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The Light-er Side of Treating Seasonal Affective Disorder

(PSYCHIATRIC TIMES) - Rosenthal et al. (1984) first described seasonal affective disorder (SAD) as a pattern of recurrent depressions with a winter onset and a full remission the following summer. The emergence of treatment, specifically light therapy, was met with a mixture of enthusiasm and cautious skepticism. However, there is now substantial evidence to support its efficacy. This paper will review the treatment of SAD with a focus on new developments in the area.

The clinical presentation of SAD frequently includes the prominence of reverse vegetative or atypical symptoms (Rosenthal et al., 1984). Of these symptoms, increased appetite, carbohydrate craving, weight gain and hypersomnia are most commonly reported in large samples of patients with SAD. Prevalence estimates suggest that the condition occurs in 1% to 3% of the North American population (Blazer et al., 1998; Levitt and Boyle, 2002) with a female to male sex ratio of 1.6:1 (Lam and Levitt, 1999). Although initial research seemed to suggest a high frequency of bipolar disorders among patients with SAD (Rosenthal et al., 1987; Thompson and Isaacs, 1988), this has not been confirmed in subsequent reports (Levitt and Boyle, 2002; Thalen et al., 1995; Wehr et al., 1991).

The etiology and pathophysiology of SAD are still unknown; however, various hypotheses have garnered prominence in the literature. Most notably among these hypotheses is the theory of a dysregulated circadian rhythm, causing a phase delay (Lewy and Sack, 1988). This theory has been supported by evidence that early-morning light therapy is superior to evening light therapy (Eastman et al., 1998; Lewy et al., 1998b; Terman et al., 1998).

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