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Seasonal affective disorder
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The examples and perspective in this article deal primarily with the United
States and do not represent a worldwide view of the subject. Please improve this
article and discuss the issue on the talk page. (January 2011)
Bright light therapy is a common treatment for seasonal affective disorder and for
circadian rhythm sleep disorders.
Seasonal affective disorder (SAD), also known as winter depression, winter blues, summer
depression, summer blues, or seasonal depression, is a mood disorder in which people who
have normal mental health throughout most of the year experience depressive symptoms in
the winter or summer,[1] spring or autumn year after year. In the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV), SAD is not a unique mood disorder, but is "a
specifier of major depression".[2]
Although experts were initially skeptical, this condition is now recognized as a common
disorder, with its prevalence in the U.S. ranging from 1.4 percent in Florida to 9.7 percent
in New Hampshire.[3]
The U.S. National Library of Medicine notes that "some people experience a serious mood
change when the seasons change. They may sleep too much, have little energy, and may
also feel depressed. Though symptoms can be severe, they usually clear up."[4] The
condition in the summer can include heightened anxiety.[5]
SAD was formally described and named in 1984 by Norman E. Rosenthal and colleagues
at the National Institute of Mental Health.[6][7]
There are many different treatments for classic (winter-based) seasonal affective disorder,
including light therapy with sunlight or bright lights, antidepressant medication,
cognitive-behavioral therapy, ionized-air administration,[8] and carefully timed
supplementation of the hormone melatonin.[9]
Contents
[hide]

1 Symptoms

2 Diagnostic criteria
3 Physiology
4 History
5 Origin
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6 Treatment
7 Incidence
o 7.1 Nordic countries
o 7.2 Other countries
8 SAD and bipolar disorder
9 Role of Occupational Therapy in Treating SAD
o
o
9.1 Biomedical approaches
 9.1.1 Light Therapy
 9.1.1.1 Effectiveness
 9.1.2 Antidepressant Medications (Pharmacotherapy)
9.2 Psychosocial approaches to SAD interventions
 9.2.1 Group Therapy
 9.2.2 Cognitive Behavioural Therapy
 9.2.3 Mindfulness-based cognitive therapy (MBCT)
 9.2.4 Behavioural activation
 9.2.5 Problem-solving therapies
9.2.6 Positive psychotherapy
 9.2.7 Self-System Therapy
 9.2.8 Outdoor therapy
o 9.3 Assessments for SAD
10 See also
11 External links
12 References

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13 External links
Symptoms
Symptoms of SAD may consist of difficulty waking up in the morning, morning sickness,
tendency to oversleep and over eat, especially a craving for carbohydrates, which leads to
weight gain. Other symptoms include a lack of energy, difficulty concentrating on or
completing tasks, and withdrawal from friends, family, and social activities and decreased
sex drive.[citation needed] All of this leads to the depression, pessimistic feelings of hopelessness,
and lack of pleasure which characterize a person suffering from this disorder.[citation needed]
People who experience spring and summer depression show symptoms of classic
depression including insomnia, anxiety, irritability, decreased appetite, weight loss, social
withdrawal, decreased sex drive,[5] and suicide.
Diagnostic criteria
According to the American Psychiatric Association DSM-IV criteria,[10] Seasonal Affective
Disorder is not regarded as a separate disorder. It is called a "course specifier" and may be
applied as an added description to the pattern of major depressive episodes in patients with
major depressive disorder or patients with bipolar disorder.
The "Seasonal Pattern Specifier" must meet four criteria: depressive episodes at a
particular time of the year; remissions or mania/hypomania at a characteristic time of year;
these patterns must have lasted two years with no nonseasonal major depressive episodes
during that same period; and these seasonal depressive episodes outnumber other
depressive episodes throughout the patient's lifetime. The Mayo Clinic[5] describes three
types of SAD, each with its own set of symptoms.
In the popular culture, sometimes the term "seasonal affective disorder" is applied
inaccurately to the normal shift to lower energy levels in winter, leading people to believe
they have a physical problem that should be addressed with various therapies or drugs.[11]
Physiology
Seasonal mood variations are believed to be related to light. An argument for this view is
the effectiveness of bright-light therapy.[12] SAD is measurably present at latitudes in the
Arctic region, such as Finland (64°00′N) where the rate of SAD is 9.5%.[13] Cloud cover
may contribute to the negative effects of SAD.[14]
The symptoms of SAD mimic those of dysthymia or even major depressive disorder. There
is also potential risk of suicide in some patients experiencing SAD. One study reports
6-35% of sufferers required hospitalization during one period of illness. [14] At times,
patients may not feel depressed, but rather lack energy to perform everyday activities.[12]
Various proximate causes have been proposed. One possibility is that SAD is related to a
lack of serotonin, and serotonin polymorphisms could play a role in SAD,[15] although this
has been disputed.[16] Mice incapable of turning serotonin into N-acetylserotonin (by
Serotonin N-acetyltransferase) appear to express "depression-like" behavior, and
antidepressants such as fluoxetine increase the amount of the enzyme Serotonin
N-acetyltransferase, resulting in an antidepressant-like effect.[17] Another theory is that the
cause may be related to melatonin which is produced in dim light and darkness by the
pineal gland, since there are direct connections, via the retinohypothalamic tract and the
suprachiasmatic nucleus, between the retina and the pineal gland.
Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an
estimated 14.3% (vs. 6.1% SAD) of the U.S. population.[18] The blue feeling experienced
by both SAD and SSAD sufferers can usually be dampened or extinguished by exercise
and increased outdoor activity, particularly on sunny days, resulting in increased solar
exposure.[19] Connections between human mood, as well as energy levels, and the seasons
are well documented, even in healthy individuals.[citation needed]
Mutation of a gene expressing melanopsin has been implicated in the risk of having
Seasonal Affective Disorder.[20]
History
SAD was first systematically reported and named in the early 1980s by Norman E.
Rosenthal, M.D., and his associates at the National Institute of Mental Health (NIMH).
Rosenthal was initially motivated by his desire to discover the cause of his own experience
of depression during the dark days of the northern US winter. He theorized that the lesser
amount of light in winter was the cause. Rosenthal and his colleagues then documented the
phenomenon of SAD in a placebo-controlled study utilizing light therapy.[6][7] A paper
based on this research was published in 1984. Although Rosenthal's ideas were initially
greeted with skepticism, SAD has become well recognized, and his 1993 book, Winter
Blues[21] has become the standard introduction to the subject.[22]
Research on SAD in the United States began in 1970 when Herb Kern, a research engineer,
had also noticed that he felt depressed during the winter months. Kern suspected that
scarcer light in winter was the cause and discussed the idea with scientists at the NIMH
who were working on bodily rhythms. They were intrigued, and responded by devising a
lightbox to treat Kern’s depression. Kern felt much better within a few days of treatments,
as did other patients treated in the same way.[7]
Origin
In many species, activity is diminished during the winter months in response to the
reduction in available food and the difficulties of surviving in cold weather. Hibernation is
an extreme example, but even species that do not hibernate often exhibit changes in
behavior during the winter. It has been argued that SAD is an evolved adaptation in
humans that is a variant or remnant of a hibernation response in some remote ancestor.[23]
Presumably, food was scarce during most of human prehistory, and a tendency toward low
mood during the winter months would have been adaptive by reducing the need for calorie
intake. The preponderance of women with SAD suggests that the response may also
somehow regulate reproduction.[23]
Treatment
One type of light therapy lamp
There are many different treatments for classic (winter-based) seasonal affective disorder,
including light therapy, medication, ionized-air administration, cognitive-behavioral
therapy and carefully timed supplementation[24] of the hormone melatonin.
Photoperiod-related alterations of the duration of melatonin secretion may affect the
seasonal mood cycles of SAD. This suggests that light therapy may be an effective
treatment for SAD.[25] Light therapy uses a lightbox which emits far more lumens than a
customary incandescent lamp. Bright white "full spectrum" light at 10,000 lux, blue light at
a wavelength of 480nm at 2,500 lux or green (actually cyan or blue-green [26]) light at a
wavelength of 500nm at 350 lux are used, with the first-mentioned historically
preferred.[27][28]
Bright light therapy is effective[18] with the patient sitting a prescribed distance, commonly
30–60cm, in front of the box with her/his eyes open but not staring at the light source [13]
for 30–60 minutes. A 1995 study showed that 500 nm cyan light therapy at doses of 350
lux produces melatonin suppression and phase shifts equivalent to 10,000 lux bright light
therapy in winter depressives.[27] However, in this study, the improvement in depression
ratings did not reach statistical significance. A study published in May 2010 suggests that
the blue light often used for SAD treatment should perhaps be replaced by green or white
illumination.[29] Discovering the best schedule is essential. One study has shown that up to
69% of patients find lightbox treatment inconvenient and as many as 19% stop use because
of this.[13] A study from a company in Finland has shown that bright light therapy delivered
directly to photosensitive regions of the brain via the ear canal may also be an effective
alternative to light box treatment. In studies without control groups 92% of SAD sufferers
experienced total relief from their symptoms when receiving bright light treatment in this
way. [30][unreliable source?]
Dawn simulation has also proven to be effective; in some studies, there is an 83% better
response when compared to other bright light therapy.[13] When compared in a study to
negative air ionization, bright light was shown to be 57% effective vs. dawn simulation
50%.[8] Patients using light therapy can experience improvement during the first week, but
increased results are evident when continued throughout several weeks.[13] Most studies
have found it effective without use year round but rather as a seasonal treatment lasting for
several weeks until frequent light exposure is naturally obtained.[12]
Light therapy can also consist of exposure to sunlight, either by spending more time
outside[31] or using a computer-controlled heliostat to reflect sunlight into the windows of a
home or office.[32][33]
SSRI (selective serotonin reuptake inhibitor) antidepressants have proven effective in
treating SAD. Bupropion is also effective as a prophylactic.[14] Effective antidepressants are
fluoxetine, sertraline, or paroxetine.[12][34] Both fluoxetine and light therapy are 67%
effective in treating SAD according to direct head-to-head trials conducted during the 2006
Can-SAD study.[35] Subjects using the light therapy protocol showed earlier clinical
improvement, generally within one week of beginning the clinical treatment.[12]
Negative air ionization, which involves releasing charged particles into the sleep
environment, has been found effective with a 47.9% improvement if the negative ions are
in sufficient density (quantity).[36][37][38] Depending upon the patient, one treatment (e.g.,
lightbox) may be used in conjunction with another (e.g., medication).[12]
Modafinil may be an effective and well-tolerated treatment in patients with seasonal
affective disorder/winter depression.[39]
Alfred J. Lewy of Oregon Health & Science University and others see the cause of SAD as
a misalignment of the sleep-wake phase with the body clock, circadian rhythms out of
synch, and treat it with melatonin in the afternoon. Correctly timed melatonin
administration shifts the rhythms of several hormones en bloc.[24]
Another explanation is that vitamin D levels are too low when people do not get enough
Ultraviolet-B on their skin. An alternative to using bright lights is to take vitamin D
supplements.[40][41][42][43] However, one study did not show a link between vitamin D levels
and depressive symptoms in elderly Chinese.[44]
Incidence
Nordic countries
Winter depression is a common slump in the mood of some inhabitants of most of the
Nordic countries. It was first described by the 6th century Goth scholar Jordanes in his
Getica wherein he described the inhabitants of Scandza (Scandinavia).[45] Iceland, however,
seems to be an exception. A study of more than 2000 people there found the prevalence of
seasonal affective disorder and seasonal changes in anxiety and depression to be
unexpectedly low in both sexes.[46] The study's authors suggested that propensity for SAD
may differ due to some genetic factor within the Icelandic population. A study of
Canadians of wholly Icelandic descent also showed low levels of SAD. [47] It has more
recently been suggested that this may be attributed to the large amount of fish traditionally
eaten by Icelandic people, in 2007 about 90kilograms per person per year as opposed to
about 24kg in the US and Canada,[48] rather than to genetic predisposition; a similar
anomaly is noted in Japan, where annual fish consumption in recent years averages about
60kg per capita.[49] Fish are high in vitamin D. Fish also contain docosahexaenoic acid
(DHA), which has been shown to help with a variety of neurological dysfunctions. [50] To
give an example of how widespread the popular understanding of SAD is, a character
suffers from seasonal affective disorder in the Swedish Horror film Marianne.
Other countries
In the United States, a diagnosis of seasonal affective disorder was first proposed by
Norman E. Rosenthal, MD in 1984. Rosenthal wondered why he became sluggish during
the winter after moving from sunny South Africa to New York. He started experimenting
increasing exposure to artificial light, and found this made a difference. In Alaska it has
been established that there is a SAD rate of 8.9%, and an even greater rate of 24.9%[51] for
subsyndromal SAD.
Around 20% of Irish people are affected by SAD, according to a survey conducted in 2007.
The survey also shows women are more likely to be affected by SAD than men. [52] An
estimated 10% of the population in the Netherlands suffer from SAD.[53]
SAD and bipolar disorder
Most people with SAD experience major depressive disorder, but as many as 20% may
have or may go on to develop a bipolar disorder (manic-depressive disorder). It is
important to discriminate the improved mood associated with recovery from the winter
depression and a manic episode because there are important treatment differences. [54] In
these cases, people with SAD may experience depression during the winter and hypomania
in the summer.
Role of Occupational Therapy in Treating SAD
Given that SAD impacts a wide variety of occupational performance areas in a person’s
life as described in the aforementioned section, occupational therapists (OTs) play a key
role in helping individuals cope with SAD. OTs incorporate best practices and principles
from various health care disciplines into their therapeutic practice with clients with SAD,
including assessment, treatment, and evaluation. Care and treatment are holistic and
tailored to the client’s identified goals, needs, and responsiveness to treatments.
In addition to educating clients on the etiology, prevalence, symptoms and occupational
performance issues associated with SAD, OTs play a large role in treating patients or
educating them on the different types of interventions available. Of particular importance is
educating clients on fatigue management and energy conservation, as low energy level is
commonly reported in people with SAD.[55] With increased energy levels, clients can
hopefully return to doing activities that they need and want to do with respect to self-care,
productivity, and leisure. The two main treatment approaches that OTs come across are the
biomedical approach and the psychosocial approach.
Biomedical approaches
OTs can play a large role in educating their clients on biomedical interventions, which can
be very effective in minimizing symptoms that impact occupational performance issues in
the areas of leisure, productivity and self-care. OTs should be knowledgeable about the
most commonly used biomedical treatment approaches, which are light therapy and
pharmacotherapy, to address SAD.
Light Therapy
Bright light therapy, or phototherapy, has been used for over 20 years to treat SAD[56] with
numerous studies citing its effectiveness.[57][58] Light therapy is recommended as a first-line
treatment for SAD in Canadian, American, and international clinical guidelines.[58] The
mood of individuals with SAD can improve with as little as 20 minutes of bright light
exposure.[59] Bright light is more effective than dim light in protecting against “mood
lowering” which commonly occurs in SAD.[59][60]p2
Light boxes are widely available devices which typically provide fluorescent light as a
treatment for SAD.[56]
OTs should be familiar with typical usage guidelines provided to users of light boxes and
emphasize to clients the need for clinical monitoring to ensure the appropriate doses of
light.[56] Effective doses of light therapy vary depending on the individual. Studies have
shown effective doses ranging between 3,000 lux 2 hours/day for 5 weeks[61] to 10,000 lux
30 minutes/day for 8 weeks.[58] Patients are typically advised to sit “within several
yards” of the device and glance occasionally (rather than stare) at it.[62]p20 Commercial
light boxes are not regulated by U.S. law and, as such, OTs should recommend medical
consultation and advise caution when selecting and using them.[56][62] Only 41% of SAD
patients comply with clinical practice guidelines and use light therapy regularly due to
reasons of inconvenience and ineffectiveness.[63] As such, OTs can help clients develop
methods for incorporating light therapy effectively into their daily routines and complying
with clinical guidelines.[64]
[edit] Effectiveness
Light therapy does not work for everyone. Twenty to fifty percent of those diagnosed with
SAD do not gain adequate relief from it.[65] In addition to the lack of efficacy, the required
time commitment and the tendency for recurrence are additional reasons why individuals
with SAD explore alternative treatments to light therapy.[66] In a study comparing the
effectiveness of light therapy and an antidepressant medication, fluoxetine, evidence was
found to support the effectiveness and tolerability of both treatments for SAD.[58]
Antidepressant Medications (Pharmacotherapy)
Antidepressant medication (ADM) has been shown to be effective in treating various forms
of depression.[67] Of the various types of ADMs used to treat SAD, selective serotonin
reuptake inhibitors (SSRIs) such as fluoxetine and sertraline appear to be most effective.[68]
OTs play a role in helping their clients understand how such medications, if prescribed, can
decrease acute symptoms and lead to enhanced engagement in daily occupations.
ADMs are considered to be largely compensatory in nature.[67] In other words, ADMs may
suppress depressive symptoms while they are being used, but lasting changes are not
guaranteed once treatment is discontinued. A growing body of evidence is showing that
psychosocial approaches to therapy, such as cognitive and behavioural interventions, may
have more enduring effects than biomedical interventions.[67]
Psychosocial approaches to SAD interventions
OTs play an important role in the implementation and recommendation of
psychotherapeutic interventions, which follow psychosocial rehabilitation and
recovery-based approaches.
The roles of OTs in psychosocial rehabilitation often include the following:

Identifying the clients' psychosocial issues, strengths and limitations associated
with the condition

Assessing clients’ readiness, motivation, and belief in their abilities to make
changes in their lives

Identifying what is meaningful to the client

Identifying social support systems that are available to help the client achieve their
goals.[69]
OTs often use guiding frameworks, such as the Canadian Model of Occupational
Performance[70] and the Model of Human Occupation[71] to help clients set rehabilitation
goals and identify areas of occupational performance that are affected by the symptoms
associated with SAD.
Several types of interventions fall within the psychosocial scope of occupational therapy,
and are used by an interdisciplinary team of health care providers who work with clients
with SAD. In a health care system that is driven largely by medical models, OTs can play
an important role in promoting psychosocial rehabilitation and recovery when addressing
the underlying issues associated with SAD.[72] OTs use clinical reasoning to draw
holistically upon principles of a variety of treatment approaches when implementing
individual and group therapy among clients with SAD.
Group Therapy
OTs in mental health settings often lead groups for inpatients and outpatients with mood
disorders.[73] Some group therapy topics that target occupational performance issues related
to SAD could include:

Stress management

Weight control and nutrition

Smoking cessation

Substance abuse

Time management

Social skills and networking

Wintertime activities

Sleep education

Self-esteem

Sexual health
These group therapy sessions are often guided by a number of different theoretical and
therapeutic frames of references, which use methods that are shown by research to be
effective. Cognitive Behavioural Therapy, Mindfulness-Based Cognitive Therapy,
Behavioural Activation, Problem-Solving Therapy, Positive Psychotherapy, Self-System
Therapy and Outdoor Therapy are just some of the more common approaches that OTs use
when framing their interventions for client with SAD.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) is used widely by OTs to treat SAD and other mood
disorders. Originally developed by Beck and colleagues,[74] CBT aims to help clients
identify the expectations and interpretations that can lead them towards depression and
anxiety; adjust to reality; and break through their avoidances and inhibitions. [75] When
implemented appropriately, it can help people change their cognitive processes, which may
then correspond with changes in their feelings and behaviours.[76] CBT for SAD focuses on
the early identification of negative anticipatory thoughts and behavior changes associated
with the winter season, and helps clients develop coping skills to address these changes.[77]
By adopting a CBT approach, OTs can help clients with SAD engage in pleasurable
activities in the winter months (i.e. behavioral activation) and help people think more
positively (i.e. cognitive restructuring).[77] If qualified, OTs can deliver CBT skills training
groups to SAD patients. The skills that OTs teach can have a direct impact on occupational
performance issues and can include:[77]

developing a repertoire of wintertime leisure interests

using diaries to record automatic negative thoughts

creating a balanced activity level

improving time management skills

problem solving about situations that initiate negative thinking

setting goals and plans for maintaining gains and preventing relapse
CBT, or a combination of CBT and LT, can lead to a significant decrease in levels of
depression amongst those with SAD.[64][66] With non-seasonal depression, CBT appears to
be about as effective as ADM in terms of acute distress reduction; however, the effects of
CBT are shown to be longer lasting than ADM.[67][78] There have been no direct
comparisons made between CBT and ADM specifically for SAD. [77] CBT is effective in
treating both mild and more severely depressed patients, and is shown to prevent or delay
the relapse of depressive symptoms better than other treatments for depression.[77][79] There
are no known adverse physical side effects of CBT.[77]
Mindfulness-based cognitive therapy (MBCT)
Mindfulness-based cognitive therapy (MBCT) is an intervention that aims to increase
meta-cognitive awareness to the negative thoughts and feelings associated with relapses of
major depression.[80] Unlike CBT, MBCT does not emphasize changing thought contents or
core beliefs related to depression. It instead focuses on meta-cognitive awareness
techniques, which are said to change the relationship between one’s thoughts and
feelings.[81]
The act of passively and repetitively focusing one’s attention on the symptoms, meanings,
causes, and consequences of the negative emotional state of depression is called
rumination.[82] MBCT aims to reduce rumination by addressing the cognitive patterns
associated with negative thinking and cultivating mindfulness through meditation and
self-awareness exercises.[83] Once awareness of feelings and thoughts are cultivated, MBCT
emphasizes accepting and letting them go.[83]
OTs can train clients with SAD in MBCT skills, which often takes place in a group setting
over a number of weeks. Training focuses on the concept of “decentering,” which is the
[83]
act of taking a present-focused and non-judgmental stance towards thoughts and feelings.
By learning how to decenter, a person can distance themselves from the negative thoughts
and feelings that may affect occupational performance in areas such as eating healthily,
maintaining social relationships and being productive at work. By bringing attention back
to the present (e.g. by focusing on their breath), clients gradually begin to observe their
thought processes rather than reacting to them, thus, facilitating occupational engagement.
Behavioural activation
Behavioural activation (BA) is considered to be a traditional form of psychotherapy.[84] It is
based on activity scheduling and aims to increase the number of positively reinforcing
experiences in a person’s life. BA has shown comparable efficacy with other
psychosocial therapies such as CBT, as well as with ADM treatment among mildly to
moderately depressed patients.[85] BA has the potential to be very effective when used in
occupational therapy, as it focuses on occupying one’s time with activities and
experiences that are meaningful, positive, and engaging to the client. As such, clients who
have occupational performance issues in productivity, leisure, and self-care may benefit
from such therapy.
Problem-solving therapies
This intervention involves the patient creating a list of problems, identifying possible
solutions, choosing the best solutions, creating a plan to implement them, and evaluating
outcomes with respect to the problem. Further studies are needed to better understand the
conditions under which problem-solving therapy is effective for depression;[86] however,
this type of therapy is compatible with occupational therapy approaches to SAD. The
Canadian Occupational Performance Measure (COPM)[87] is a widely used instrument that
supports clients working with OTs in identifying their occupational needs, setting goals,
and assessing change in occupational performance. Similar to the use of the COPM, OTs
can use problem-solving therapy to focus on client choice and empowerment - principles
that are fundamental to psychosocial rehabilitation and recovery.[88]
Positive psychotherapy
Positive psychotherapy (PPT) works to increase positive emotions in depressed clients and
enhance engagement and meaning in activities that take place in a person’s life. Seligman
and colleagues[89] found that group PPT was effective in treating mild to moderate
depression for up to one year after the treatment was terminated. They also found that
individual PPT led to greater remission rates than non-PPT treatments plus
pharmacotherapy. OTs could adopt a PPT approach when conducting individual and group
therapy sessions with clients with SAD. For example, they could introduce activities that
instill success and learning, identify clients' interests, and encourage clients to engage in
positive and personally meaningful occupations.
Self-System Therapy
Self-System Therapy (SST) is based on the notion that depression arises from chronic
failure to attain personal goals due to one’s inability to self-motivate and pursue their
goals.[90] SST is designed to improve one's ability to self-regulate and attain personal goals
by helping define goals, identify the steps needed to attain them, identify the barriers that
are preventing progress, and create a plan for how the goals may be achieved. This
intervention draws upon techniques from cognitive therapy and BA, but has an overall
emphasis on self-regulation. OTs can play a large role in helping SAD clients set and attain
goals related to self-care, productivity, and leisure.
Outdoor therapy
Outdoor therapy is yet another psychotherapeutic intervention that OTs can recommend.
Outdoor work has been used effectively as a therapy to treat those with mood difficulties
during the winter season in Denmark.[91] As an example, horticulture groups have shown
positive impacts on depressive symptoms, which can be associated with psychosocial
adaptation leading to healthy occupational performance.[92] Similarly, outdoor walking can
provide a “therapeutic effect” to individuals with SAD that is on par with light
therapy.[93] OTs should incorporate outdoor occupations into their interventions with clients
diagnosed with SAD.
Assessments for SAD
OTs also play a role in assessing and providing ongoing evaluation of clients who have
SAD or who are suspected to have SAD. Assessments are most often used to determine if a
particular treatment is working and what aspects of the disorder require the most attention.
Two commonly used assessments for SAD are the Structured Interview Guide for the
Hamilton Rating Scale for Depression – Seasonal Affective Disorder version
(SIGH-SAD)[94] and the Beck Depression Inventory, 2nd edition (BDI-II).[95]
The SIGH-SAD is a semi-structured interview that includes 21 non-seasonal depression
items and an extra 8-item SAD-specific subscale. The BDI-II is quicker to administer and
contains 21 measures of depressive symptom severity, which also captures atypical
symptoms that are common in SAD.
See also





Circadian rhythm sleep disorder
Depression (mood)
Risks and benefits of sun exposure
Social anxiety disorder
Seasonal effects on suicide rates
External links

New York Times article on S.A.D.
References
1. ^ Seasonal Depression can Accompany Summer Sun. Ivry, Sara. The New York Times.
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http://www.aafp.org/afp/20061101/1521.html.
3. ^ Friedman, Richard A. [1] “Brought on by Darkness, Disorder Needs Light”. New
York Times’’, 2007-12-18.
4. ^ MedlinePlus Overview seasonalaffectivedisorder
5. ^ a b c Seasonal Affective Disorder by Mayo Clinic
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Newsome DA, Wehr TA. et al. (1984). "Seasonal Affective Disorder: A Description of the
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Disorder", p.77. Hunter House, Alameda, Calif. ISBN 0-89793-413-X.
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Terman, M.; Terman, J.S. (2006). "Controlled Trial of Naturalistic Dawn Simulation
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9. ^ "Properly Timed Light, Melatonin Lift Winter Depression by Syncing Rhythms"
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11. ^ Rose, Phil Fox (2 November 2010). "SAD That DST is Ending--Dealing with the
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External links

Seasonal Affective Disorder at the Open Directory Project

Retrieved
from
"http://en.wikipedia.org/w/index.php?title=Seasonal_affective_disorder&oldid=509
141649"