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Seasonal Affective Disorder

Seasonal Affective Disorder only became a recognized syndrome in the mid-Eighties, but for those suffering from it, there was little doubt as to the climate`s impact on their moods. While the world gleefully prepares for snowball fights and fireside fondues, SAD patients dread another season of depression, diminishing motivation and insomnia. This climate-reliant disorder first appeared in the DSM-III, after a series of convergent trials left no room for denial. Many psychiatrists hope that the DSM-V will present SAD as a condition with two modifiers. Most patients experience worsening mood during autumn, but some patients` moods plummet during summer. There are two categories for SAD, encompassing both major unipolar depression and bipolar disorder. The current diagnostic manual refers to SAD as a modifier that relates to existing mood disorders rather than an entity in itself. Patients suffering from SAD predictably respond to increased light exposure, with potential increa ses in serotonin levels. Trials suggest that those affected have impaired ocular processing. They also experience diminished melatonin levels in comparison to unaffected individuals.

The mood changes present in SAD patients are often more severe than those suffered by unseasonable unipolar depression. Typical symptoms include weight changes, crying spells, concentration problems and suicidal ideas, which usually begin during fall and end when spring starts. Depression is a life threatening disorder, so treatment is imperative. Since light exposure seems to have a potent impact on winter-worsening SAD, phototherapy is often the first port of call for treatment. Patients who winter in warmer locations often experience respite from their symptoms. Phototherapy is used to increase exposure to set light wavelengths using fluorescent, dichroic and full spectrum lamps. While the efficacy of artificial light has been proven, none are quite as powerful as full sunlight. Heliostats and light boxes are often used in home-based therapy, but SAD treatment should be multi-tiered and carefully controlled according to individual patient response. Each mood disorder has a unique reaction range that varies according to the patient. For some, light therapy is entirely ineffectual and for others, antidepressants are the most potent cure.

Dawn simulation is a technique that is more convenient than light therapy, so patient compliance is often improved. In this technique, light signals are used to simulate sunrise before the patient wakes up. The sleep cycle is corrected, provoking the body`s healthy chemical changes and waking the patient naturally without the need for an audible alarm. Dusk simulation can be included and many patients respond more markedly to a combination of light therapy and sleep cycle correction.

Seratonin re-uptake inhibitors are the most effective medications for SAD that presents as a major depressive episode. Those with bipolar disorder usually need a different approach to treatment, as light exposure and SSRIs can precipitate mania. When combined with psychotherapy, the impact of medication is magnified. As yet, no talk therapy has triumphed quite as definitively as cognitive behavioral therapy. This short term, practical method seeks to correct distorted perceptions and find healthier coping mechanisms. The depressive response is identified by the patient using journaling and existing negative assumptions are responded to differently. The technique relies on the premise that depression is caused by entrenched reactions, whereas interpersonal therapy focuses on childhood`s impact on depression. Symptoms and current problems are assessed more generally, examining relationships and daily interactions with a view towards correction. Interpersonal therapy is most appropriate for patients with stunted emotional responses to past traumas.

When other proven tactics fail, off-label prescriptions often offer much needed relief. Medications that have proven to be effective for treatment resistant SAD include Keppra, second generation anti-psychotics and lithium. For patients with refractory SAD, a patient-empowered relationship with a psychiatrist becomes particularly crucial. A goal oriented approach in which both patient and psychiatrist are motivated to find an effective cure through intercommunication offers patients the best possible outcome. The Healthcounter pharmacy doctors advise SAD patients on a range of holistic and medical treatment options.

 

Article courtesy of:
GetSet for Health

GetSet for Health

Maple Ridge, BC, Canada

Phone: 604-465-0037   Fax: 604-465-1062
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DateArticle TitleSource
Jan 2013  Seasonal Affective Disorder  GetSet for Health 
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