Seasonal Affective Disorder Research Articles

Association of Postpartum Depression with Maternal Suicide: A Nationwide Population-Based Study.

Background: To examine the association of postpartum depression (PPD) with maternal suicide in the Taiwanese population. Methods: We examined the medical records of women aged 18–50 years who experienced childbirth and had PPD (the study cohort, n = 2882), who experienced childbirth but did not have PPD (comparison cohort 1, n = 5764), and who neither experienced childbirth nor had PPD (comparison cohort 2, n = 5764) between 2000 and 2015. The patients were followed up until suicide, withdrawal from the National Health Insurance program, or 31 December 2015. Results: The rates of anxiety and depression symptoms, as well as the cumulative risk of suicide, were significantly higher in the study cohort. PPD was significantly correlated with an increased risk of maternal suicide and was associated with a greater risk of developing comorbidities such as hypertension, diabetes mellitus, hyperlipidemia, and stroke. The comparison cohorts did not differ significantly in terms of suicide risk. Conclusion: PPD was associated with a significantly higher rate of suicide and a shorter time to suicide after childbirth. Younger age, winter, and subclinical depression and anxiety positively predicted suicide in the study cohort. To prevent maternal suicide, clinicians should be observant of subclinical depression and anxiety symptoms among patients.

Effects of dynamic bedroom lighting on measures of sleep and circadian rest-activity rhythm in inpatients with major depressive disorder

Bright light therapy is an effective treatment option for seasonal and non-seasonal affective disorders. However up to now, no study has investigated effects of dynamic bedroom lighting in hospitalized patients with major depression. A bedroom lighting system, which automatically delivered artificial dawn and dusk and blue-depleted nighttime lighting (DD-N lighting) was installed in a psychiatric ward. Patients with moderate to severe depression were randomly assigned to stay in bedrooms with the new lighting or standard lighting system. Patients wore wrist actimeters during the first two treatment weeks. Additionally, hospitalization duration and daily psychotropic medication were retrieved from patients’ medical charts. Data from thirty patients, recorded over a period of two weeks, were analyzed. Patients under DD-N lighting generally woke up earlier (+ 20 min), slept longer (week 1: + 11 min; week 2: + 27 min) and showed higher sleep efficiency (+ 2.4%) and shorter periods of nighttime awakenings (− 15 min). In the second treatment week, patients started sleep and the most active 10-h period earlier (− 33 min and − 64 min, respectively). This pilot study gives first evidence that depressed patients’ sleep and circadian rest/activity system may benefit from bedroom lighting when starting inpatient treatment.

Analysis of Seasonal Clinical Characteristics in Patients With Bipolar or Unipolar Depression.

This study was to investigate the characteristics of seasonal symptoms and non-enzymatic oxidative stress in the first hospitalized patients with bipolar and unipolar depression, aiming to differentiate bipolar depression from unipolar depression and reduce their misdiagnosis. A total of 450 patients with bipolar depression and 855 patients with depression were included in the present study. According to the season when the patients were admitted to the hospital due to the acute onset of depression, they were further divided into spring, summer, autumn and winter groups. According to the characteristics of symptoms of bipolar disorder in the DSM-5, the characteristic symptoms of bipolar disorder were collected from the medical record information, and clinical biochemical indicators that can reflect the oxidative stress were also recorded. The seasonal risk factors in patients with bipolar or unipolar depression were analyzed. The relationship of age and gender with the bipolar or unipolar depression which attacked in winter was explored. There were significant differences between groups in the melancholic features, atypical features and conjugated bilirubin in spring. In summer, there were significant differences between groups in the melancholic features, uric acid and conjugated bilirubin. In autumn, there were marked differences between groups in melancholic features, anxiety and pain, atypical features, uric acid, total bilirubin, conjugated bilirubin and albumin. In winter, the conjugated bilirubin and prealbumin were significantly different between two groups. The melancholic features and uric acid that in summer as well as melancholic features, uric acid and total bilirubin in autumn were the seasonal independent risk factors for the unipolar depression as compared to bipolar depression. In winter, significant difference was noted in the age between two groups. In conclusion, compared with patients with unipolar depression, patients with bipolar depression have seasonal characteristics. Clinical symptoms and indicators of oxidative stress may become factors for the differentiation of seasonal unipolar depression from bipolar depression. Young subjects aged 15–35 years are more likely to develop bipolar depression in winter.

Seasonal patterns in mindfulness in people with seasonal affective disorder (SAD)

Mindfulness-based cognitive therapy (MBCT) is a well-known, effective treatment in the prevention of relapse in Major Depression Disorder (MDD). However, a recent study in people with Seasonal Affective Disorder (SAD) showed that MBCT given in spring was ineffective in preventing a next depressive episode. To test the hypothesis that people with SAD may experience sufficient levels of mindfulness in spring and therefore less benefit from MBCT, this study examines variations in levels of mindfulness over seasons. This longitudinal prospective study followed 77 people with SAD over a two-year period. Participants filled out a self-report questionnaire, Five Facet Mindfulness Questionnaire (FFMQ) on a quarterly basis. Levels of mindfulness differed throughout the seasons, with overall results suggesting lower levels of mindfulness in winter. The results are limited by the small sample size and varying levels of mindfulness over the two years of the study period. Findings suggest a seasonal component in levels of mindfulness exists, implying that people with SAD are less mindful during the winter compared to other seasons. Future research is needed to examine to what extent the motivation of people with SAD to participate in MBCT and benefit from it is higher in the winter.

Seasonal photoperiodic influence of pineal melatonin on hypothalamic-pituitary-adrenal axis-hippocampal-receptor in male rats

Based on the effect of seasonal changes on human visceral function, this study investigated the impact of seasonal photoperiod of the pineal body on hypothalamic-pituitary-adrenal axis-hippocampal-receptor in rats, aiming to reveal the mechanism by which pineal gland melatonin regulates the seasonal secretion of hippocampal neurotransmitters. Vernal equinox, summer solstice, autumn equinox, and winter solstice were selected as four experimental time points, and rats were randomly divided into normal control group, sham operation group, and pinealectomized group. The seasonal changes in corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), corticosterone, hypothalamic melatonin receptor (MTR), and hippocampal corticosterone receptor (CORTR) were examined by enzyme-linked immunosorbent assay. Comparing the same group between different seasons, we showed that in the normal control group, CRH, ACTH, corticosterone, and MTR were higher, while CORTR was lower in autumn and winter than in spring (all P < .05). Compared with the normal control group, the pinealectomized group showed higher levels of corticosterone ( P = .01), MTR ( P = .01), and CORTR ( P = .03) during spring; reduced levels of MTR and CORTR (both P < .001) during summer; higher levels of ACTH ( P = .001) and MTR ( P < .001), and lower levels of CRH ( P = .001), corticosterone ( P < .001), and CORTR ( P = .003) during autumn; and lower levels of CRH ( P < .001) and MTR ( P = .004), and higher level of ACTH ( P < .001) in winter. Seasonal photoperiod acts on the pineal gland to secrete different levels of melatonin, resulting in seasonal changes in the hypothalamic-pituitary-adrenal axis-hippocampal-receptor, which may be the pathophysiological basis for the onset of seasonal affective disorder.

Banish winter blues with wellbeing support

Banish winter blues with wellbeing support

The Timing of Clinical Effects of Bupropion Misuse Via Insufflation Reported to a Regional Poison Center.

Bupropion is an antidepressant medication with expanding indications including smoking cessation, weight loss, attention-deficit/hyperactivity disorder, seasonal affective disorder, and amphetamine dependence. Despite its increasing popularity among providers, it has a well-known narrow therapeutic window that can lead to delayed onset of symptoms with extended-release formulations and devastating consequences in overdose. We have noticed some patients misusing bupropion via insufflation, which added a layer of complexity with regards to the therapeutic application of the drug. This route of use created difficult decisions regarding clinical monitoring in these patients. To determine if prolonged observation is required after insufflation of bupropion and to further describe effects from this route of use. This is a retrospective observational study reviewing all the cases of insufflated bupropion use reported to a single poison center without any other coingestants. The majority (85.7%) of patients had mild or moderate effects, and seizures occurred in 19.6% of cases; and the vast majority of patients were symptomatic by the time of the initial call to the poison center. We did not encounter any delayed effects after this route of use. This report describes the clinical effects reported, and the timing of these effects, after insufflation of bupropion.

CME: Light Therapy: Why, What, for Whom, How, and When (And a Postscript about Darkness).

Light therapy has become established as an evidence-based treatment for Seasonal Affective Disorder. Light impacts the timing and stability of circadian rhythms as expressed in sleep, mood, alertness, and cognition. Forty years of clinical trials and open treatment have led to guidelines for patient selection, using light alone or in combination with antidepressants (or lithium for bipolar depression). Mood and sleep disturbances can also respond to adjunct light therapy in a broader set of psychiatric, neurologic and medical illnesses. We specify criteria for choice of treatment devices: optimum dose (10,000 lux), spectrum (white light), exposure duration (30-60 minutes) and timing (early morning). Protocol adjustment requires continual monitoring with attention to rate of improvement and management of potential side effects.

Melatonin/Cyclodextrin Inclusion Complexes: A Review.

Melatonin (MLT) is involved in many functions of the human body, mainly in sleeping-related disorders. It also has anti-oxidant potential and has been proven very effective in the treatment of seasonal affective disorders (SAD), which afflict some people during short winter days. Melatonin has been implicated in a range of other conditions, including Parkinson’s disease, Alzheimer’s and other neurological conditions, and in certain cancers. Its poor solubility in water leads to an insufficient absorption that led scientists to investigate MLT inclusion in cyclodextrins (CDs), as inclusion of drugs in CDs is a way of increasing the solubility of many lipophilic moieties with poor water solubility. The aim of this review is to gather all the key findings on MLT/CD complexes. The literature appraisal concluded that MLT inclusion leads to a 1:1 complex with the majority of CDs and increases the solubility of the hormone. The interactions of MLT with CDs can be studied by a variety of techniques, such as NMR, FT-IR, XRD and DCS. More importantly, the in vivo experiments showed an increase in the uptake of MLT when included in a CD.

What is seasonal affective disorder and can it be treated?

What is seasonal affective disorder and can it be treated?

Adjusting to seasonal affective disorder

Adjusting to seasonal affective disorder

The influence of vitamin D on postpartum depression

Postpartum depression is considered a childbirth-related mood disorder and starts between the first day and four months after delivery. Its clinical manifestation includes extreme sadness, pleasure loss, sleep disturbances, guilt feelings and worthlessness, anxiety, and suicidal thoughts. Maternal depression can impair the baby's behavioral, emotional, and cognitive development. Vitamin D is considered a steroid hormone derived from cholesterol, with endogenous synthesis after sun exposure, and can be found through food sources such as fish and egg yolks. Low serum 25-Hydroxy-vitamin D (25(OH)D) are linked to several diseases: osteopenia; mood disorder; cardiovascular diseases; premenstrual syndrome; major depressive disorder; cancer; autoimmune disorders; pre-eclampsia; seasonal affective disorder; and postpartum depression. Studies have shown that low levels of 25-OH-D can be related to symptoms of postpartum depression, whose symptoms of depression are obtained through validated questionnaires. This review paper aimed to establish the relationship between low vitamin D levels and postpartum depression symptoms. A search for review articles published between 2016 and 2021 was performed. The articles analyzed show that low vitamin D levels are related to postpartum depression symptoms. More research is needed to track vitamin D levels during pregnancy to prevent and/or reduce postpartum depression.

Verification, analytical validation and clinical validation (V3) of wearable dosimeters and light loggers.

Light exposure is an important driver and modulator of human physiology, behavior and overall health, including the biological clock, sleep-wake cycles, mood and alertness. Light can also be used as a directed intervention, e.g., in the form of light therapy in seasonal affective disorder (SAD), jetlag prevention and treatment, or to treat circadian disorders. Recently, a system of quantities and units related to the physiological effects of light was standardized by the International Commission on Illumination (CIE S 026/E:2018). At the same time, biometric monitoring technologies (BioMeTs) to capture personalized light exposure were developed. However, because there are currently no standard approaches to evaluate the digital dosimeters, the need to provide a firm framework for the characterization, calibration, and reporting for these digital sensors is urgent. This article provides such a framework by applying the principles of verification, analytic validation and clinical validation (V3) as a state-of-the-art approach for tools and standards in digital medicine to light dosimetry. This article describes opportunities for the use of digital dosimeters for basic research, for monitoring light exposure, and for measuring adherence in both clinical and non-clinical populations to light-based interventions in clinical trials.

Fully Nonparametric Methods for Multivariate Data in Factorial Designs. Asymptotics, Finite Sample Approximations, and Implementation in R

Abstract This article methodologically complements the R package nparMD, and it presents the follow-up to a previous article that had built the foundation for the procedure implemented initially within the package. We consider non-parametric rank-based inference methods for multivariate samples in completely randomized factorial designs. Assumption on the data are minimal: the variables need to be at least ordinal (including binary), and the multivariate observation vectors from different experimental units are assumed independent although there may be dependencies within the vectors. Different endpoints may be measured on different scales. That is, multivariate observation vectors with a count variable, a continuous metric response, and ordinal endpoints, are allowed for. Two different asymptotic settings are considered: (1) sample sizes are large while the number of factor levels is small and bounded, (2) small samples while the number of factor levels is large. Special attention is paid to deriving inference methods for the interaction effect, as here the variance-covariance matrix does not simplify under the null. In addition, we discuss some finite sample approximations and demonstrate application of the methods using real data from a psychological study on Seasonal Affective Disorder (SAD), also commonly referred to as Winter depression

Methods to Assess Melatonin Receptor-Mediated Phase-Shift and Re-entrainment of Rhythmic Behaviors in Mouse Models.

The neurohormone melatonin facilitates entrainment of biological rhythms to environmental light-dark conditions as well as phase-shifts of circadian rhythms in constant conditions via activation of the MT1 and/or MT2 receptors expressed within the suprachiasmatic nucleus of the hypothalamus. The efficacy of melatonin and related agonists to modulate biological rhythms can be assessed using two well-validated mouse models of rhythmic behaviors. These models serve as predictive measures of therapeutic efficacy for treatment of circadian phase disorders caused by internal (e.g., clock gene mutations, blindness, depression, seasonal affective disorder) or external (e.g., shift work, travel across time zones) causes in humans. Here we provide background and detailed protocols for quantitative assessment of the magnitude and efficacy of melatonin receptor ligands inmouse circadian phase-shift and re-entrainment paradigms. The utility of these models in the discovery of novel therapeutics acting on melatonin receptors will also be discussed.

Humidity as the meteorological factor that influences seasonal depression

Humidity as the meteorological factor that influences seasonal depression

Bright Light Therapy for Parkinson Disease: A Literature Review and Meta-Analysis of Randomized Controlled Trials.

Simple SummaryParkinson’s disease (PD) is a common neurodegenerative disease that manifests as motor dysfunction and nonmotor symptoms (NMSs). Apart from motor symptoms, NMSs include sleep disorders, neuropsychiatric problems, and cognitive impairment, which negatively influence patients’ daily lives and caregivers. Disturbances of the sleep cycle also worsen overall health, causing dysregulation of cortisol and melatonin secretion. Furthermore, bright light therapy (BLT) is a well-known treatment for circadian rhythm sleep disorders, seasonal affective disorders, and dementia-related sleep disturbances under the regulation of circadian rhythm by melatonin, a chronological pacemaker. BLT is also applied to treat depressive symptoms and bipolar disorder through unknown mechanisms. The present study, at first, conducted a literature review, which found that a few non-controlled studies demonstrated improvements in motor symptoms and NMSs in PD. Secondly, the present study performed a meta-analysis of the randomized controlled trials which treated the PD patients with BLT. The results revealed that BLT nonsignificantly alleviated symptoms of depression and sleep disorders in patients with PD. However, the inconsistency between BLT protocols, such as varied timing, dosages, and treatment durations, may render BLT’s efficacy challenging to demonstrate, and future RCTs must be obtained.Sleep disorders and depression are significant nonmotor symptoms (NMSs) of Parkinson disease (PD). However, few effective, evidence-proven medical treatments are available for alleviating these symptoms. Bright light therapy (BLT) is a well-established treatment for circadian rhythm sleep disorders and seasonal affective disorder. The present study conducted a literature review for the effect of BLT on PD, especially a meta-analysis of randomized controlled trials (RCTs). We searched for studies using the PubMed and Cochrane Library databases. The major outcomes were the effects on sleep and depression. The effect on motor symptoms was also analyzed as a secondary outcome. This study was registered with PROSPERO (CRD42020204454). Six studies were included in the literature review only, and the other five RCTs were included in the meta-analysis. Despite the positive effects of BLT on PD patients, which were demonstrated in noncontrolled studies, in the meta-analysis of the RCTs, BLT did not significantly improve the depressive symptoms (standardized mean difference (SMD): −0.15, 95% confidence interval (CI): −0.48 to 0.17, p = 0.36) and excessive daytime sleepiness (EDS) (SMD: −0.12, 95% CI: −0.49 to 0.25, p = 0.53) in PD patients. Regarding motor symptoms, no significant beneficial effects were conferred (SMD: −0.11, 95% CI: −0.44 to 0.21, p = 0.49). In conclusion, BLT did not significantly alleviate depression and sleepiness. The inconsistency between BLT protocols, such as the varied timing, dosages, and treatment durations, may render BLT’s efficacy difficult to demonstrate. The small effect size obtained from the present meta-analysis indicates that future RCTs are necessary, for which BLT protocols are standardized and more patients are enrolled to determine whether a significant therapeutic benefit was conferred.

Chronobiology of Depression

Seasonal fluctuations in mood, drive, energy, sleeping- and eating behavior, weight, as well as further important mental and physical functions, and the utilization of light as an effective treatment option were already described by Hippocrates of Kos and Araeteus, the Cappadocian. The concept of the so-called seasonal affective disorder (SAD) as a disruption of the circadian rhythm precipitated by a deficiency of environmental light during darker seasons was first described in the 1980s. Furthermore, chronobiological and hormonal dysregulation in SAD patients was repeatedly shown to be accompanied by alterations on a neuroreceptor and neurotransmitter level and to normalize after remission. Hence, SAD represents one of the most important models of a chronobiological disorder with over 1000 international publications on its aetiology and treatment options, whereby their underpinnings could be elucidated on a clinical as well as molecular level. The present article summarizes the current understanding of etiological mechanisms of SAD and provides an overview of diagnostic and therapeutic strategies, which are based on available international evidence including clinical trials, systematic reviews, and meta-analyses. According to current recommendations of international guidelines, promising treatment options as bright light therapy, psychopharmacotherapy, therapeutic sleep deprivation, and their underlying mechanisms of action are presented.

Increase in the left hippocampal dentate gyrus head volume after a 4-week bright light exposure in healthy participants: A randomized controlled study

IntroductionBright light therapy (BLT) has been used for treating seasonal affective disorder, depression and bipolar depression. However, it's precise mechanism remains unclear. Bright light exposure (BL) induces neurogenesis in the adult rat hippocampal dentate gyrus (DG). We hypothesized that BL may induce neurogenesis in the human DG as well. MethodA 4-week randomized controlled trial study was conducted, where healthy participants were randomly assigned to a BL group (10,000 lux) or dim light exposure group (DL group; 50 lux). Magnetic resonance imaging was performed at baseline and after 4 weeks. Longitudinal hippocampal subfield segmentation was generated via the FreeSurfer 7.1.1 hippocampal subfields module to evaluate volume of bilateral granule cell and molecular layer of the DG-head and -body. ResultsOur final sample size was 20, which consisted of BL group (n = 10) and DL group (n = 10). After age and sex adjustment, significant effects of time and group were detected in the left DG-head volume (p = 0.04). In the BL group, the left DG-head volume significantly increased (p = 0.004), whereas no significant volumetric change was observed in the DL group. ConclusionsThis study revealed that 4-week BL significantly increased left DG-head volume in healthy participants. Thus, neurogenesis might be induced by BL in the human DG, which is a completely new mechanism of BLT.

Incidence rate and clinical characteristics of seasonal affective disorders in senior medical students

Aim. To study the incidence rate, clinical features, and prognosis of seasonal affective disorder (SAD) in senior (6th-year) medical students.Materials and methods. SAD screening using the Seasonal Pattern Assessment Questionnaire (SPAQ, 1987) included 119 undergraduate medical students. 78 students were females (65.5%) and 41 – males (34.5%) (p = 0.001). The average age of women was 23 (22; 23) years, the average age of men – 23 (22; 24) years. Statistical processing was performed using the Mann – Whitney U-test, Pearson’s χ2 test, and Spearman’s rank correlation coefficient (rs).Results. The data on the prevalence of affective disorders with a seasonal pattern in medical students were obtained: SAD – 9.2%, sub-SAD – 13.5%, psychological undulation of season perception (PUSP) – 16.8%. The number of students who did not exhibit seasonal undulation of the six main characteristics recorded by the SPAQ was 72 (60.5%) (p = 0.001). There were statistically significant differences in the higher median Global Seasonality Score of the SPAQ for SAD compared with PUSP, both with and without account of the gender factor (p = 0.001). The use of a binary logistic regression model made it possible to identify groups of students with or without SAD according to the SPAQ. The data obtained determined the contribution of the following factors: gender, seasonality, body weight, and the number of sleep hours per day in spring.Conclusion. The study made it possible to obtain a logistic regression model that allowed to predict the greatest likelihood of developing SAD.