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Seasonal Affect Disorder (Sad)

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Seasonal affective disorder, likewise abbreviated as SAD, is a type mood disorder that is annual consistent with the seasons. The most common SAD depressive symptoms starts late in the fall, continues throughout the winter (most crucial stage), and the symptoms lessen in the spring. However, it is possible for someone to have SAD during the summer season. For example, during the summer time a person may suffer from summer depression and or summer blues, then less depressed in the winter time when it gets colder. It is a type of depression generated by shorter days and longer nights. This form of depression can prevent the sufferer's ability to cope with their daily life activities, but the symptoms usually fade when there is a change in the season. According to the handbook Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) fourth edition text revised, SAD is considered a pattern “a specifier of major depression”, or subtype, of another mood disorder diagnosis. For example, an individual may be diagnosed as having a major depressive episode with a seasonal pattern. SAD was introduced and named in 1984 by Norman E. Rosenthal as well as his colleagues at the National Institute of Mental Health. Rosenthal is a psychiatrist and a scientist who was born and educated in South Africa and moved to the United States to finish his medical training. In all, he has written a total of seven books, and published two-hundred scholarly papers. In the following you will learn about the different treatments, the causes, the symptoms, diagnosis and many more of SAD.
Symptoms
The symptoms experienced by people with SAD are similar to some of those experienced by depressed people. In general it starts with a change in appetite, fatigue, significant weight gain or loss, irritability, frustration and avoidance of social situations. As indicated in the DSM-IV-TR, to meet the diagnostic criteria these symptoms must be present during “the season the individual is depressed and must lessen or abate when that season is over”.
Treatment
Occupational therapists (OTs) help individuals’ copes with SAD by incorporating the best practices and principals into their therapeutic practice with clients that is suffering from SAD. This includes: assessments, treatment, and evaluation.
1st effective treatment is the Light therapy: It has been put in use for over 20 years, it works effectively. This is recommended to be the first line of practice. According to J Psychosoc the person that is suffering from SAD has to sit “within several yards” in front of the light for at least 20 minutes to seek improvement. (1)
Antidepressant medications: Serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline appear to be most effective. OTs play a role in helping their clients understands how such medications can decrease acute symptoms and ultimately to boosted their participation in daily livelihoods.
Group therapy: this helps an individual to learn how to deal with similar issues with a larger group. Below are some examples:
• Stress management
• Substance abuse
• Social skills and networking
• Self-esteem
• Wintertime activities

Causes The causes of SAD are not fully known, but it is most likely a combination of genetic, biologic, and environmental factors play a role. Other factors that may make SAD more likely include:
• Amount of light
• Body temperature
• Hormones
Since depression often runs in families, it may have a genetic factor. Data were collected from family, twin, adoption, and genetic studies strongly indicate that there was a genetic factor. Studies have initiated that close relatives of patients with depression symptoms are two to six times more likely to develop the problem than those individuals without a family history.
Biological Factors
The basic biologic causes of depression are strongly linked to abnormalities in the delivery of certain key neurotransmitters. These neurotransmitters include:
Serotonin: it is to believe, serotonin, is the most important neurotransmitter in depression. The imbalances of the level in the brain’s serotonin can trigger mood disorders as well as depression.
Other neurotransmitters: acetylcholine and catecholamines, are a group of neurotransmitters that consist of dopamine, norepinephrine, and epinephrine. Corticotropin-releasing factor (CRF), is a stress hormone and neurotransmitter, it may be involved in depression and anxiety disorders.
Hormones: The reproductive Hormones in women estrogen and progesterone may have play a role in depression.
Environmental Factors: A person being on a certain medication can have an effect on SAD. The medications can increase depression causing that person to experience mood disorders, or depression. These medications include certain types of drugs used for high blood pressure, contraception, inflammation and other conditions.
Test and Diagnosis A diagnosis of depression is based on symptoms that meet on specific criteria. It is recommended that family doctors now have to follow a specific guideline in order to screen adults and adolescents for depression. To check if patient have depression a doctor might ask questions like:
• Over the past month, have you felt down, depressed or hopeless?
• Over the past month, have you felt little interest or pleasure in doing things?
• Over the past 30 days or so have you ever thought of hurting yourself?
Individuals might ask their doctor to screen them if they have certain factors:
• People with a family or personal history of depression
• Patients with multiple medical problems
• Patients with physical symptoms that have no clear medical cause
• Individuals who visit their doctor more frequently than expected which indicates they might have a problem.
Most mental health professionals generally diagnose depression based on symptoms and other meet criteria. However, mental health professionals can administer a screening test based on 20 questions known as the “Beck Depression Inventory”, or the “Hamilton Rating Scale”. (2) (3)

Prognosis There is no cure for SAD, but with the proper treatment, the prognosis for seasonal affective disorder is good. The key is to know how to manage SAD symptoms until it ultimately goes away. Light therapy is considered to be a safe and effective treatment. SAD can be a persistent problem; even if light therapy works one year, symptoms may return back the following year.
Prevention
Maintaining a healthy lifestyle is a key to prevent getting SAD. If in the winter time a person starts to experience any symptoms of SAD the best thing for that person to do is to try to relocate somewhere that has more sunshine. Perhaps being in regions closer to the equator might help. For example, in the United States, if a person is living in the New England area where the weather changes frequently (more colder days than warm days), the best thing for that individual to do is to move to Florida, Georgia, California or wherever else has longer sunshine days. If it the opposite where it is the summer, the best thing would have to be to keep the house really cool. St. John's Wort is a dietary supplement and herbal remedy that can help. It (4) is probably the most studied herbal remedy. Although its efficiency has not been clearly shown, it may help some patients with mild-to-moderate depression. It does not appear to help patients with moderate or severe depression. People with depression should not use this remedy without consulting their pshysician. Pregnant Women nor children should not be taking this substance. It takes up to three weeks to have an affect. St. John’s Wort should not be combine with any antidepressants because it may increase the rish of bleeding. The side effects are usually dry month, nausea, allergic reactions and so on. This may increase the sensitivity to light. Some people have been reported nerve damage after being expose in the sun. Fish oil, and L-Tryptopan can help a lot. Exersice can help people that are depress. For example: aorabics and yoga. The chinesse medical practice of accupunture can relief one from depression.
Complications
Since depression is chronic, where recurring and improving is a process, so is SAD. About a third of patients with a single episode of major depression will have another episode within 1 year after discontinuing treatment, and more than half will have a recurrence at some point in their lives.
Risk factors if any? People that live in places with long, cold winter nights are at greater risk for SAD. The suicide rate is very high in patients with SAD. Substance abuse is also very high in these patients. Depression is known to cause two-thirds of all suicides. Any signs of treats of suicides should be taking very seriously. Ironically men with depression are most likely to commit suicide than women, but SAD and depression exist more in females. Other treatment such as medications may increase the risk for suicidal behavior in some children and adolescents. Through behavioral therapies, combined with antidepressants, may help ease the thought of one wanting to commit suicide. At the same time, antidepressants can increase the risk for suicidal thoughts and behaviors especially from young adults’ ages from 18 to 24. These are some signs to look for:
• Withdrawal from friends, social networking, social life
• A sudden decrease in school performance
• Loss of interest in activities that were joy able beforehand
• Gets frustrated, irritated easily
• An unusual change in sleep or eating habits
Other risk factors to look out for are:
• Any history of self-abuse
• Any history towards self-harm
• A family member who once previously committed the act of suicide
• Access to firearms
Parents should take any treats serious and proceed to seek immediate professional help for their teens. This can have bad impact in a person’s daily life activities and relationships: Effects of Parental Depression; a depress parent(s) may increase the risk for childhood depression. The effects on a marriage; People who suffer from psychiatric disorders tend to have higher divorce rates. Spouses of partners with depression are themselves at higher risk for depression.
The effect on Work; It significantly increases the risk for unemployment and lower income.
Family and Friends People with SAD usually withdraw from being around families and friends. That is because they no longer have any interest in taking part of any social networking. Their social life is completely gone. In order for them to recover and to prevent worsen depression; they have a strong social support. Support from family and friends must, however, be healthy and stay positive.
Statistic
“As with depression generally, more women than men appear to suffer from this condition, at a ratio some estimates put as high as two to one. It is most common among women in their reproductive years, but its onset sometimes comes as early as childhood. Researchers think it may also have a genetic component; more than two-thirds of patients with SAD have a relative with a major mood disorder. (Ivry, Sara)” SAD is more common in women than that of men. According to DSM-IV-TR, women make up 60-90 percent of people with seasonal pattern of depression. The countries that are located near the equator, where changes in climate are mild, SAD primarily does not occur. SAD is mostly located in the Arctic region, where the rate is nearly 10 percent. However, Canadians, and Icelanders seems to be an exception. It has been suggested that this may be due to the high level of fish eating about 60 kg per capita. Fish are high in Vitamin D. Fish also contain docosahexaenoic acid (DHA), which helps neurological dysfunctions. “In Alaska it has been established that there is a SAD rate of 8.9%, and an even greater rate of 24.9% for subsyndromal SAD.” Seasonal Affective Disorder are mostly present in adults, but symptoms can start as early as adolescents. SAD impacts a wide range of various people.
Conclusion
Seasonal Affective Disorder is a real disorder and it does exist. When I first read about it I thought wow is this really true but it was. So I had decided to learn more about it because I feel like I do have that disorder. SAD is mostly generated by depression symptoms. SAD does not only affect the person with the disorder but it affects other surrounded by that person. Also, the people with SAD are at high risk to commit suicide. Suicides are more common in men than women that’s only because the guys would use firearm instead of the female trying to overdose on pills, which can sometimes recover.

Cited page
1. Seasonal Depression can Accompany Summer Sun. Ivry, Sara. The New York Times. Retrieved September 6, 2008”
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.
3. Howland RH. Somatic therapies for seasonal affective disorder. J Psychosoc Nurs Ment Health Serv 2009;47(1):17-20.
4. Picture (1) - Albany.com. Marjorie Gross. SPOTTING THE SIGNS OF SEASONAL AFFECTIVE DISORDER. Albany, Albany, 2010, February.
5. Picture (2)- http://withfriendship.com/user/mithunss/beck-depression-inventory.php
6. Picture (3) - University Health System. Hamilton Depression Rating. Antonio, Texas; University Health Science 2011.
7. Picture (4) – University of Maryland Medical Center (UMMC). St. John's Wort. Baltimore, Maryland; UMMC, 2011.

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