Seasonal Affective Disorder Treatment – A New Approach to Treating Psychiatric Disorders?

Seasonal Affective Disorder Treatment – A New Approach to Treating Psychiatric Disorders?

Paul Bloch

I have noticed that some students seem as though they are in better moods whenever spring comes. When I asked them why their mood is uplifted during the change in season, they reply that they just love the warmth and brightness. This led me to investigate correlations between good weather and mood. My research led me to one fascinating disorder: seasonal affected disorder (SAD). Patients with seasonal affective disorder suffer depression during the fall and winter seasons but become functional again when the season changes to spring/summer.

The disorder itself is very interesting, but I am more fascinated by the available treatment. While psychiatrists often prescribe exogenous, psychotropic drugs (many times combined with psychotherapy) to treat such illnesses like depression, simple light boxes are used to treat SAD.

Therapy in the drug form is traditional, main stream, and often expected by depressed patients. The rationale for drug treatment is rather simple. A series of observations indicate that monoamine neurotransmitters are present in abnormally low amounts in the brains of depressed patients. The enzyme that degrades monoamines, monoamine oxidase A, is often hyperactive or present in high concentrations in brains of depressed patients. Monoamines are a class of neurotransmitters that include dopamine, serotonin, and other neurotransmitters that affect mood, sleep, appetite, and other behaviors that are affected by depression (1). Hence, it is rational that mood disorders are often cause by an imbalance of monoamines, and treatment consists of balancing the imbalance with synthesized drugs.

Medication based psychiatric treatment is a double edge sword, however. While medication has helped many patients regain their lives, it has also facilitated in the ending of many lives. One example of such medication is Paxil. The slogan for Paxil is “Your life is waiting” (2). In many cases, patients’ lives were essentially disabled by depression, and Paxil was a key factor in regaining it. Terry Bradshaw, a pro-football hall of famer, suffered from severe depression. He testifies that under Paxil, “My depression improved and I can pay attention to the elements of my life that are important.” However, a six word warning on the Paxil website after Bradshaw’s testimonial gives a very dire message: “Your results may vary from Terry's” (3).

This warning comes from observations that Paxil has been harmful, rather than therapeutic, to some patients. Among children, adolescents, and young adult patients, Paxil has been observed to increase suicidal thoughts (4). In fact, a 16 year old girl had committed suicide after a couple months on Paxil. The girl suffered from mild depression and had not reported having suicidal thoughts prior to taking Paxil. The family claimed that Paxil was a causative factor in the girl’s suicide and sued the drug company (5). Such losses are absolutely devastating to families and cause a newfound suspicion to drug based treatment. My point: An alternative treatment to medication is a very good investment for depression and other psychiatric disorders.

This is why I am so fascinated with seasonal affective disorder and its treatment. As mentioned before, SAD is depression, whose onset occurs at specific seasons. The devastating symptoms include change of appetite, low energy, excessive sleep, dysphoria, anxiety, and others (8). These symptoms lower quality of life for both patients and love ones.

Although the cause of SAD is unknown, there are several theories. Some believe melatonin, a hormone that is released to induce sleep, is involved with SAD. Melatonin is produced by the pineal gland. It helps regulate the circadian rhythms, which is cycle of sleeping and waking hours. During the early evening, the levels of melatonin rise and remain high during the night. In the morning, levels go down so that one can awake. The crests and troughs are directly affected by light intensity. During the shorter days and gloomier days in winter, melatonin production may start earlier or later. The change in fluctuation is said to give rise to certain symptoms of SAD, including excessive sleep and low energy levels, resulting in an inability to carry out daily functions and dysphoria (6).

Others assert that serotonin is involved with SAD. Serotonin is a neurotransmitter, and it has roles in various behaviors, including eating, sleeping, and the general feeling of contentment. Observations have been recorded that serotonin levels in specific areas of the brain are low in depressed and suicidal patients (7). Interestingly, observations have suggested that sunlight affects serotonin levels. In a study involving 101 healthy individuals, it was shown that the turnover of serotonin in the brain was directly affected by luminosity. The rate of serotonin turnover was higher or brighter days than on darker ones (8). This observation suggests that the onset of SAD may be through sunlight-serotonin interacting pathways.

Regardless of whether SAD is caused by sunlight-melatonin interactions or by sunlight-serotonin interactions, light emulating sunlight treats the disorder (9). Light therapy is a common treatment for SAD. In fact, many therapists consider the light therapy as the standard way to treat SAD. Light therapy consists of sitting in front of a light box that emits a certain type of light at a specific intensity. This light is different from household lighting as it mimics outdoor light. This light reacts with biochemicals in the brain such as melatonin and serotonin, and treats the depression of SAD patients (10).

This treatment for SAD is inspiring for those interested in alternative therapy for psychiatric disorders. As demonstrated by tragic drug-induced induced suicides, medication is dangerous. A seemingly therapeutic drug for one could cause much grief for another. Hence, when effective alternative therapy is available, one should take advantage.

The light box is a fantastic display of the effectiveness of a non-dangerous treatment. Psychiatric researchers should investigate how outside environments affect moods rather than just ‘fixing’ the brain’s environment. Many psychiatric illnesses are genetically based, in which case people are predisposed to have neurochemical imbalances. Nevertheless, the light box is proof that we can treat such imbalances by safely manipulating our outside environment rather than dangerously experimenting with our interior environment.

(1) Meyer, Jeffery et al. “Elevated Monoamine Oxidase A Levels in the Brain: An explanation for the Monoamine Imbalance for Major Depression.” Arch Gen Psychiatry 2006;63:1209-1216
http://archpsyc.ama-assn.org/cgi/content/abstract/63/11/1209, accessed 4/24/08

(2) GlaxoSmithKlein Author, “Depression.” PaxilCR website. http://www.paxilcr.com/depression/depression.html, accessed 4/26/08

(3) GlaxoSmithKlein Author. “Terry Bradshaw’s Story.” PaxilCR website. http://www.paxilcr.com/depression/depression_testimonial.html, accessed 4/25/08

(4) Annonymous. “Paxil: Drug Description.” RxList Website. http://www.rxlist.com/cgi/generic/parox.htm, accessed 4/23/08

(5) Mayberry, Jodine. “Paxil Teen Suicide Case Trumped by Michigan Law.” Find Law Website. http://news.findlaw.com/andrews/pl/ddr/20080327/20080327_white.html, accessed 4/27/08

(6) Anonymous. “Melatonin: An Overview” WebMD Website. http://www.webmd.com/sleep-disorders/tc/melatonin-overview, accessed 4/25/08

(7) Ho, Katheryn. “Serotonin and Depression.” Serendip Website. /bb/neuro/neuro99/web3/Ho.html, accessed 427/08

(8) McConnell, Harvey. “Brain Serotonin Production Directly Related to Degree of Sunlight.” Doctor’s Guide Website. http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C86003D5B1F, accessed 4/24/08

(9) UCSF Medical Staff, “Sleep Disorders: Seasonal Affective Disorder.” UCSF Medical Center Website. http://www.ucsfhealth.org/adult/medical_services/neuro/sleep_disorders/conditions/sad/signs.html, accessed 4/27/08

(10) Mayo Clinic Staff. “Seasonal Effective Disorder: Treatment with Light Therapy.” Mayo Clinic Website. http://www.mayoclinic.com/health/seasonal-affective-disorder/MH00023, accessed 4/27/08