2006) Michael Terman, Jiuan Su Terman (Dec 2006)
Controlled Trial of Naturalistic Dawn Simulation and Negative Air
Ionization for Seasonal Affective Disorder. Am J Psychiatry
163 :2126-2133.
(Tsuno, 2005) Tsuno, N, Besset, A, Ritchie, K (2005) Sleep and
Depression. J Clin Psychiatry (66) 1254-1269.
(Vieth, 2004) Reinhold Vieth, Samantha Kimball, Amanda Hu, Paul
G Walfish (2004) Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition
Journal, 3 :8.
BMES 531 20 Glenn Booker

(Wehr, 2001) Wehr, TA, Duncan, WC Jr, Sher, L, Aeschbach, D, Schwartz,
PJ, Turner, EH, Postolache, TT, Rosenthal, NE (2001) A Circadian Signal of
Change of Season in Patients with Seasonal Affective Disorder. Arch Gen
Psychiatry. (58) 1108-1114.
(WHO, 1992) World Health Organization. (1992) The ICD-10 Classification of Mental and Behavioral Disorders. Diagnostic Criteria for Research.
Geneva, Switzerland: World Health Organization.
(Williams, 1988) Williams, J. B. W., Link, M. J., Rosenthal, N. E. & Terman,
M. (1988) Structured Interview Guide for the Hamilton Depression Rating
Scale: Seasonal Affective Disorder Version (SIGH-SAD) (New York State
Psychiatric Institute, New York).
(Winkler, 2005) D. Winkler, S. Kasper. (2005) Seasonal affective disorder: from diagnosis to treatment. Medicographia, Vol 27 , No. 3.
(Wirz-Justice, 2005) Anna Wirz-Justice, Francesco Benedetti, Mathias
Berger, Raymond W. Lam, Klaus Martiny, Michael Terman, Joseph C. Wu
(2005) Chronotherapeutics (light and wake therapy) in affective disorders.
Psychological Medicine, 35, 939 –944.
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