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• Seasonal affective disorder

AUTHOR(S): Jacobsen FM; Mueller EA; Rosenthal NE; Rogers S; Hill JL; Murphy DL

AUTHOR'S ADDRESS: Laboratory of Clinical Science, National Institute of Mental Health (NIMH), Bethesda, MD 20892.

ARTICLE TITLE: Behavioral responses to intravenous meta-chlorophenylpiperazine in patients with seasonal affective disorder and control subjects before and after phototherapy.

ARTICLE SOURCE: Psychiatry Res (Ireland), May 1994, 52(2) p181-97

ABSTRACT: A comparison of the baseline and post-infusion effects of the serotonin agonist meta-chlorophenylpiperazine (m-CPP) in 10 patients with seasonal affective disorder (SAD) and 11 healthy control subjects revealed significantly different subjective response profiles between the groups. Several baseline and m-CPP-stimulated responses in symptoms putatively related to serotonergic function changed significantly after a week's exposure to phototherapy in the SAD patients but not the control subjects. Before phototherapy, depressed patients with SAD reported activation-euphoria responses to m-CPP and significant decreases in carbohydrate hunger, but insignificant changes in feeling slowed or sleepy, while control subjects reported no mood or appetite changes but significant increases in feeling slowed down following m-CPP. After phototherapy, which led to a significant reduction in baseline depressive symptom rating to near-euthymic levels in the SAD patients, almost all of the patients' responses to m-CPP were normalized and no longer differed from the control subjects' responses. These results provide evidence of a possible dysregulation in serotonergic neurotransmission in depressed SAD patients that normalizes following treatment with phototherapy.

AUTHOR(S): Lam RW; Levitan RD; Tam EM; Yatham LN; Lamoureux S; Zis AP

AUTHOR'S ADDRESS: Department of Psychiatry, University of British Columbia, Vancouver. rlam@unixg.ubc.ca.

ARTICLE TITLE: L-tryptophan augmentation of light therapy in patients with seasonal affective disorder.

ARTICLE SOURCE: Can J Psychiatry (Canada), Apr 1997, 42(3) p303-6

ABSTRACT: OBJECTIVE: Up to one-third of patients with seasonal affective disorder (SAD) do not have a full response to light therapy. Given the evidence for serotonergic dysregulation in SAD, we examined the possible role of l-tryptophan as an augmentation strategy for nonresponders and partial responders to light therapy. METHOD: Eligible drug-free patients meeting DSM-IV criteria for SAD were treated for 2 weeks using a standard morning light therapy regimen (10,000 lux cool-white fluorescent light for 30 minutes). Partial and nonresponders were treated for 2 weeks with open-label l-tryptophan (1 g 3 times daily) while light therapy was continued. Ratings at baseline and follow-up included the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) and the Clinical Global Impression (CGI) scale. RESULTS: Sixteen patients began the l-tryptophan augmentation phase. Two patients discontinued medications within 3 days because of side effects. In the 14 patients completing treatment, the addition of l-tryptophan resulted in significant reduction of mean depression scores. Nine of 14 patients (64%) showed very good clinical responses to combined treatment and minimal side effects. CONCLUSION: This open-label study suggests that l-tryptophan may be an effective augmentation strategy for those patients with SAD who show limited or poor response to bright ligh therapy. Further placebo-controlled studies are warranted to demonstrate efficacy.

AUTHOR(S): Moller SE

AUTHOR'S ADDRESS: Department of Clinical Pharmacology, St. Hans Hospital, Roskilde, Denmark.

ARTICLE TITLE: Serotonin, carbohydrates, and atypical depression.

ARTICLE SOURCE: Pharmacol Toxicol (Denmark), 1992, 71 Suppl 1 p61-71

ABSTRACT: At least three categories of atypical depression have been described. The hysteroid dysphoria is characterized by repeated episodes of depressed mood in response to feeling rejected, and a craving for sweets and chocolate. Two other issues are characterized by a cyclical occurrence of changes of mood and appetite, i.e., the late luteal phase dysphoric disorder (DSM-III-R, appendix), or "the premenstrual syndrome" (PMS), and the major depression with seasonal pattern (DSM-III-R), or seasonal affective disorder (SAD). The reactive mood changes are frequently accompanied by features as hypersomnia, lethargy and increased appetite, particularly with a preference for carbohydrates. Central serotonin pathways participate in the regulation of mood and behavioural impulsivity, and modulate eating patterns qualitatively and quantitatively. Depressives with PMS og SAD benefit, in general, from treatments with serotonin potentiating drugs, suggesting that brain serotonin plays a role in the pathophysiology. Ingestion of carbohydrates increases the plasma ratio of tryptophan to other large neutral amino acids in man and animal, and the serotonin synthesis in the rat brain. Based on these findings it has been suggested that the excessive carbohydrate intake by patients with PMS and SAD reflects a self-medication that temporarily relieves the vegetative symptoms via an increased central serotonergic activity.

AUTHOR(S): Partonen T; Lonnqvist J

AUTHOR'S ADDRESS: Department of Mental Health, National Public Health Institute, Helsinki, Finland.

ARTICLE TITLE: Prevention of winter seasonal affective disorder by bright-light treatment.

ARTICLE SOURCE: Psychol Med (England), Sep 1996, 26(5) p1075-80

ABSTRACT: In patients with winter seasonal affective disorder (SAD) the onset of a depressive episode is probably associated with the decreasing amount of light during the autumn. A highly predictable onset of a recurrent depressive episode with seasonal pattern provides a rationale for testing the efficacy of bright-light treatment as a preventive measure. Twelve out-patients with winter SAD were assigned to start bright light treatment either when they were well, or not to start it until the first symptoms of depression had already emerged. The severity of depressive symptoms was prospectively rated for a parallel randomized comparison. Bright light given well in advance of the emerging symptoms prevented a depressive episode. Clinical remission was significantly more frequent in the former subgroup of the patients in January and in March. To sum up, bright light can be successfully administered as prophylactic treatment for the prevention of winter SAD.

AUTHOR(S): Swedo SE; Allen AJ; Glod CA; Clark CH; Teicher MH; Richter D; Hoffman C; Hamburger SD; Dow S; Brown C; Rosenthal NE

AUTHOR'S ADDRESS: Department of Psychiatry, McLean Hospital, Belmont, MA, USA.

ARTICLE TITLE: A controlled trial of light therapy for the treatment of pediatric seasonal affective disorder.

ARTICLE SOURCE: J Am Acad Child Adolesc Psychiatry (United States), Jun 1997, 36(6) p816-21

ABSTRACT: OBJECTIVE: To evaluate the efficacy of light therapy for the treatment of pediatric seasonal affective disorder (SAD). METHOD: 28 children (aged 7 to 17 years) at two geographically distinct sites were enrolled in a double-blind, placebo-controlled, crossover trial of bright-light treatment. Subjects initially entered a week-long baseline period during which they wore dark glasses for an hour a day. They were then randomly assigned to receive either active treatment (1 hour of bright-light therapy plus 2 hours of dawn simulation) or placebo (1 hour of clear goggles plus 5 minutes of low-intensity dawn simulation) for 1 week. The treatment phase was followed by a second dark-glasses phase lasting 1 to 2 weeks. After this phase, the children received the alternate treatment. Response was measured using the parent and child versions of the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders version (SIGH-SAD). RESULTS: Data were analyzed as change from baseline. SIGH-SAD-P total depression scores were significantly decreased from baseline during light therapy compared with placebo (one-way analysis of variance, rho = .009), and no differences were found between the placebo and control phases. Subscores of atypical and typical depression were also significantly decreased during the active treatment (rho = .004 and .028, respectively). A similar trend was noted with the SIGH-SAD-C, but this did not reach significance. At the end of the study, 78% of the parents questioned and 80% of the children questioned rated light therapy as the phase during which the child "felt best." CONCLUSION: Light therapy appears to be an effective treatment for pediatric SAD.

AUTHOR(S): Tam EM; Lam RW; Levitt AJ

AUTHOR'S ADDRESS: Department of Psychiatry, University of British Columbia, Vancouver.

ARTICLE TITLE: Treatment of seasonal affective disorder: a review.

ARTICLE SOURCE: Can J Psychiatry (Canada), Oct 1995, 40(8) p457-66

ABSTRACT: OBJECTIVE: To review the status of current treatment of seasonal affective disorder (SAD). METHOD: Treatment studies of SAD published between January 1989 and March 1995 were identified using a computerized MEDLINE literature search. Additional citations were obtained from the reference sections of these articles. Studies included in this review were selected using operational methodologic criteria. RESULTS: Many studies support the efficacy of bright light therapy using a fluorescent light box. The best studied protocol is 2500 lux white light for 2 hours per day, but newer protocols using 10,000 lux for 30 minutes have comparable response rates. Studies of light visors and other head-mounted devices also report similar response rates, but have not yet shown superiority over putative control conditions. There are fewer medication studies in SAD, but controlled studies suggest that fluoxetine, d-fenfluramine and propranolol are effective. Other treatments such as dawn simulation require further study. No studies of psychological treatments for SAD were found. Many studies had methodologic limitations, including brief treatment periods, small sample sizes, and lack of replication, that limit the generalizability of findings. CONCLUSION: There are several well-studied, effective treatments for SAD, including light therapy and medications. However, further research must be done to demonstrate sustained treatment response over time, to clarify the intensity-response relationship of light therapy, to clarify the role of light therapy and medications, and to assess combination treatments.

AUTHOR(S): Terman M; Amira L; Terman JS; Ross DC

AUTHOR'S ADDRESS: Department of Psychiatry, Columbia University, New York, USA.

ARTICLE TITLE: Predictors of response and nonresponse to light treatment for winter depression.

ARTICLE SOURCE: Am J Psychiatry (United States), Nov 1996, 153(11) p1423-9

ABSTRACT: OBJECTIVE: The authors' goal was to determine whether the pattern and severity of depressive symptoms predict response to light treatment for seasonal affective disorder. METHOD: Subjects with winter depression (N = 103) were given bright light treatment. Seventy-one were classified as responders, 15 as nonresponders, and 17 as partial responders. Using depression rating scale data and correlational and multivariate analysis, the authors sought predictors of response in baseline symptom and scale scores. RESULTS: Responders were characterized by atypical symptoms, especially hypersomnia, afternoon or evening slump, reverse diurnal variation (evenings worse), and carbohydrate craving. By contrast, nonresponders were characterized mainly by melancholic symptoms, retardation, suicidality, depersonalization, typical diurnal variation (mornings worse), anxiety, early and late insomnia, appetite loss, and guilt. The ratio of atypical to classical symptoms of depression, rather than severity per se, best predicted treatment outcome for the group as a whole. Pretreatment expectations were positively correlated with improvement on the Hamilton Depression Rating Scale but not on a supplementary scale of atypical symptoms. CONCLUSIONS: Light-responsive seasonal affective disorder is distinguished by a dominant atypical symptom profile closely associated with depressed mood. Nonresponders from a clinically distinct group with melancholic features. The patient's symptom profile, therefore, should be considered when diagnosing seasonal affective disorder and selecting treatment.

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