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Bright Nights Community Forum

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lamps and blue (or bluish) lamps provide no known therapeutic advantage. ... Randy Nesse, MD. University of Michigan. Tom Zelnik, MD. St Joseph's Medical Center ... – PowerPoint PPT presentation

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Title: Bright Nights Community Forum


1
Bright Nights Community Forum
  • Seasonal Affective Disorder
  • University of Michigan Depression Center
  • Ann Arbor Public Library

2
Bright Nights Forums
  • U-M Depression Center and Ann Arbor Public
    Library
  • Presentation on topics of interest relevant to
    mental health in community
  • Panel of experts from U-M Depression Center and
    Professionals in community
  • Q/A format
  • Improve community awareness of resources
    available.

3
Bright Nights Forums
  • Bipolar Disorder March 29th
  • Suicide May 24th

4
Seasonal Affective Disorder
  • What is Seasonal Affective Disorder - SAD
  • The formal Diagnosed syndrome
  • Sub-syndromal SAD
  • Hypotheses surrounding SAD
  • Research relevant to SAD
  • Treatment options
  • Physical Treatments
  • Medication
  • Panel Discussion

5
On the treatment of disorders of mood.
Live in rooms full of light Avoid heavy food Be
moderate in the drinking of wine Take massage,
baths, exercise, and gymnastics Fight insomnia
with gentle rocking or the sound of running
water Change surroundings and take long
journeys Strictly avoid frightening ideas
Indulge in cheerful conversation and amusements
Listen to music.
Cornelius Celsus (first century AD)
6
What is SAD?
  • SAD Seasonal Affective Disorder
  • Affective Disorder that occurs predictably at a
    specific season - most frequently in the fall or
    winter months.
  • Affective Disorder is used interchangeably with
    Mood Disorder and usually refers to depression.

7
Understanding Affective Disorders
  • Kraepelin proposed affect to consist of 3
    components
  • Volition
  • Energy Drive
  • Emotion
  • Happy / Sad
  • Intellect
  • Rate of thoughts
  • Content of thoughts

8
Affect - Affection
Volition the drive to care for our
offspring Emotion the love for our
children Intellect the thoughts speech
related to our interactions with family and loved
ones
9
Normal Affect
- Moods and disposition fluctuate over time
Volition
Emotion
Intellect
10
Depression
Volition
Emotion
Intellect
11
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12
Affect and Affective Disorders
  • Volition drives energy levels
  • Depression - lowered
  • Emotion mood (happy vs sad)
  • Depression sad low guilt
  • Intellect thinking
  • Depression decreased rate - negative

13
SAD - clinical features
  • Clinicians refer to atypical depressive sxs
  • Sleep hypersomnia - too much sleep
  • Difficulty getting out of bed
  • Slow to get going
  • Fatigued throughout the day
  • Atypical because majority of depressed patients
    experience difficulties sleeping (frequent
    awakenings during the night or awakening more
    that 1 or 2 hours earlier than custom).

14
SAD - atypical features
  • Appetite Increase (hyperphagia)
  • Carbohydrate craving
  • Comfort eating / grazing
  • Eating at non-meal times
  • Atypical because most people with depression
    experience decrease in appetite.

15
Sub-syndromal SAD
  • Winter Blues - Winter Doldrums
  • Common 10 - 25 of middle latitude population
  • Defies a clear definition.
  • Does not meet diagnostic criteria for Depression
  • Milder form of SAD with distinct discomfort and
    qualitative change in functioning (decrease) and
    activity level
  • Slowed down / Irritable
  • Some symptoms of atypical depression
  • Over-eating Over-sleeping

16
SAD - Research
  • Epidemiology
  • SAD 1-3
  • Sub-syndromal SAD (Winter Doldrums) 25
  • Chronic Course - 40 with seasonal pattern at 10
    year follow-up 40 became non-seasonal.
  • High association with eating, anxiety, and
    substance abuse disorders.
  • Associated with higher latitudes.
  • Middle latitudes (such as Michigan !)
  • Extreme northern latitudes show lower frequency

17
SAD ResearchCircadian Rhythms
  • Photoperiod hypothesis
  • The shorter winter photoperiod results in SAD.
  • Northern latitudes, controverted findings
  • Melatonin secretion longer during winter in SAD
  • Artificial light treats SAD
  • Phase-shift hypothesis
  • Phase delay of circadian rhythm relative to
    external clock waking later into evening and
    arising later in morning.
  • Light therapy in am causes phase advance -
    correcting phase delay.

18
SAD - Genetics
  • Individuals with SAD frequently have family
    history of Depression (2/3) or SAD (1/3).
  • Are there genetic variants that predispose to
    depression and SAD?
  • Class of genes - circadian clock genes have
    shown association with SAD.
  • Are there genetic variants of these clock genes
    associated with SAD.
  • Preliminary evidence suggests this but not always
    replicated in independent studies.
  • No specific tests to diagnose SAD.

19
Controversies in SAD
  • Phase delay / advance studies of circadian rhythm
    require rigorous monitoring of body chemicals,
    sleep EEGs, temp, etc.
  • Small numbers of individuals studied
  • Conclusions often conflict
  • Conflicting results of effects of light therapy
    on phase change.
  • Phase advance not always associated with clinical
    improvement.

20
SAD - treatment
  • Light therapy
  • 30 min per day
  • Begin with AM light
  • 10,000 Lux
  • Specialty light box
  • Medication.
  • Usually required for major depression with
    seasonal pattern
  • (10 - 15 respond to light alone)

21
Sub-syndromal SAD
  • Light therapy alone often lifts the
    winter-blues
  • Ok for individual to buy box on own accord, buy
    from established company.
  • Follow instructions
  • Consult physician if taking medication.
  • Some medications cause light sensitivity.

22
Let there be light.
Any light box you buy should have been tested
successfully in peer-reviewed clinical trials.
The box should provide 10,000 lux of
illumination at a comfortable sitting distance.
Product specifications are often missing or
unverified. Fluorescent lamps should have a
smooth diffusing screen that filters out
ultraviolet (UV) rays. UV rays are harmful to the
eyes and skin. The lamps should give off
white light rather than colored light. "Full
spectrum" lamps and blue (or bluish) lamps
provide no known therapeutic advantage. The
light should be projected downward toward the
eyes at an angle to minimize aversive visual
glare. Smaller is not better When using a
compact light box, even small head movements
will take the eyes out of the therapeutic range
of the light.
Center for Environmental Therapeutics -
www.cet.org
23
Review of studies 1975 - 2003
  • 20 studies reviewed for efficacy of light therapy
    in SAD.
  • Very strong effect-size for light therapy
  • SAD
  • Non SAD depression

Golden et al, Am J Psych. 2005
24
Activity level improves using 4 weeks of Bright
Lights
25
Side Effects of Bright Light
  • Possibility of .
  • Sleep disturbances
  • Irritability
  • Headache
  • Eye irritation
  • Marginal increase (but not significant) compared
    to control group.

26
SAD - Conclusions
  • SAD - refers to a seasonal pattern occuring in
    individuals with major Depression
  • Symptoms are often atypical
  • Increased appetite and over-sleeping
  • Sub-syndromal SAD is common
  • Noticeable qualitative change in functioning
  • Light therapy is useful in treatment of SAD
  • Effects noticeable within 2 weeks
  • Difficult to establish routine of using light
    therapy.

27
Panel Members
  • John Greden, MD
  • University of Michigan
  • Randy Nesse, MD
  • University of Michigan
  • Tom Zelnik, MD
  • St Josephs Medical Center
  • Julie Kuebler, RN, NursePractioner
  • University of Michigan
  • Laura Nitzberg, LCSW
  • University of Michigan
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