Introduction
A mood condition called seasonal affective disorder (SAD) is characterized by depression symptoms that emerge during a particular time of year and completely disappear afterward. It often happens in the autumn or winter, though a less frequent variation can also happen in the spring or summer. An overall SAD prevalence constitutes 0.5% to 2.4% of the general population, according to studies conducted in the U.S., Canada, and the U.K. (Galima et al., 2020). Moreover, 10% to 20% of people with serious depression exhibit seasonal symptomatology that resembles SAD (Galima et al., 2020). In this context, the current paper provides an overview of SAD’s symptomatology, pathophysiology, diagnosis, and potential treatment in order to increase SAD awareness.
Symptomatology
SAD is a form of severe depression, and those who have it may display any of the accompanying symptoms. For instance, self-harm, suicidal ideation, apathy, deliberate social isolation, insomnia, eating, concentrating, decision-making issues, low libido, lack of energy, or being agitated are a few examples of these symptoms (Galima et al., 2020). Winter depression and SAD are commonly related, but other seasonal mood patterns, such as spring lethargy, are also common.
Pathophysiology
Many potential proximal reasons have been put forth. It is possible that serotonin deficiency contributes to SAD (Galima et al., 2020). Mice who are unable to convert serotonin into N-acetylserotonin, for example, appear to exhibit depressive behavior. This state can be countered by fluoxetine, which produces an antidepressant effect by increasing the enzyme serotonin N-acetyltransferase (Galima et al., 2020). There is also the possibility that the sleep-regulating hormone melatonin is the cause (Nussbaumer‐Streit et al., 2019). In other words, the onset of SAD may be caused by a relative phase shift of circadian rhythms in regard to the time of the sleep-wake pattern.
Diagnosis
DSM-5 does not regard SAD as a separate disorder family. Particularly, it attributes the same diagnostic criteria as major depressive disorder or bipolar disorder (Galima et al., 2020, p. 669). There must also be a temporal connection between the season and the incidence of behavioral alterations – brief intervals when a patient exhibits depressive symptoms. Moreover, the stipulated season must end before full remission can take place. Finally, to diagnose the season of SAD, mood episodes must occur twice in the same season for two years in a row (Galima et al., 2020). With SAD, a person’s lifetime is markedly more susceptible to seasonal mood episodes than non-seasonal ones.
Treatment
Light therapy, antidepressants, and therapeutical interventions are all employed as SAD-preventative treatments. Light therapy is frequently utilized as the first-line solution for SAD due to its high success rate (Pjrek et al., 2020). In turn, “bupropion XL extendedrelease”, a second-generation antidepressant, is also proven effective against SAD (Nussbaumer‐Streit et al., 2019, p. 6). Its effectiveness in treating SAD serves as the foundation for the use of second-generation antidepressants in SAD prevention. Lastly, the efficacy of a number of psychological treatments for SAD has been currently studied (Nussbaumer‐Streit et al., 2019). Regardless of its type, therapeutical intervention may prevent SAD by encouraging patients to take deliberate actions against symptoms that decrease their mood.
Conclusion
SAD is a unique manifestation of a major depressive disorder with a characteristic seasonal attribute. Its symptomatology resembles one of the other known depression disorders and is diagnosed accordingly with respect to its seasonal occurrence. SAD’s pathophysiology may lie in serotonin deficiency or melatonin disbalance. Consequently, the existing treatment options focus on either of the two hormones, addressing the respective issues through the use of therapy and antidepressants.
References
Galima, S. V., Vogel, S. R., & Kowalski, A. W. (2020). Seasonal affective disorder: Common questions and answers. American family physician, 102(11), 668-672.
Nussbaumer‐Streit, B., Greenblatt, A., Kaminski‐Hartenthaler, A., Van Noord, M. G., Forneris, C. A., Morgan, L. C., & Gartlehner, G. (2019). Melatonin and agomelatine for preventing seasonal affective disorder. Cochrane Database of Systematic Reviews, (6), 1-37. Web.
Pjrek, E., Friedrich, M. E., Cambioli, L., Dold, M., Jäger, F., Komorowski, A., & Winkler, D. (2020). The efficacy of light therapy in the treatment of seasonal affective disorder: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 89(1), 17-24. Web.