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Bright Nights Community Forum Seasonal Affective Disorder University of Michigan Depression Center Ann Arbor Public Library.

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Presentation on theme: "Bright Nights Community Forum Seasonal Affective Disorder University of Michigan Depression Center Ann Arbor Public Library."— Presentation transcript:

1 Bright Nights Community Forum Seasonal Affective Disorder University of Michigan Depression Center Ann Arbor Public Library

2 Bright Nights Forums U-M Depression Center and Ann Arbor Public Library U-M Depression Center and Ann Arbor Public Library Presentation on topics of interest relevant to mental health in community Presentation on topics of interest relevant to mental health in community Panel of experts from U-M Depression Center and Professionals in community Panel of experts from U-M Depression Center and Professionals in community Q/A format Q/A format Improve community awareness of resources available. Improve community awareness of resources available.

3 Bright Nights Forums Bipolar Disorder: March 29th Bipolar Disorder: March 29th Suicide: May 24th Suicide: May 24th

4 Seasonal Affective Disorder What is Seasonal Affective Disorder - SAD What is Seasonal Affective Disorder - SAD The formal Diagnosed syndrome The formal Diagnosed syndrome Sub-syndromal SAD Sub-syndromal SAD Hypotheses surrounding SAD Hypotheses surrounding SAD Research relevant to SAD Research relevant to SAD Treatment options Treatment options Physical Treatments Physical Treatments Medication Medication Panel Discussion Panel Discussion

5 Live in rooms full of light Avoid heavy food Be moderate in the drinking of wine Take massage, baths, exercise, and gymnastics Fight insomnia with gentle rocking or the sound of running water Change surroundings and take long journeys Strictly avoid frightening ideas Indulge in cheerful conversation and amusements Listen to music. Cornelius Celsus (first century AD) On the treatment of disorders of mood…….

6 What is SAD? SAD = Seasonal Affective Disorder SAD = Seasonal Affective Disorder Affective Disorder that occurs predictably at a specific season - most frequently in the fall or winter months. Affective Disorder that occurs predictably at a specific season - most frequently in the fall or winter months. Affective Disorder is used interchangeably with Mood Disorder and usually refers to depression. Affective Disorder is used interchangeably with Mood Disorder and usually refers to depression.

7 Understanding Affective Disorders Kraepelin proposed affect to consist of 3 components Kraepelin proposed affect to consist of 3 components Volition Volition Energy & Drive Energy & Drive Emotion Emotion Happy / Sad Happy / Sad Intellect Intellect Rate of thoughts Rate of thoughts Content of thoughts Content of thoughts

8 Affect - Affection Volition – the drive to care for our offspring Emotion – the love for our children Intellect – the thoughts & speech related to our interactions with family and loved ones

9 Normal Affect Volition Emotion Intellect - Moods and disposition fluctuate over time

10 Volition Emotion Intellect Depression

11 Mania Volition Emotion Intellect

12 Affect and Affective Disorders Volition – drives – energy levels Volition – drives – energy levels Depression - lowered Depression - lowered Emotion – mood (happy vs sad) Emotion – mood (happy vs sad) Depression – sad – low – guilt Depression – sad – low – guilt Intellect – thinking Intellect – thinking Depression – decreased rate - negative Depression – decreased rate - negative

13 SAD - clinical features Clinicians refer to atypical depressive sxs Clinicians refer to atypical depressive sxs Sleep: hypersomnia - too much sleep Sleep: hypersomnia - too much sleep Difficulty getting out of bed Difficulty getting out of bed Slow to get going Slow to get going Fatigued throughout the day Fatigued throughout the day Atypical because majority of depressed patients experience difficulties sleeping (frequent awakenings during the night or awakening more that 1 or 2 hours earlier than custom).Atypical because majority of depressed patients experience difficulties sleeping (frequent awakenings during the night or awakening more that 1 or 2 hours earlier than custom).

14 SAD - atypical features Appetite Increase (hyperphagia) Appetite Increase (hyperphagia) Carbohydrate craving Carbohydrate craving Comfort eating / grazing Comfort eating / grazing Eating at non-meal times Eating at non-meal times Atypical because most people with depression experience decrease in appetite.Atypical because most people with depression experience decrease in appetite.

15 Sub-syndromal SAD Winter Blues - Winter Doldrums Winter Blues - Winter Doldrums Common: % of middle latitude population Common: % of middle latitude population Defies a clear definition…. Defies a clear definition…. Does not meet diagnostic criteria for Depression Does not meet diagnostic criteria for Depression Milder form of SAD with distinct discomfort and qualitative change in functioning (decrease) and activity level Milder form of SAD with distinct discomfort and qualitative change in functioning (decrease) and activity level Slowed down / Irritable Slowed down / Irritable Some symptoms of atypical depression Some symptoms of atypical depression Over-eating & Over-sleeping Over-eating & Over-sleeping

16 SAD - Research Epidemiology: Epidemiology: SAD ~ 1-3% SAD ~ 1-3% Sub-syndromal SAD (Winter Doldrums) ~25% Sub-syndromal SAD (Winter Doldrums) ~25% Chronic Course - ~40% with seasonal pattern at 10 year follow-up; 40% became non-seasonal. Chronic Course - ~40% with seasonal pattern at 10 year follow-up; 40% became non-seasonal. High association with eating, anxiety, and substance abuse disorders. High association with eating, anxiety, and substance abuse disorders. Associated with higher latitudes. Associated with higher latitudes. Middle latitudes (such as Michigan !) Middle latitudes (such as Michigan !) Extreme northern latitudes show lower frequency Extreme northern latitudes show lower frequency

17 SAD Research Circadian Rhythms Photoperiod hypothesis: Photoperiod hypothesis: The shorter winter photoperiod results in SAD. The shorter winter photoperiod results in SAD. Northern latitudes, controverted findings Northern latitudes, controverted findings Melatonin secretion longer during winter in SAD Melatonin secretion longer during winter in SAD Artificial light treats SAD Artificial light treats SAD Phase-shift hypothesis: Phase-shift hypothesis: Phase delay of circadian rhythm relative to external clock; waking later into evening and arising later in morning. Phase delay of circadian rhythm relative to external clock; waking later into evening and arising later in morning. Light therapy in am causes phase advance - correcting phase delay. Light therapy in am causes phase advance - correcting phase delay.

18 SAD - Genetics Individuals with SAD frequently have family history of Depression (2/3) or SAD (1/3). Individuals with SAD frequently have family history of Depression (2/3) or SAD (1/3). Are there genetic variants that predispose to depression and SAD? Are there genetic variants that predispose to depression and SAD? Class of genes - circadian clock genes have shown association with SAD. Class of genes - circadian clock genes have shown association with SAD. Are there genetic variants of these clock genes associated with SAD. Are there genetic variants of these clock genes associated with SAD. Preliminary evidence suggests this but not always replicated in independent studies. Preliminary evidence suggests this but not always replicated in independent studies. No specific tests to diagnose SAD. No specific tests to diagnose SAD.

19 Controversies in SAD Phase delay / advance studies of circadian rhythm require rigorous monitoring of body chemicals, sleep EEGs, temp, etc. Phase delay / advance studies of circadian rhythm require rigorous monitoring of body chemicals, sleep EEGs, temp, etc. Small numbers of individuals studied Small numbers of individuals studied Conclusions often conflict Conclusions often conflict Conflicting results of effects of light therapy on phase change. Conflicting results of effects of light therapy on phase change. Phase advance not always associated with clinical improvement. Phase advance not always associated with clinical improvement.

20 SAD - treatment Light therapy Light therapy 30 min per day 30 min per day Begin with AM light Begin with AM light 10,000 Lux 10,000 Lux Specialty light box Specialty light box Medication…. Medication…. Usually required for major depression with seasonal pattern Usually required for major depression with seasonal pattern ( % respond to light alone) ( % respond to light alone)

21 Sub-syndromal SAD Light therapy alone often lifts the winter-blues Light therapy alone often lifts the winter-blues Ok for individual to buy box on own accord, buy from established company. Ok for individual to buy box on own accord, buy from established company. Follow instructions Follow instructions Consult physician if taking medication. Consult physician if taking medication. Some medications cause light sensitivity. Some medications cause light sensitivity.

22 Any light box you buy should have been tested successfully in peer-reviewed clinical trials. The box should provide 10,000 lux of illumination at a comfortable sitting distance. Product specifications are often missing or unverified. Fluorescent lamps should have a smooth diffusing screen that filters out ultraviolet (UV) rays. UV rays are harmful to the eyes and skin. The lamps should give off white light rather than colored light. "Full spectrum" lamps and blue (or bluish) lamps provide no known therapeutic advantage. The light should be projected downward toward the eyes at an angle to minimize aversive visual glare. Smaller is not better: When using a compact light box, even small head movements will take the eyes out of the therapeutic range of the light. Center for Environmental Therapeutics - Let there be light….

23 Review of studies studies reviewed for efficacy of light therapy in SAD. 20 studies reviewed for efficacy of light therapy in SAD. Very strong effect- size for light therapy Very strong effect- size for light therapy SAD SAD Non SAD depression Non SAD depression Golden et al, Am J Psych. 2005

24 Activity level improves using 4 weeks of Bright Lights

25 Side Effects of Bright Light Possibility of …. Possibility of …. Sleep disturbances Sleep disturbances Irritability Irritability Headache Headache Eye irritation Eye irritation Marginal increase (but not significant) compared to control group. Marginal increase (but not significant) compared to control group.

26 SAD - Conclusions SAD - refers to a seasonal pattern occuring in individuals with major Depression SAD - refers to a seasonal pattern occuring in individuals with major Depression Symptoms are often atypical Symptoms are often atypical Increased appetite and over-sleeping Increased appetite and over-sleeping Sub-syndromal SAD is common Sub-syndromal SAD is common Noticeable qualitative change in functioning Noticeable qualitative change in functioning Light therapy is useful in treatment of SAD Light therapy is useful in treatment of SAD Effects noticeable within 2 weeks Effects noticeable within 2 weeks Difficult to establish routine of using light therapy…. Difficult to establish routine of using light therapy….

27 Panel Members John Greden, MD John Greden, MD University of Michigan University of Michigan Randy Nesse, MD Randy Nesse, MD University of Michigan University of Michigan Tom Zelnik, MD Tom Zelnik, MD St Josephs Medical Center St Josephs Medical Center Julie Kuebler, RN, NursePractioner Julie Kuebler, RN, NursePractioner University of Michigan University of Michigan Laura Nitzberg, LCSW Laura Nitzberg, LCSW University of Michigan University of Michigan


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