The prevalence of seasonal affective disorder among the blind and patients with serious visual impairment.

BACKGROUND: Seasonal affective disorder (SAD) is an interesting disorder in which depression should occur at a particular time of a year, each year and it should disappear at a specific time of the year. While the prevalence of SAD among generally healthy individuals is well known, the information about the prevalence of this disorder among the blind and visually impaired patients is very limited. The aim of the study was to investigate the prevalence of SAD among the blind and people with serious visual impairment in polish population. SUBJECTS AND METHODS: 250 blind or seriously visually impaired individuals and 258 healthy controls were assessed with the usage of Seasonal Pattern Assessment Questionnaire (SPAQ). In research group survey was conducted with the Computer Assisted Telephone Interview (CATI) technique. In control group the questionnaire was distributed via Internet. The results were analysed with the usage statistical package - Statistica 13.1. RESULTS: The results revealed that among people suffering from SAD there is statistically significant difference in SPAQ scores between completely blind and seriously visually impaired people. The study shows that is the control group age is negatively correlated with score in SPAQ score, while in the study group age is positively correlated with SPAQ score. The data show that there is a difference in occurrence of SAD between men and women. CONCLUSION: The study has shown a significant difference in occurrence of SAD between study and control groups. What is more the analysis has indicated major difference in the occurrence of SAD between men and women from the study group. Taking into consideration the fact that this is the second analysis of this type in Europe further investigations are needed.

Depressive mood and circadian rhythms disturbances as outcomes of seasonal affective disorder treatment: A systematic review.

BACKGROUND: The present systematic review was aimed at critically summarizing the evidence about interventions focused on circadian rhythms and mood symptoms in seasonal affective disorder (SAD). METHODS: A systematic search of the electronic databases PUBMED, PsycINFO and Web of Science was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Original papers reporting data about the effects of treatments on both mood and circadian rhythms disturbances in SAD patients were considered for inclusion. The quality of the evidence provided by the eligible studies was assessed using the Revised Cochrane Risk of Bias Tool (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies of Interventions Tool (ROBINS-I). RESULTS: Forty papers were deemed eligible for the systematic review. The evidence of treatment outcomes referring to circadian disturbances was not robust. Despite this, bright light therapy (BLT) demonstrates to phase-advance delayed rhythms and to improve sleep-wake disorders. As for mood symptoms, both BLT and selective serotonin reuptake inhibitors (SSRIs) show evidence of efficacy. The possible connection between improvements of mood symptoms and changes in circadian outcomes seems controversial. LIMITATIONS: The included studies presented considerable methodological heterogeneity, small sample sizes and non-optimal sample selection. CONCLUSIONS: The effectiveness of BLT in depressive symptoms and circadian disturbances of SAD was outlined by the present systematic review. The evidence about other biological and pharmacological treatments, although promising, should be replicated. A multifactorial etiopathogenesis could explain the heterogeneous clinical presentations of SAD and the complex link between mood and circadian symptoms.

Night eating in bipolar disorder.

OBJECTIVE: Night eating syndrome (NES) involves reduced feeding during the day and evening hyperphagia sometimes accompanied by frequent nocturnal awakenings with conscious episodes of compulsive ingestion of food. Previously, NES has not been evaluated in bipolar disorder (BD). The objective of this study was to identify NES in euthymic BD patients. PATIENTS/METHODS: Eighty BD patients and 40 controls were examined using the Night Eating Questionnaire, Hamilton Rating Scale for Depression and Anxiety, Young Mania Rating Scale, Functioning Assessment Short-Test and International Physical Activity Questionnaire. Sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), severity of insomnia (Insomnia Severity Index) and morning-evening preference (Morningness-Eveningness Questionnaire) were also evaluated. RESULTS: BD patients presented NES in 8.8% while the controls showed no NES. Patients with and without NES were not different with respect to gender, disease duration, smoking, heavy drinking, body mass index, waist-to-hip ratio and neck circumference. BD patients with NES scored higher for functioning as well as for the following specific components: occupational functioning, financial issues, interpersonal relationships and leisure time. They also had more anxiety, higher insomnia severity and worse sleep quality. Furthermore, BD patients with NES were more evening type. CONCLUSION: NES occurs more frequently in BD patients than in controls. BD patients with NES present more disease-related manifestations such as more anxiety, poorer functioning and worse sleep parameters. Patients with NES were more evening type. We speculate whether changing circadian preference in these patients can reduce NES.

Differences in sleep functioning between individuals with seasonal affective disorder and major depressive disorder in Finland.

BACKGROUND: Sleep problems are commonly reported in seasonal affective disorder (SAD) and major depressive disorder (MDD). However, the specific characteristics of sleep difficulties differ. Frequent sleep problems in MDD are insomnia and night awakenings, whereas SAD patients complain of hypersomnia and daytime sleepiness. No previous studies have reported differences in sleep functioning between these two disorders. METHODS: We interviewed 4554 subjects from the Health 2011 survey and included 4153 individuals in this study. We selected participants who fulfilled the criteria for SAD (n = 223), nonseasonal-MDD (n = 238), SAD + MDD (n = 65), and controls (n = 3627). They completed the World Health Organization Composite International Diagnostic Interview, Munich version (M-CIDI), the Seasonal Pattern Assessment Questionnaire (SPAQ), The Beck Depression Inventory (BDI), the EuroQoL (EQ-5), the Alcohol Use Disorders Identification Test (AUDIT) and several questions about sleeping, based on the Basic Nordic Sleep Questionnaire (BNSQ). RESULTS: We found Significant differences between groups for "enough sleep", "breathing interruptions during sleep", "tiredness during the day", and "sleeping difficulties". Controls reported better functioning in all sleep variables. SAD + MDD individuals showed more problems in "enough sleep" than SAD, more "breathing interruptions during sleep" than SAD and nonseasonal-MDD, felt more "tired during the day" than SAD and nonseasonal-MDD, and reported more "sleeping difficulties" than SAD and nonseasonal-MDD. Finally, nonseasonal-MDD individuals felt more "tired during the day" than SAD. CONCLUSION: Individuals with SAD + MDD show generalized sleeping problems. However, when SAD and nonseasonal-MDD appear separately, similar sleep functioning is observed. Nonseasonal-MDD subjects report to be more tired during the day than SAD.

Seasonal mood changes in patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is frequently associated with mood disorders. However, to date, the co-occurrence of OCD with seasonal affective disorder (SAD) has not been investigated. We have aimed to estimate the prevalence of seasonal mood changes in patients with OCD and explore the contribution of seasonality in mood to the severity of OCD. The Seasonal Pattern Assessment Questionnaire (SPAQ), the Yale-Brown Obsession and Compulsion Scale (Y-BOCS), the Hamilton Depression Rating Scale-17 Items (HDRS-17), and the Beck Anxiety Inventory (BAI) were administered to patients with OCD (n=104) and controls (n=125). The degree of seasonality was measured by the Global Seasonality Score (GSS) calculated from the SPAQ. SAD and subsyndromal seasonal affective disorder (S-SAD) were significantly more prevalent in patients with OCD (53%, n=55) than controls (25%, n=31). When patients were assessed in the season in which SAD occurs, depression and compulsions (but not obsessions, OCD or anxiety) were more severe than those assessed in a season during which SAD does not occur. SAD frequently co-occurs with OCD and, given this co-occurrence, depression symptoms in some patients with OCD might be expected to vary on a seasonal basis.

Enhanced inflammatory and T-helper-1 type responses but suppressed lymphocyte proliferation in patients with seasonal affective disorder and treated by light therapy.

BACKGROUND: Animals show seasonal changes in the endocrine and immune system in response to winter stressors. Even though increased inflammation has been implicated in the pathophysiology of depression, whether immune disorder is a key mediator in seasonal affective depression (SAD) is unknown. Here, we hypothesized that short photoperiods in winter may induce inflammatory response, which contributes to SAD, and that light treatments should normalize immune function and improve depressive symptoms. METHODS: Twenty patients with a diagnosis of SAD, and a score on the HAM-29 of 20 or higher were recruited for this study. Twenty-one healthy subjects with no personal and family history of psychiatric disorder were matched to patients according to age and sex. Patients and controls were sampled during winter between November and January, inclusive. A subset of SAD patients (N=13) was re-sampled after 4 weeks of light therapy. Blood samples were assayed for macrophage activity, lymphocyte proliferation and cytokine release. RESULTS: SAD patients showed significantly higher macrophage activity and lower lymphocyte proliferation in winter compared to healthy subjects. The concentrations of macrophage-produced proinflammatory cytokines interleukin-1ß and tumour necrosis factor-α, and T-helper (Th)-1 produced cytokine, interferon-γ were all significantly increased. In contrast, no significant changes in Th2-produced cytokines were observed. Light therapy significantly improved depressive scores, which was associated with attenuation of decreased lymphocyte functions, increased macrophage activity and level of proinflammatory cytokines. CONCLUSION: SAD patients have increased macrophage and Th1 type responses in winter, and light therapy normalized immune functions and depressive symptoms. These results support an inflammatory hypothesis for SAD and an immunomodulatory role of light therapy.

The first observation of seasonal affective disorder symptoms in Rhesus macaque.

Diurnal animals are a better model for seasonal affective disorder (SAD) than nocturnal ones. Previous work with diurnal rodents demonstrated that short photoperiod conditions brought about depression-like behavior. However, rodents are at a large phylogenetic distance from humans. In contrast, nonhuman primates are closely similar to humans, making them an excellent candidate for SAD model. This study made the first attempt to develop SAD in rhesus macaque (Macaca mulatta) and it was found that short photoperiod conditions could lead monkeys to display depressive-like huddling behavior, less spontaneous locomotion, as well as less reactive locomotion. In addition to these depression-related behavioral changes, the physiological abnormalities that occur in patients with SAD, such as weight loss, anhedonia and hypercortisolism, were also observed in those SAD monkeys. Moreover, antidepressant treatment could reverse all of the depression-related symptoms, including depressive-like huddling behavior, less spontaneous locomotion, less reactive locomotion, weight loss, anhedonia and hypercortisolism. For the first time, this study observed the SAD symptoms in rhesus macaque, which would provide an important platform for the understanding of the etiology of SAD as well as developing novel therapeutic interventions in the future.

Short-term effects of bright light therapy in adults with chronic nonspecific back pain: a randomized controlled trial.

OBJECTIVE: The present trial evaluated incorporation of bright light therapy in the treatment of chronic nonspecific back pain (CNBP). DESIGN: A prospective, randomized, controlled, multicenter, open design with three parallel trial arms was used. SETTING: Subjects received a novel therapeutic, an expected therapeutic ineffective low dose, or no light exposure at three different medical centers. PATIENTS: A total of 125 CNBP patients reporting pain intensity of ≥3 points on item 5 of the Brief Pain Inventory (BPI) were included. INTERVENTION: Over 3 weeks, 36 active treatment, 36 placebo controls, and 33 controls received 3 or no supplementary light exposures of 5.000 lx or 230 lx, respectively. OUTCOME MEASURES: Changes in self-reported scores of pain intensity (BPI sub-score 1) and depression (Hospital Anxiety and Depression Questionnaire) were the primary outcome measures. Secondary outcome measures were changes in self-reported overall pain sensation (BPI total score), grade of everyday life impairment (BPI sub-score 2), mood (visual analog scale), and well-being (World Health Organization-Five Well-Being Index). RESULTS: Changes in pain intensity were higher (1.0 [0.8-1.6]) in the bright light group compared with controls (0.3 [-0.1-0.8]; effect size D = 0.46). Changes in the depression score were also higher in the intervention group (1.5 [0.0-2.5]) compared with controls (0.0 [0.0-2.0]; effect size D = 0.86). No differences were seen in change scores between intervention vs sham group. CONCLUSION: The present randomized controlled trial shows that light therapy even in low dose could improve depressive symptoms and reduce pain intensity in CNBP patients. Further research is needed for optimizing parameters of frequency, dose, and duration of therapeutic light exposure.

Prevalence and correlates of binge eating in seasonal affective disorder.

Eating pathology in Seasonal Affective Disorder (SAD) may be more severe than hyperphagia during winter. Although research has documented elevated rates of subclinical binge eating in women with SAD, the prevalence and correlates of binge eating disorder (BED) in SAD remain largely uncharacterized. We examined the prevalence and correlates of binge eating, weekly binge eating with distress, and BED as defined by the DSM-IV-TR in SAD. We also tested whether binge eating exhibits a seasonal pattern among individuals with BED. Two samples were combined to form a sample of individuals with SAD (N=112). A third sample included non-depressed adults with clinical (n=12) and subclinical (n=11) BED. All participants completed the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R) and modified Seasonal Pattern Assessment Questionnaire (M-SPAQ). In the SAD sample, 26.5% reported binge eating, 11.6% met criteria for weekly binge eating with distress, and 8.9% met criteria for BED. Atypical symptom severity predicted binge eating and BED. In the BED sample, 30% endorsed seasonal worsening of mood, and 26% reported a winter pattern of binge eating. The spectrum of eating pathology in SAD includes symptoms of BED, which are associated with atypical depression symptoms, but typical depression symptoms.

Winter depression and diabetes.

Depression is a common and often harmful disorder, which is frequently associated with the winter season. Research has shown a link between type 2 diabetes mellitus and depression. Furthermore, diabetics with depression have a higher rate of adverse outcomes. Little has been published regarding the seasonality of depression in diabetics. The case report described in this article concerns a 65-year-old woman with type 2 diabetes and a history of winter depression. Current evidence-based management options are reviewed.

Depresión en adultos de 60 a 75 años en San Lorenzo, Valle, marzo 2011 / Depression in adults aged 60-75 years in San Lorenzo, Valle, March 2011

La depresión es la enfermedad psiquiatrica mas frecuente en ancianos en países en desarrollo, es la responsable del sufrimiento del anciano y de incrementar la prevalencia de la mala evolución de las complicaciones médicas. Objetivo: calcular la tasa de prevalencia de depresión y algunos factores asociados en la población adulta de 60-75 años de edad en San Lorenzo, Departamento de Valle, marzo 2011. Metodología: tipo de estudio: se realizo un estudio descriptivo de corte transversal. La población de estudio estaba distribuida 4, 423 casas y 11 barrios y 11 colonias que forman la ciudad de San Lorenzo, Departamento de Valle el tamaño de la muestra fue de casas. El Método el muestreo utilizado por conglomerado; una vez seleccionados los barrios se utilizo el sistema estratificado por adecuación para elegir un numero de casas por barrio para este fin se utilizo la tabla de numeros aleatorios. Procedimiento: previo consentimiento informado, los adultos respondieron cuatro cuestionarios que fueron: Escala de Depresión Geriátrica Yesavage en su versión completa de de 30 items. Esta escala es la unica validada en atención primaria siendo diseñada exclusivamente para este grupo de edad. Tiene una sensibilidad de un 84% y especialidad de un 95%. la Puntuación de clasificación es: 0-10, normal; 11-15, depresión leve; 15 depresión establecida. La escala de Katz, es la valoración funcional de las actividades basicas de la vida diaria (ADV) a niveles elementales de función física. La escala de Pfeiffer, diseñada para detectar la posible existencia de deterioro congnitivo. el cuestionario de carácter general para información sobre datos demográficos y factores de riesgo. Resultados: La prevalencia de depresión fue de 177 (52.5%);

[When a season means depression]. / Quand la saison devient synonyme de dépression.

Although becoming more and more recognized among physicians and psychiatrists the etiology of seasonal affective disorder (SAD) remains unclear. Indeed, the only incontestable fact is the close link between the decrease in sunlight occurring during fall and winter and the onset of depressive symptoms. But why does this seasonal decrease in the amount of light trigger a depression in some individuals while not affecting others? Why and how has sun exposure such an impact on brain-mood regulation? This review intends to shed some light on the main neurochemical hypotheses that have been advanced for the past 25 years. While several hypotheses have been advanced to explain SAD, the present review will focus on three major suspects which are: (1) melatonin due to its crucial role in circadian rhythms (2) serotonin which has been linked with depressive disorders in general and atypical symptoms and (3) catecholamine because as for serotonin, many data reported an implication of these neurotransmitter family in depressive disorders. However, similarly to other reviews about SAD, we conclude that none of those could explain the pathophysiology of this northern disease on its own.

Recognizing emotions in faces: effects of acute tryptophan depletion and bright light.

In healthy never-depressed individuals, acute tryptophan depletion (ATD) may selectively decrease the accurate recognition of fearful facial expressions. Here we investigated the perception of facial emotions after ATD in more detail. We also investigated whether bright light, which can reverse ATD's mood-lowering effect, can also reverse its effect on the perception of facial emotions. On two separate test days, spent in a room that was either bright (n = 14) or dim (n = 16), healthy never-depressed women completed a facial emotion perception task six hours after ingesting tryptophan-deficient and balanced amino acid mixtures. Treatments were administered double blind and in randomized order using a crossover design. In dim light ATD decreased recognition accuracy of anger, disgust, and surprise. The labeling of fear and sadness was not affected. In bright light no effects of ATD were seen. Bright light was identified as a potential confounding factor in task performance. The effects of ATD on facial emotion perception may be less emotion-specific than thought previously, and occurred in a direction opposite to what might be expected based on theories of mood-congruent bias.

[Less need for insulin, a surprising effect of phototherapy in insulin-dependent diabetes mellitus]. / Verminderde insulinebehoefte; een verrassend effect van lichttherapie bij insulineafhankelijke diabetes mellitus.

A 40-year-old woman with insulin-dependent diabetes mellitus was treated successfully with phototherapy for a seasonal affective disorder. Following sessions of phototherapy she developed hypoglycaemias and required less insulin. A review of the literature showed that melatonin has an inhibiting effect on insulin sensitivity. The melatonin secretion, which is suppressed by phototherapy, may cause an immediate decrease in the plasma glucose levels. This decrease may well be important for patients with insulin-resistant diabetes mellitus and seasonal affective disorder.

Seasonal changes in mood and behavior are linked to metabolic syndrome.

BACKGROUND: Obesity is a major public health problem worldwide. Metabolic syndrome is a risk factor to the cardiovascular diseases. It has been reported that disruptions of the circadian clockwork are associated with and may predispose to metabolic syndrome. METHODOLOGY AND PRINCIPAL FINDINGS: 8028 individuals attended a nationwide health examination survey in Finland. Data were collected with a face-to-face interview at home and during an individual health status examination. The waist circumference, height, weight and blood pressure were measured and samples were taken for laboratory tests. Participants were assessed using the ATP-III criteria for metabolic syndrome and with the Seasonal Pattern Assessment Questionnaire for their seasonal changes in mood and behavior. Seasonal changes in weight in particular were a risk factor of metabolic syndrome, after controlling for a number of known risk and potential confounding factors. CONCLUSIONS AND SIGNIFICANCE: Metabolic syndrome is associated with high global scores on the seasonal changes in mood and behavior, and with those in weight in particular. Assessment of these changes may serve as a useful indicator of metabolic syndrome, because of easy assessment. Abnormalities in the circadian clockwork which links seasonal fluctuations to metabolic cycles may predispose to seasonal changes in weight and to metabolic syndrome.

[Association of obesity and depression]. / Az elhízás és a depresszió kapcsolatai.

It has been long known that the frequency of overweight and obese people is higher among depressed and bipolar patients than in the general population. The marked alteration of body weight (and appetite) is one of the most frequent of the 9 symptoms of major depressive episode, and these symptoms occur during recurrent episodes of depression with a remarkably high consequence. According to studies with representative adult population samples, in case of obesity (BMI over 30) unipolar or bipolar depression is significantly more frequently (20-45%) observable. Since in case of depressed patients appetite and body weight reduction is observable during the acute phase, the more frequent obesity in case of depressed patients is related (primarily) not only to depressive episodes, but rather to lifestyle factors, to diabetes mellitus also more frequently occurring in depressed patients, to comorbid bulimia, and probably to genetic-biological factors (as well as to pharmacotherapy in case of medicated patients). At the same time, according to certain studies, circadian symptoms of depression give rise to such metabolic processes in the body which eventually lead to obesity and insulin resistance. According to studies in unipolar and bipolar patients, 57-68% of patients is overweight or obese, and the rate of metabolic syndrome was found to be between 25-49% in bipolar patients. The rate of metabolic syndrome is further increased by pharmacotherapy. Low total and HDL cholesterol level increases the risk for depression and suicide and recent studies suggest that omega-3-fatty acids possess antidepressive efficacy. Certain lifestyle factors relevant to healthy metabolism (calorie reduction in food intake, regular exercise) may be protective factors related to depression as well. The depression- and possibly suicide-provoking effect of sibutramine and rimonabant used in the pharmacotherapy of obesity is one of the greatest recent challenges for professionals and patients alike.

Enhanced serotonin transporter function during depression in seasonal affective disorder.

Decreased synaptic serotonin during depressive episodes is a central element of the monoamine hypothesis of depression. The serotonin transporter (5-HTT, SERT) is a key molecule for the control of synaptic serotonin levels. Here we aimed to detect state-related alterations in the efficiency of 5-HTT-mediated inward and outward transport in platelets of drug-free depressed patients suffering from seasonal affective disorder (SAD). 5-HTT turnover rate, a measure for the number of inward transport events per minute, and tyramine-induced, 5-HTT-mediated outward transport were assessed at baseline, after 4 weeks of bright light therapy, and in summer using a case-control design in a consecutive sample of 73 drug-free depressed patients with SAD and 70 nonseasonal healthy controls. Patients were drug-naive or medication-free for at least 6 months prior to study inclusion, females patients were studied in the follicular phase of the menstrual cycle. All participants were genotyped for a 5-HTT-promoter polymorphism (5-HTTLPR) to assess the influence of this polymorphism on 5-HTT parameters. Efficiency of 5-HTT-mediated inward (p=0.014) and outward (p=0.003) transport was enhanced in depressed patients. Both measures normalized toward control levels after therapy and in natural summer remission. Changes in outward transport showed a clear correlation with treatment response (rho=0.421, p=0.001). Changes in inward transport were mediated by changes in 5-HTT transport efficiency rather than affinity or density. 5-HTTLPR was not associated with any of the 5-HTT parameters. In sum, we conclude that the 5-HTT is in a hyperfunctional state during depression in SAD and normalizes after light therapy and in natural summer remission.