Seasonal Affective Disorder Research Articles

Can Rehabilitative Travel Mobility improve the Quality of Life of Seasonal Affective Disorder Tourists?

Rehabilitation mobility has become a new demand and travel mode for people to pursue active health. A large number of tourists choose to escape the cold in warm places to improve their health every winter. In this study, we collected the health index data of Seasonal Affective Disorder (SAD) tourists from western China before and after their cold escape in Hainan Island in winter, aiming to compare whether rehabilitating cold escape can improve the Quality of Life (QOL) of SAD tourists by hierarchical analysis. Compared with previous studies, this paper has the following contributions: Firstly, the study samples were accurately screened according to the pathogenesis of SAD tourists and the confounding factors were strictly controlled; Secondly, the observational experimental method was used to conduct inter-group and intra-group control studies on 695 samples, and the results were more objective and reliable. Thirdly, the effect of treatment on the quality of life (QOL) of 397 tourists in the rehabilitation mobility group was quantitatively evaluated from three factors including age, gender and sunshine exposure level by multivariate analysis of variance. Research results show that the rehabilitation environment brought by rehabilitation activities can help improve the health status of tourists. Therefore, this paper proposes the concept of “Tourism Therapy” and constructs a theoretical framework. The conclusion of this paper provides a scientific basis and reference for the study of tourism healing as a non-medical alternative therapy.

Modafinil as an alternative in the treatment of excessive daytime sleepiness associated with affective disorders

Excessive daytime sleepiness or an increased need for sleep are an increasingly common reason of medical appointments. For years, the literature on sleep disorders has reported a complex two-way relationship between excessive sleepiness and mental disorders – especially mood disorders, which include winter depression in seasonal affective disorder. Assessment and effective treatment of excessive sleepiness in patients with seasonal affective disorder is an important component of the therapy. Hypersomnia is often a residual symptom of affective disorders, compromising the quality of life and daily functioning. Modafinil is an agent used in adults to treat excessive sleepiness associated with narcolepsy, with or without cataplexy. In addition to the registered indications, previous studies have shown efficacy and good tolerance of modafinil as augmentation treatment of depressive episodes in patients with residual symptoms in the form of fatigue and excessive daytime sleepiness, who received drugs from the group of serotonin reuptake inhibitors. The aim of this paper is to present the problem of excessive daytime sleepiness in the course of seasonal affective disorder and to propose modafinil therapy.

Bupropion - an antidepressant drug with broad therapeutic potential

Introduction: Bupropion is currently mainly used as an atypical antidepressant due to its psychotropic effects. In addition, it shows high potential in reducing withdrawal cravings in addicts, which is also used in the treatment of nicotinism. However, studies in recent years have shown that it may also be useful in other conditions.Aim of the study: Our aim was to review the known usage of bupropion in the fields of psychiatry, neurology and internal medicine, and to identify potential directions for further research. Methods and materials: We reviewed the literature available in the PubMed database, using the key words: "bupropion"; "depression"; "smoking cessation"; "obesity"; "ADHD".Results: Bupropion- an antidepressant drug belonging to the group of selective norepinephrine and dopamine reuptake inhibitors. Bupropion is approved by the FDA(Food and Drug Administration) for the treatment of depression, seasonal affective disorder and nicotinism. The literature shows that it is also effective in off-label indications - treatment of antidepressant-induced sexual dysfunction, attention deficit hyperactivity disorder (ADHD), depression in bipolar disorder, obesity, neuropathic pain and cancer-related fatigue syndrome.Conclusion: Due to the specific effects of bupropion, there are many more usage for the drug than the primary indications for which it is usually used. The usage of the drug described in the literature require additional studies on a larger group of patients.

Effectiveness of the Australian breeding value for heat tolerance at discriminating responses of lactating Holstein cows to heat stress.

Heat stress has negative consequences for milk production and reproduction of dairy cattle. These adverse effects are likely to increase because of climate change and anticipated increases in milk yield. Some of the variation among cows in ability to resist effects of heat stress is genetic. The current objective of this observational study was to assess the effectiveness of the Australian breeding value for heat tolerance (ABVHT) based on the decline in milk yield with heat stress for predicting cow differences in effects of heat stress on regulation of body temperature, milk production, and reproductive function. Genomic breeding values for heat tolerance were calculated for 12,487 cows from a single California dairy farm. Rectal temperature in the afternoon (1100-2045 h) was measured on a subset of 626 lactating cows with ABVHT ≥102 (heat tolerant) or <102 (heat sensitive). Rectal temperature was 0.12°C lower for heat-tolerant cows than heat-sensitive cows. Vaginal temperatures were measured every 15 min for 5 d in 118 cows with ABVHT ≥108 (extreme heat tolerant) or <97 (extreme heat sensitive). Vaginal temperature was 0.07°C lower for extreme heat-tolerant cows than extreme heat-sensitive cows. Lactation records for 4,703 cows with ABVHT were used to evaluate seasonal variation in first 90-d milk yield, fat percent, and protein percent for each ABVHT quartile. Overall, cows with higher ABVHT had lower milk yield, fat percentage, and protein percentage and higher first service pregnancy rate. There was no summer depression in production or reproduction or interactions between season and ABVHT quartile. We observed that ABVHT can successfully identify heat-tolerant cows that maintain lower body temperatures during heat stress. The lack of a pronounced seasonality in milk production or reproduction precluded evaluation of whether ABVHT is related to the magnitude of effect of heat stress on those traits.

EEG-responses to mood induction interact with seasonality and age.

The EEG is suggested as a potential diagnostic and prognostic biomarker for seasonal affective disorder (SAD). As a pre-clinical form of SAD, seasonality is operationalized as seasonal variation in mood, appetite, weight, sleep, energy, and socializing. Importantly, both EEG biomarkers and seasonality interact with age. Inducing sad mood to assess cognitive vulnerability was suggested to improve the predictive value of summer assessments for winter depression. However, no EEG studies have been conducted on induced sad mood in relation to seasonality, and no studies so far have controlled for age. We recorded EEG and calculated bandpower in 114 participants during rest and during induced sad mood in summer. Participants were grouped by age and based on a seasonality score as obtained with the seasonal pattern assessment questionnaire (SPAQ). Participants with high seasonality scores showed significantly larger changes in EEG power from rest to sad mood induction, specifically in the alpha frequency range (p = 0.027), compared to participants with low seasonality scores. Furthermore, seasonality interacted significantly with age (p < 0.001), with lower activity in individuals with high seasonality scores that were older than 50 years but the opposite pattern in individuals up to 50 years. Effects of sad mood induction on brain activity are related to seasonality and can therefore be consider as potential predicting biomarkers for SAD. Future studies should control for age as a confounding factor, and more studies are needed to elaborate on the characteristics of EEG biomarkers in participants above 50 years.

Spondias mangifera Willd.: A highly healthful turpentines aromatic plant for the management of the seasonal affective disorders

Spondias mangifera Willd.: A highly healthful turpentines aromatic plant for the management of the seasonal affective disorders

Effect of Short Photoperiod on the Behavior and Brain Serotonin System in Zebrafish Danio rerio.

Reduced daylight duration causes the development of seasonal affective disorder (SAD; depression-like disorders characterized by depressed mood, apathy, bulimia, and weight gain) in sensitive individuals. Neurotransmitter serotonin (5-HT) is involved in the mechanism of SAD. Zebrafish (D. rerio) is a promising model for translational studies. We studied changes in the behavior, content of 5-HT and its major metabolite 5-hydroxyindoleacetic acid (5-HIAA), and the expression of genes encoding the key enzymes of 5-HT metabolism, tryptophan hydroxylases TPH1A, TPH1B, TPH2, monoamine oxidase (MAO), 5-HT transporter, and 5-HT1A and 5-HT2A receptors in the brain of zebrafish reared for 60 days under short (04:20 h) compared to those reared at normal (12:12 h) photoperiod. Exposure to short photoperiod decreased locomotor activity in the novel tank diving test, increased the level 5-HIAA, and reduced the level of Mao gene mRNA, but did not affect the level of 5-HT and expression of Tph1a, Tph1b, Tph2, Slc6a4a (transporter), Htr1aa, and Htr2aa (receptors) genes. Thus, zebrafish can be used as a promising model to study the involvement of 5-HT in the SAD mechanism.

Lack of Differential Symptom Change with Cognitive-Behavioral versus Light Therapy for Winter Depression: A Network Intervention Analysis

Lack of Differential Symptom Change with Cognitive-Behavioral versus Light Therapy for Winter Depression: A Network Intervention Analysis

Vision-Related Quality of Life and Seasonal Affective Disorder in Patients with Glaucoma and Macular Degeneration.

Seasonal affective disorder (SAD) is characterized by depressive episodes related to changes in the seasons. Patients with severe vision loss are at an increased risk of SAD. This study seeks to determine the extent to which patients with moderate vision loss report symptoms of SAD. In this cross-sectional, comparative case series, the Seasonal Pattern Assessment Questionnaire (SPAQ) and the National Eye Institute Visual Function Questionnaire (VFQ-39) were used to screen 111 patients with age-related macular degeneration (AMD) and/or primary open-angle glaucoma (POAG). A multiple regression analysis was performed to create a predictive model for SAD based on the Global Seasonality Score (GSS) using the VFQ-39. Subjects who reported symptoms of SAD (GSS > 8) had lower vision-related quality of life (composite score: 57.2 versus 73.2, p < 0.001). Exploratory factor analysis revealed that the items on the VFQ-39 split into two distinct dimensions that together accounted for 63.2% of the total variance in the GSS. One group of questions addressed vision-related problems; the other group comprised questions related to the quality of life. Whereas this model successfully identified patients with vision loss at risk of SAD, a model restricted to the questions available on the shorter, widely used VFQ-25 instrument did not reliably identify patients at risk of SAD.

Bright Light Therapy for MDD in Children and Adolescents: a narrative review of literature

IntroductionMajor Depressive Disorder (MDD) is a common mood disorder diagnosed in children and adolescents. Bright light therapy has been effective for seasonal affective disorders, however its role in the treatment of MDD is under studied.ObjectivesOur objective is to evaluate if bright light therapy (BLT) is a practical approach in treating Child and Adolescents having MDD.MethodsWe performed an extensive literature search using a wide range of MeSH terms in PubMed, PubMed Central and Google Scholar. We reviewed the literature for studies (published between 1983-2021) assessing the efficacy of BLT in the treatment of MDD in children and adolescents.Results The final search results yielded 8 randomized clinical trials and 1 case report from 1983 to 2021. BLT showed a superior effect in children and adolescents with MDD compared to the control group in the majority of the randomized trials and a case report. In six studies BLT showed good effect, however in a study by Magnusson et al. and Sonis et al., found a milder degree of improvement in depression symptoms when compared to the control group. In the majority of the studies, patients’ age range was 7 years 18 and in most of the studies, patients were not on antidepressants.Conclusions The use of BLT in children and adolescents suffering from MDD can be a promising alternative method of biological treatment, which is effective as well as well tolerated. Future long-term studies on large sample size are necessary in this field.DisclosureNo significant relationships.

0196 Retinal responsivity is associated with circadian phase and circadian alignment but not sleep timing

Abstract Introduction Light entrains the central circadian clock, with projections from the retina to the SCN through melanopsin-containing retinal ganglion cells (ipRGCs). Altered responsivity to light reflects ipRGC functioning and may be a physiological vulnerability for disrupted photoentrainment. Understanding how retinal responsivity relates to sleep and circadian timing may inform who might most benefit from sleep and circadian interventions. Methods 64 participants (85 observations) ages 20-66 years old were recruited during winter (n=35) and summer months (n=50), and included individuals with seasonal depression (n=33) and nonseasonal, never depressed controls (n=31). The post-illumination pupil response (PIPR) to red and blue light was used to measure the responsivity of ipRGCs (average 1:30pm; 10am-7pm). Circadian phase was assessed using Dim Light Melatonin Onset (DLMO), collected every 30-minutes on Friday evenings. Midsleep timing was measured using actigraphy (average number nights=4), and circadian alignment was calculated as the DLMO-midsleep phase angle. We performed a multilevel regression to determine the relationship between PIPR and markers of sleep and circadian timing, accounting for repeated seasonal assessments with a random intercept of participant. Covariates included age, gender, diagnostic group, and circadian time of PIPR assessments. We ran sensitivity analyses including photoperiod length on the day of PIPR assessment to account for potential light exposure on the PIPR. Results Greater retinal responsivity was associated with later DLMO (b=4.45; partially standardized b=0.28; SE=1.84; p=0.03), and shorter DLMO-midsleep phase angle (b= -7.33; partially standardized b= -0.32; SE=2.51; p=0.004), but not midsleep (b= -3.44; partially standardized b= -0.14; SE=2.35; p&amp;gt;0.05). Individuals with later DLMO had PIPR assessments at earlier circadian times (b= -0.12; SE=0.04; p=0.01). Older participants (b= -0.04; SE=0.02; p=0.04) and controls (b= -0.95; SE=0.44; p=0.04) had earlier sleep midpoints, but covariates were not associated with circadian markers. The association between circadian timing and PIPR became nonsignificant (b=4.15; partially standardized b=0.26; SE=1.88; p=0.06) when including photoperiod. Conclusion Retinal responsivity was associated with circadian but not behavioral sleep timing, suggesting ipRGC functioning may have downstream effects on circadian entrainment. Assessing circadian variation of retinal responsivity remains a crucial next step prior to testing whether retinal responsivity impacts response to circadian-focused interventions. Support (If Any) NIMH K.A.R.MH103303

0661 Lightbox Therapy for Seasonal Affective Disorder in College Students

Abstract Introduction Seasonal affective disorder (SAD) is a mental health issue that can be defined as depressive mood disturbances that align with a seasonal pattern. Research shows that college students are at a higher risk of having SAD leading to poor academic performance and other severe mental disorders. Light therapy can help alleviate the symptoms of SAD. However, few detailed investigations have been conducted on the impacts of light therapy for SAD symptoms and adherence barrier for the therapy. The purpose of this project was to review a light therapy program for college students. Specifically, we aimed to assess the changes in depressive symptoms before and after using a light box and assessed feedback. Methods 207 college students (mean age of 22.5 years (SD=5.3); female (80.7%)) participated in the light therapy program. Participants were given user instructions and asked to utilize the lightbox daily. Participants completed the patient health questionnaire (PHQ-9) at baseline and when they returned the lightbox along with their feedback of this therapy. Students also completed the open-ended questions. We used paired sample t-test to assess changes in the total PHQ-9 score. Results Participants spent 45 days, on average, using the device. Results showed that there was a significant decrease in PHQ-9 score from pre- to post-therapy [M(post-pre) = -2.78; p &amp;lt; .0001]. Most students said the therapy was effective (96.5%) and helped ease SAD symptoms and improve their mood. Some students planned to purchase a light box after the therapy. The major adherence barriers were finding enough time to use it and excessive brightness issue. Conclusion The findings suggest that light therapy has positive outcomes in easing college students’ SAD symptoms. Future randomized control trials are needed to assess the effectiveness of the intervention. However, to the time and brightness issues need to be assessed when designing the therapy instructions for college students. Support (If Any) This work was supported by the Alzheimer’s Association Research Grant (AARG-19-618403), University of Iowa Institute for Clinical and Translational Science (NIH/NCATS, UL1 TR002537), and the University of Iowa Center for Advancing Multimorbidity Science (NIH/ NINR P20 NR018081).

0199 Iris color predicts melanopsin-driven retinal responses in older but not younger individuals

Abstract Introduction The retina contains melanopsin-containing retinal ganglion cells, which underlie non-image forming responses to light. The Post-Illumination Pupil Response (PIPR) can assess melanopsin cell responsivity, with applications for sleep disorders, mood disorders, and circadian entrainment. Lighter pigmented irises allow more light to pass through the retina. The present study tested an association between the PIPR and iris pigmentation. Methods Participants (N=49) included seasonal depression (n=26) and never-depressed controls (n=23). Photos of participants’ irises were rated using both the Franssen (2008) scale, a set of 24 standardized iris photos, and the Mackey (2011) scale, a 9-category rating system. Red and blue stimuli 13.5 log photons/cm2/s were presented, and infrared pupillometry measured pupil diameter for 40 seconds. We used multilevel regression with a random intercept of participant to predict the PIPR from each iris rating system separately, controlling for age, gender, and circadian time of testing determined from Dim Light Melatonin Onset. Results Agreement between raters, calculated using Cohen's κ, was moderate for both scales (Franssen, κ=0.57, 95% CI: 0.42 to 0.71, p&amp;lt;0.001; Mackey, κ=0.67, 95% CI: 0.53 to 0.81, p&amp;lt;0.001). Bivariate correlations showed age was inversely associated with iris color: older individuals had lighter iris pigmentation. Analyses were therefore stratified by age (older &amp;gt;=31 years: n=24; younger &amp;lt;31 years, n=25). Greater retinal responsivity was associated with lighter iris pigmentation in the older sample (Mackey: unstandardized b=-0.016; SE=0.005; p=0.002; Franssen: unstandardized b=-0.006; SE=0.002, p=0.002), but not the younger sample (Mackey: unstandardized b=-0.0008; SE=0.003; p=0.770; Franssen: unstandardized b=-0.0009; SE=0.002, p=0.619). There was no effect of iris color on PIPR in the whole sample (p’s &amp;gt;0.13). Conclusion Iris color explained ~8% of variance in the PIPR, indicating that PIPR studies should recruit samples with similar distributions of iris pigmentation across conditions and ages, as this finding was only seen in the older sample with more individuals with lighter iris pigmentation. Future studies will test iris pigmentation by light exposure interactions on the PIPR. Light stimuli focused to a point on the pupil (i.e., Maxwellian) would eliminate variation in the amount of light incident on the retina due to iris pigmentation. Support (If Any) NIMH K.A.R. MH103303

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Elucidating treatment targets and mediators within a confirmatory efficacy trial: study protocol for a randomized controlled trial of cognitive-behavioral therapy vs. light therapy for winter depression

BackgroundThis study is a confirmatory efficacy trial of two treatments for winter seasonal affective disorder (SAD): SAD-tailored group cognitive-behavioral therapy (CBT-SAD) and light therapy (LT). In our previous efficacy trial, post-treatment outcomes for CBT-SAD and LT were very similar, but CBT-SAD was associated with fewer depression recurrences two winters later than LT (27.3% in CBT-SAD vs. 45.6% in LT). CBT-SAD engaged and altered a specific mechanism of action, seasonal beliefs, which mediated CBT-SAD’s acute antidepressant effects and CBT-SAD’s enduring benefit over LT. Seasonal beliefs are theoretically distinct from LT’s assumed target and mechanism: correction of circadian phase. This study applies the experimental therapeutics approach to determine how each treatment works when it is effective and to identify the best candidates for each. Biomarkers of LT’s target and effect include circadian phase angle difference and the post-illumination pupil response. Biomarkers of CBT-SAD’s target and effect include decreased pupillary and sustained frontal gamma-band EEG responses to seasonal words, which are hypothesized as biomarkers of seasonal beliefs, reflecting less engagement with seasonal stimuli following CBT-SAD. In addition to determining change mechanisms, this study tests the efficacy of a “switch” decision rule upon recurrence to inform clinical decision-making in practice.MethodsAdults with SAD (target N = 160) will be randomzied to 6-weeks of CBT-SAD or LT in winter 1; followed in winter 2; and, if a depression recurrence occurs, offered cross-over into the alternate treatment (i.e., switch from LT➔CBT-SAD or CBT-SAD➔LT). All subjects will be followed in winter 3. Biomarker assessments occur at pre-, mid-, and post-treatment in winter 1, at winter 2 follow-up (and again at mid-/post-treatment for those crossed-over), and at winter 3 follow-up. Primary efficacy analyses will test superiority of CBT-SAD over LT on depression recurrence status (the primary outcome). Mediation analyses will use parallel process latent growth curve modeling.DiscussionConsistent with the National Institute of Mental Health’s priorities for demonstrating target engagement at the level of Research Domain Criteria-relevant biomarkers, this work aims to confirm the targets and mechanisms of LT and CBT-SAD to maximize the impact of future dissemination efforts.Trial registrationClinicalTrials.gov identifier: NCT03691792. Registered on October 2, 2018.

Blue-Light Therapy for Seasonal and Non-Seasonal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ObjectivesTo determine the efficacy and safety of blue-light therapy in seasonal and non-seasonal major depressive disorder (MDD), by comparison to active and inactive control conditions.MethodsWe searched Web of Science, EMBASE, Medline, PsycInfo, and Clinicaltrials.gov through January 17, 2022, for randomized controlled trials (RCTs) using search terms for blue/blue-enhanced, light therapy, and depression/seasonal affective disorder. Two independent reviewers extracted data. The primary outcome was the difference in endpoint scores on the Structured Interview Guide for the Hamilton Depression Rating Scale - Seasonal Affective Disorder (SIGH-SAD) or the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement (SIGH-ADS) between blue light and comparison conditions. Secondary outcomes were response (≥ 50% improvement from baseline to endpoint on a depression scale) and remission rates (endpoint score in the remission range).ResultsOf 582 articles retrieved, we included nine RCTs (n = 347 participants) assessing blue-light therapy. Seven studies had participants with seasonal MDD and two studies included participants with non-seasonal MDD. Four studies compared blue light to an inactive light condition (efficacy studies), and five studies compared it to an active condition (comparison studies). For the primary outcome, a meta-analysis with random-effects models found no evidence for the efficacy of blue-light conditions compared to inactive conditions (mean difference [MD] = 2.43; 95% confidence interval [CI], −1.28 to 6.14, P = 0.20); however, blue-light also showed no differences compared to active conditions (MD = −0.11; 95% CI, −2.38 to 2.16, P = 0.93). There were no significant differences in response and remission rates between blue-light conditions and inactive or active light conditions. Blue-light therapy was overall well-tolerated.ConclusionsThe efficacy of blue-light therapy in the treatment of seasonal and non-seasonal MDD remains unproven. Future trials should be of longer duration, include larger sample sizes, and attempt to better standardize the parameters of light therapy.

Should clinicians and the general population be concerned about seasonal affective disorder in Australia?

Should clinicians and the general population be concerned about seasonal affective disorder in Australia?

Solar Radiation in Architectural Projects as a Key Design Factor for the Well-Being of Persons with Alzheimer’s Disease

The beneficial effects of solar radiation on human health are well documented. One necessary mechanism triggers the production of vitamin D, whose insufficiency has been linked to a variety of disorders such as diabetes; hypertension; and, more recently, amyloidosis and Alzheimer’s disease. However, there are few architectural designs capable of ensuring the adequate provision of solar radiation inside buildings. Conventional fenestration is not sufficient to provide for significant doses of sunlight, even to prevent seasonal affective disorder (SAD). In this paper, we discuss the effect of new design alternatives for skylights, especially in the refurbishment of obsolete facilities. Based on the authors’ previous studies, we defined a theoretical model that was subsequently adapted to a real building that was to be retrofitted in an area near Sevilla. After such complex refurbishment was executed, we analyzed the performance of buildings in warm and sunny climates, as is the case of southern Spain, where cloudiness is very scarce and available simulation models are not useful. The study of the factors that relate to sunlight; UV reception and energy; and, to a certain extent, other aspects such as ventilation and insulation has been considered a priority. Many architectural designs are presented as correct if the thermal requirements alone are met, even at the risk of later energy waste in lighting devices and visual or physical discomfort. On the other hand, large glazed areas allow for more daylight and UV radiation into a space if properly treated, but they may also produce excessive heat gains or losses, which increase the air-conditioning cooling or heating load, respectively. The uncontrolled increase in temperature can have negative effects on the well-being of a person with Alzheimer’s dementia. To avoid these problems, we have considered the combined effect of daylight and energy from the beginning of the skylight design-process. Daylighting software, based on configuration factors that we have applied in studies of the complex problem of there being direct sunlight over architectural structures, has been used. This question cannot be treated adequately with conventional programs for overcast skies. The skylights have already been constructed, with special UV increasing glazing and on-site measurements in the offices to complement the computer simulation data. The results show that it is possible to achieve energy saving and high radiation levels in winter without increasing heat loads during the summer. Ventilation is also improved through the aerodynamic design of the clerestories. All this is considered beneficial to improve the condition of users with cognitive diseases as Alzheimer’s disease, by virtue of adapted spaces.

P367. Seasonal Depression Does Not Affect Depression Outcomes From Repetitive Transcranial Magnetic Stimulation

A seasonal pattern affects 10-20% of those with major depressive disorder (MDD) in temperate climates. While repetitive transcranial magnetic stimulation (rTMS) is a first-line treatment for MDD, whether a seasonal pattern to MDD affects rTMS outcomes for depression is unexplored.

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.