• Sleep Medicine and Psychophysiology
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• v.30 no.1
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• pp.13-21
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• 2023

The Seasonal Affective Disorder (SAD) is a disorder characterized by prolonged periods of depression and various physical and psychological symptoms experienced during specific seasons, typically winter. In this review aims to provide a comprehensive overview of SAD with a specific focus on psychophysiological aspects. Through the review from ancient times to the present, this paper explores the characteristics, causes, and underlying mechanisms of SAD. Particularly, it comprehensively reviews the research findings on the relationship between external factors such as light, sunlight, climate, and their association with SAD. Furthermore, the paper discusses the interplay between SAD and psychophysiological changes, along with the latest research trends in treatment and prevention strategies. By combining theoretical and practical perspectives on SAD, this article aims to provide a holistic understanding and offer suggestions for future research directions and clinical interventions.

• Sleep Medicine and Psychophysiology
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• v.5 no.2
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• pp.170-176
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• 1998

Nowadays light therapy is accepted practice in the treatment for Seasonal Affective Disorder. The author reviewed the practical aspects of light therapy, latest treatment research on optimal parameters of light therapy and the mechanisms of action of light therapy. Therapeutic efficacy of light therapy using light visors & dawn simulators has been suggested but further studies are needed to clarify the efficacy. The treatment most strongly supported by research studies is light therapy using a light box to administer bright white light (2500 lux for 2 hours or 10000 lux for 30 minutes). Although some patients may be selective responders to morning light exposure, the optimal timing of light exposure still remains controversial. In practice, generally the duration of exposure can be increased or decreased as necessary and also the timing of exposure can be splitted (e.g. AM/PM usage) if optimal response is obtained. For most, a positive response of light therapy is usually noted within $4{\sim}5\;days$ and optimal response is obtained within 2 weeks. Generally the relapse of symptom occurs within days of discontinuation of light therapy, so to prevent relapse, light therapy should be continued throughout the winter season for typical seasonal affective disorder. Side effects of light therapy appear to be mild and well tolerated. Several theories for the mechanisms of action of light therapy at the basis of seasonal affective disorder had been suggested but remain still controversial. Further studies on the optimal parameters and the mechanisms of light therapy help us to better understand and treat not only seasonal affective disorders but also chronobiological disorders and nonseasonal affective disorders.

• Sleep Medicine and Psychophysiology
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• v.5 no.2
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• pp.202-209
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• 1998

Authors report the findings of nocturnal polysomnography and multiple sleep latency test(MSLT) before and after morning light treatment in a winter depressive patient with hypersomnia. On polysomnographic recordings, the sleep pattern of this case before light treatment was similar to that of narcolepsy exhibited, sleep onset REM period(SOREMP). After treatment, the shortened REM latency changed to normal condition, but, deep sleep percentage did not changed, and stage 4 sleep percentage was decreased. Depressive symptoms were improved on clinical interview with Hamilton Depressive Rating Scale. Sleep log showed shortened sleep latency and reduced sleep duration. These findings suggest that although light treatment could alter the sleep structure in seasonal affective disorder with hypersomnia, it does not necessarily imply that antidepressant response of light treatment is result of change of sleep structure.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.5-10
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• 2015

The secretion of melatonin exhibits a circadian rhythm entrained with the sleep-wake cycle. An alteration of this secretory rhythm has been found in various psychiatric disorders. This review summarizes the regulation of melatonin and its relationship to the circadian rhythm, major depressive disorder, bipolar disorder, seasonal affective disorder, Alzheimer's disease and autism. The review also looks at the effect of melatonin and melatonin agonist on sleep and symptoms of depression, bipolar disorder and seasonal affective disorder. In Alzheimer's disease, the circadian rhythm alterations are associated with the change of melatonin levels and melatonin receptors. It has been reported that melatonin and melatonin synthetic enzyme levels decrease in autism spectrum disorder.

• Korean Journal of Psychosomatic Medicine
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• v.8 no.1
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• pp.103-109
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• 2000

The authors identified a treatment-resistant patient with chronic fatigue syndrome, characterized by chronic fatigue, headache, unrefreshing sleep. Some studies reported that chronic fatigue syndrome was associated with affective disorder, especially seasonal affective disorder and many studies reported that bright light therapy was effective in seasonal affective disorder. But efficacy of light therapy for chronic fatigue syndrome was rarely reported. We treated the patient with morning light treatment using 2500lux light box, the clinical symptoms in this case were improved. The authors suggest that the light therapy can be a treatment modality for chronic fatigue syndrome.

• Korean Journal of Biological Psychiatry
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• v.17 no.3
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• pp.153-160
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• 2010

Objectives : Recurrence of mood episodes associated with a specific season has been described in various mood disorders. Seasonal change in mood and behavior as a lifetime trait is also observed in healthy individuals. This study aimed at comparing the lifetime trait of seasonal variations of mood and behavior between bipolar disorder patients and controls as well as investigating associated factors of seasonality. Methods : Subjects were ninety-four clinically stable patients with bipolar disorder and 188 age- and sex-matched healthy controls. Seasonality of mood and behavior was assessed retrospectively on lifetime basis using Seasonal Pattern Assessment Questionnaire(SPAQ). Results : The patient group showed a higher median global seasonality score(GSS) of SPAQ and a higher rate of seasonal affective disorder(SAD) compared to the control group(p < 0.0001). For subjects showing prominent seasonality, the seasonal symptom profile and seasonal pattern was similar in both patient and control groups. In addition to the diagnosis, female gender was shown to be a predictor of seasonality in the multiple linear regression analysis(p = 0.045). Conclusion : This study suggests that lifetime trait of seasonality may be related to the susceptibility of bipolar disorder.

• Sleep Medicine and Psychophysiology
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• v.13 no.1
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• pp.22-26
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• 2006

Circadian rhythms have been observed to be disturbed in mood disorders, especially seasonal affective disorder (SAD). Clock related gene variants also have been suggested to be associated with seasonality (seasonal variations in mood and behavior). This study tested the potential association between a length polymorphism of Period3 gene and seasonal variations in mood and behavior. 297 Korean college students were genotyped for the Period3 polymorphism and were for evaluated the seasonal variation by Seasonal Pattern Assessment Questionnaire (SPAQ). The genotype frequencies were 0.76 for 4R/4R, 0.22 for 4R/5R and 0.013 for 5R/5R. The global seasonality score was not different among Period3 gene variants (4R/4R, 4R/5R and 5R/5R) except for 'sleep length' subscore. The 5R/5R genotype showed the higher 'sleep length' subscore than others (p=0.024). The comparison between seasonals (syndromal plus subsyndromal SAD determined by SPAQ) and non-seasonals did not show any significant difference in frequencies of genotypes. These findings suggest that there is a possibility that the investigated Period3 polymorphism may play a partial role in the susceptibility of seasonal variations in a Korean population.

• Korean Journal of Psychosomatic Medicine
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• v.15 no.1
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• pp.14-21
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• 2007

Premenstural dysphoric disorder(PMDD) imposing 4-5% of women is possibly caused by an enhanced responsiveness to the changes of sex steroid hormones and the decrease of serotonin, melatonin and GABA. The common clinical features between PMDD and depression, seasonal affective disorder, panic disorder and anorexia nervosa suggest a relatedness between PMDD and each of them. The diagnostic criteria of DSM-IV-Tr for PMDD requires psychological symptoms, that commonly include irritability, anger, depression, mood swing, affect lability, tension, anxiety, fatigue and food craving. As of today, the best pharmacological treatment for PMDD is the selective serotonin reuptake inhibiter, and leuprolide, danazol, estradiol, spironolactone and bromocriptine are possible alternatives. Nonpharmacological treatments for patients with mild to moderate symptom severity are diet, exercise, light therapy, psychotherapy and keeping a diary.

• Sleep Medicine and Psychophysiology
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• v.11 no.2
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• pp.95-99
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• 2004

Objectives: Although many studies on seasonal variations in mood and behavior have been carried out in foreign countries, no such study has previously been undertaken in Korea. The goal of this study was to estimate the frequency of seasonal variations in mood and behavior among Korean medical students. Methods: 297 medical students from Korea University College of Medicine participated in this study. The subjects were surveyed with a Korean translation of the Seasonal Pattern Assessment Questionnaire (SPAQ), and their responses were evaluated for seasonal patterns of mood and behavioral change, including seasonal affective disorder (SAD) and subsyndromal seasonal affective disorder (S-SAD), derived from the case-finding criteria of Kasper et al. Results: The mean global seasonality score was 6.6 (SD=3.6). 83.5% (N=248) of the subjects reported some changes in behavior and mood associated with the seasons. Only 3.7% (N=11) reported no behavioral changes across the seasons. Total prevalence rates were 15.2% for SAD, and 2.7% for S-SAD. The estimated frequencies were 3.0% for summer SAD, 2.7% for summer S-SAD, 11.4% for winter SAD, and 5.8% for winter S-SAD. The prevalence rates for winter SAD or S-SAD were higher than the prevalence rates for summer SAD or S-SAD. Conclusion: These results suggest that seasonal variations in mood and behavior are common among Koreans. The higher prevalence rate of winter SAD or S-SAD than summer SAD or S-SAD is consistent with most western studies and stands in contrasts to studies in other Asian countries, such as Japan and China.

• Sleep Medicine and Psychophysiology
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• v.12 no.2
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• pp.111-116
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• 2005

Objectives: Although many reports have been written on seasonal variations in mood and behavior in foreign countries, few reports have dealt with Korean adolescents, except medical students. The goal of this study was to estimate the frequency of seasonal variations in mood and behavior among Korean high school students. Methods: A total of 656 high school students living in southeastern Seoul participated in this study. The subjects were investigated with the Korean translated version of the Seasonal Pattern Assessment Questionnaire (SPAQ), and their responses were evaluated for seasonal patterns in mood and behavior change according to Kasper's criteria to make SAD (seasonal affective disorder) or SSAD (subclinical seasonal affective disorder) diagnosis. Results: A total of 565 subjects completed the questionnaire and the responses (M：F=324：241) were collected and used for analysis. The mean age was 16.73 (SD=0.65) years, and mean global seasonality score 5.88 (SD=4.72). Of the respondents, 413 (73.1%) reported problems related with seasonal changes. Total prevalence rates were 13.6% for SAD, 10.8% for S-SAD. The estimated frequencies were 5.1% for summer SAD, 3.2% for summer S-SAD, 0.5% for winter SAD and 1.1% for winter S-SAD. The prevalence rate of summer SAD or S-SAD was higher than winter SAD or S-SAD. Conclusion: The subjects showed a higher prevalence rate of summer type than winter type in SAD or S-SAD. These results were similar to those of other studies carried out in East Asian countries. However, the unpleasant feelings resulting from high temperature and humidity in summer rather than depression may have influenced the results. Therefore, it is necessary to make new SAD criteria of the SPAQ suitable for East Asian countries.