SAD

• Seasonal affective disorder is when depressive episodes occur annually at the same time each year, usually during the winter months

  Not actually given its own diagnosis in the DSM-5 and ICD-11

  Included under recurrent depressive disorder in the ICD-11
• Clinical features:

  • Must be a clear seasonal pattern to recurrent depressive episodes
  • In the northern hemisphere it is usually around Janurary/February - winter depression
  • Symptoms generally mild to moderate
  • Low self-esteem
  • Hypersomnia
  • Fatigue
  • Carbohydrate craving with weight gain
  • Decreased social and occupational functioning
• Theories:

  • Main theory is that lack of sunlight may cause dysregulation of the hypothalamus
  • Increased production of melatonin - fatigue
  • Reduced production of serotonin
  • Dysregulation of the circadian rhythm
• There seems to be some genetic link, as some cases run in families
• Management:

  • Lifestyle measures - as much natural sunlight as possible, exercise regularly
  • Bright light therapy
  • SSRIs
  • Talking therapy - CBT