Depression seasonal affective disorder

Melatonin [73-31-4] C 2H N202 (31) has marked effects on circadian rhythm (11). Novel ligands for melatonin receptors such as (32) (12), C2yH2gN202, have affinities in the range of 10 Af, and have potential use as therapeutic agents in the treatment of the sleep disorders associated with jet lag. Such agents may also be usehil in the treatment of seasonal affective disorder (SAD), the depression associated with the winter months. Histamine (see Histamine and histamine antagonists), adenosine (see Nucleic acids), and neuropeptides such as corticotropin-like intermediate lobe peptide (CLIP) and vasoactive intestinal polypeptide (VIP) have also been reported to have sedative—hypnotic activities (7). 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

Bright light therapy (i.e., the patient looking into a 10,000-lux intensity light box for about 30 min/day) may be used for patients with seasonal affective disorder and as adjunctive use for major depression. 

Uniabeied Uses Treatment of attention-deficit/hyperactivity disorder, brain injury-re-lafed underarousal, depression, endozepine stupor, multiple sclerosis-related fatigue, parkinson-related fatigue, seasonal affective disorder... 

Kupfer 1987 Soldatos et al. 1987). However, despite these intergroup differences, a subgroup of depressed patients may actually sleep more than the control subjects (Garvey et al. 1984 Kupfer 1984 Michaelis and Hofmann 1973) this subgroup includes mainly patients with seasonal affective disorder (Rosenthal et al. 1984) and those with anergic depression of the bipolar type (Detre et al. 1972 Kupfer et al. 1972). 

Oppenheim G Estrogen in the treatment of depression neuropharmacological mechanisms. Arch Gen Psychiatry 43 569-573, 1986 Oren DA, Moul DE, Schwartz PJ, et al A controlled trial of levodopa plus carbidopa in the treatment of winter seasonal affective disorders a test of the dopamine hypothesis. J Chn Psychopharmacol 14 196-200, 1994 Ormandy G, Jope RS Analysis of the convulsant-potentiating effects of lithium in rats. Exp Neurol 111 356-361, 1991... 

Neumeister A, Praschak-Rieder N, Hebelmann B, et al. Rapid tryptophan depletion in drug-free depressed patients with seasonal affective disorder. Am J Psychiatry 1997 154 1153-1155. 

Kripke DF. Light treatment for nonseasonal major depression are we ready In Lam RW, ed. Seasonal affective disorder and beyond light treatment for SAD and non-SAD conditions, 1 st ed. Washington, DC American Psychiatric Press, 1998 159-172. 

Seasonal variation is another chronobiological rhythm that is manifested by increases in depression and suicide in spring (with smaller peaks in autumn), as opposed to mania, which increases in the summer months. These observations have led to preliminary studies on the alteration of both light and temperature as potential therapies for the two seasonal patterns of affective disturbance. The phenomenon of seasonal variation is discussed in the sections Seasonal Affective Disorders in Chapter 6 and BrighlLight in Chapter 8. 

Another recognized type of depression is seasonal affective disorder (SAD). People in far northern or southern latitudes develop this condition in the winter, apparently from lack of sunshine needed to lower the melatonin level in the morning (see Section 13). Light therapy is beneficial.1110 Persons with the SAD syndrome also tend to crave carbohydrates and to stay in bed for 9-10 hours. 

Insufficient natural light can lead to depression, tiredness, or overeating. In the winter, especially in colder countries, the level of indoor light produces only about a tenth of the illumination of a full day of natural light. A form of winter blues that can result from this is known as seasonal affective disorder (SAD). It affects around 1% of the population (more women than men) but can be successfully treated with special full spectrum light units fitted in the home or office (Thomas, 1997 and General References). 

SEASONAL AFFECTIVE DISORDER (SAD) Type of depression that occurs during the fall and winter months. 

Are depressed or have a neurological disorder. Although melatonin may be linked to the development of seasonal affective disorder (SAD), its exact role in emotional and neurological illnesses remains unclear. 

Some depressed patients, especially if younger, lethargic and/or bipolar, complain of hypersomnia rather than of insomnia [16], Recurrent winter oversleeping is even considered as a key symptom to diagnose seasonal affective disorder (SAD). Several sleep EEG studies were performed in patients with SAD and none could evidence the typical sleep pattern of major depression (see [10]). Polysomnographic studies... 

Neumeister A, Willeit M, Praschak-Rieder N, Asenbaum S, Stastny J, Hilger E, Pirker W, Konstantinidis A, Kasper S (2001) Dopamine transporter availability in symptomatic depressed patients with seasonal affective disorder and healthy controls. Psychol Med 37 1467-1473. 

Depression and seasonal affective disorder, which is a form of depressive illness characterized by symptoms with onset and course related to season of the year, have been noted to be cyclic and possibly related to alterations in circadian rhythms... 

St. John s wort is used most often for the treatment of mild to moderate depression. It is also used to treat anxiety, sleep disorders, seasonal affective disorders (SADs), and wound healing (1,4,5). 

Major depressive disorder, when severe, is characteristically associated with a reduction in appetite, often sufficient to cause significant loss of weight. This is probably related to the alterations in central neurotransmitter activity (particularly that involving serotonin and norepinephrine), which occur in this disorder. Subjects with milder depressive disorder may, by contrast, eat more when depressed and gain weight (see Chapters 7 and 9). Those with seasonal affective disorder , who experience marked seasonal variations in mood, typically have an increase in appetite, and gain weight, in the winter months (see Chapter 8). This, too, may be related to fluctuations in brain serotonin activity (Wurtman 1993). 

In this framework, disease progress refers to the evolution of a disease over time, or the disease trajectory, which can be assessed by observing the time course of a biomarker or other clinically relevant endpoint that reflects the status of a disease or is a measure of the clinical status of a patient. The status of the patient is a reflection of the state of the disease at a point in time. Disease status may improve or worsen over time, or may be a cyclical phenomenon such as the seasonal affective disorder component of depression. Therefore, a model of disease progress is a mathematical expression that describes the expected changes in patient status over time either in the absence of treatment or at least in the absence of the treatment being investigated. 

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