Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration

This article: (1) describes and reviews evidence for hypothesized biological and psychological mechanisms of winter seasonal affective disorder (SAD), (2) advocates for an integrative approach to studying SAD etiology that incorporates both biological and psychological mechanisms, and (3) delineates areas for future research from an integrative perspective. Exciting progress has been made within sub-paradigms testing candidate biological mechanisms (i.e., biological rhythm abnormalities, retinal subsensitivity to light, neurotransmitter alterations, and genetic variations) and psychological mechanisms (i.e., maladaptive cognitions and behaviors) of SAD. However, research from an integrative biological/ psychological perspective is currently lacking. In contrast to a continued exclusive focus on micro-models, we argue that an integrative approach would maximize the capacity to predict and understand the onset, maintenance, and course of SAD. An integrative approach also provides a comprehensive theoretical framework for developing strategies to effectively treat acute SAD, maintain acute treatment gains throughout the winter, and prevent future episodes of this highly recurrent form of depression.

[1]  S. Hamburger,et al.  Rates of seasonal affective disorder in children and adolescents. , 1995, The American journal of psychiatry.

[2]  M Terman,et al.  Circadian time of morning light administration and therapeutic response in winter depression. , 2001, Archives of general psychiatry.

[3]  S. Sigmon,et al.  Stress reactivity and coping in seasonal and nonseasonal depression. , 2007, Behaviour research and therapy.

[4]  T. M. Lee,et al.  Spectral properties of phototherapy for seasonal affective disorder: a meta‐analvsis , 1997, Acta psychiatrica Scandinavica.

[5]  C. Eastman,et al.  Bright Light Therapy for Winter Depression—Is Phase Advancing Beneficial? , 2004, Chronobiology international.

[6]  M. Marks,et al.  Cognitive characteristics of seasonal affective disorder: a preliminary investigation. , 1998, Journal of affective disorders.

[7]  Light Therapy for Seasonal Affective Disorder the Effects of Timing , 1995, British Journal of Psychiatry.

[8]  A. Lewy,et al.  Assessment and treatment of chronobiologic disorders using plasma melatonin levels and bright light exposure: the clock-gate model and the phase response curve. , 1984, Psychopharmacology bulletin.

[9]  M. Katz,et al.  The Psychology of depression : contemporary theory and research , 1974 .

[10]  J. Eagles,et al.  A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder , 2004, Psychopharmacology.

[11]  C. Drake,et al.  Bimodal patterns of human melatonin secretion consistent with a two-oscillator model of regulation , 1995, Neuroscience Letters.

[12]  S. Nolen-Hoeksema Responses to depression and their effects on the duration of depressive episodes. , 1991, Journal of abnormal psychology.

[13]  David Goldman,et al.  Association of a triallelic serotonin transporter gene promoter region (5-HTTLPR) polymorphism with stressful life events and severity of depression. , 2006, The American journal of psychiatry.

[14]  M Masellis,et al.  The serotonin transporter promoter repeat length polymorphism, seasonal affective disorder and seasonality , 2003, Psychological Medicine.

[15]  M. Esler,et al.  Effect of sunlight and season on serotonin turnover in the brain , 2002, The Lancet.

[16]  A. Metz,et al.  Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL , 2005, Biological Psychiatry.

[17]  R. Lam,et al.  Low electrooculographic ratios in patients with seasonal affective disorder. , 1991, The American journal of psychiatry.

[18]  S. Kasper,et al.  Effects of tryptophan depletion vs catecholamine depletion in patients with seasonal affective disorder in remission with light therapy. , 1998, Archives of general psychiatry.

[19]  Leora N. Rosen,et al.  Prevalence of seasonal affective disorder at four latitudes , 1990, Psychiatry Research.

[20]  C. Eastman,et al.  The temporal onset of individual symptoms in winter depression: differentiating underlying mechanisms. , 1991, Journal of affective disorders.

[21]  Exposure to ambient light in patients with winter seasonal affective disorder. , 1994, The American journal of psychiatry.

[22]  H. Kraemer,et al.  Coming to terms with the terms of risk. , 1997, Archives of general psychiatry.

[23]  S. Nolen-Hoeksema,et al.  Sex Differences in Unipolar Depression: Evidence and Theory Background on the Affective Disorders , 1987 .

[24]  S Kasper,et al.  Phototherapy in individuals with and without subsyndromal seasonal affective disorder. , 1989, Archives of general psychiatry.

[25]  T. Bolwig,et al.  The influence of climate on development of winter depression. , 1996, Journal of affective disorders.

[26]  C. Eastman,et al.  Which environmental variables are related to the onset of seasonal affective disorder? , 1997, Journal of abnormal psychology.

[27]  F. Goodwin,et al.  Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. , 1984, Archives of general psychiatry.

[28]  J. Krystal,et al.  Effects of rapid tryptophan depletion in patients with seasonal affective disorder in remission after light therapy. , 1996, Archives of general psychiatry.

[29]  P. Muglia,et al.  The dopamine-4 receptor gene associated with binge eating and weight gain in women with seasonal affective disorder: An evolutionary perspective , 2004, Biological Psychiatry.

[30]  P. Muglia,et al.  Childhood Inattention and Dysphoria and Adult Obesity Associated with the Dopamine D4 receptor Gene in Overeating Women with Seasonal Affective Disorder , 2004, Neuropsychopharmacology.

[31]  P. Lewinsohn,et al.  A behavioral approach to depression. , 1974 .

[32]  A. Beck Cognitive therapy and the emotional disorders: A. T. Beck , 1987, British Journal of Psychiatry.

[33]  F. Barton,et al.  A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. , 2007, Journal of consulting and clinical psychology.

[34]  M. Terman,et al.  A circadian signal of change of season in patients with seasonal affective disorder. , 2001, Archives of general psychiatry.

[35]  D. Levinson Meta-analysis in psychiatric genetics , 2005, Current psychiatry reports.

[36]  A. Wirz-Justice,et al.  Light therapy in seasonal affective disorder is independent of time of day or circadian phase. , 1993, Archives of general psychiatry.

[37]  A. Caspi,et al.  Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene , 2003, Science.

[38]  S. Sigmon,et al.  Cognitive-behavioral factors in seasonal affective disorder. , 2003, Journal of consulting and clinical psychology.

[39]  J. Froom,et al.  Winter depression and functional impairment among ambulatory primary care patients. , 1995, Comprehensive psychiatry.

[40]  J. Arendt,et al.  Phototherapy of seasonal affective disorder. Time of day and suppression of melatonin are not critical for antidepressant effects. , 1986, Archives of general psychiatry.

[41]  P N Prinz,et al.  Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression , 1993, Acta psychiatrica Scandinavica.

[42]  G. Metalsky,et al.  Hopelessness depression: A theory-based subtype of depression. , 1989 .

[43]  M Terman,et al.  Light therapy for seasonal affective disorder. A review of efficacy. , 1989, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[44]  T. Paunio,et al.  Three circadian clock genes Per2, Arntl, and Npas2 contribute to winter depression , 2007, Annals of medicine.

[45]  J. Persons,et al.  Cognitive theories of vulnerability to depression: Reconciling negative evidence , 1992, Cognitive Therapy and Research.

[46]  P. Lewinsohn,et al.  The Pleasant Events Schedule: Studies on Reliability, Validity, and Scale Intercorrelation. , 1982 .

[47]  A. Magnússon An overview of epidemiological studies on seasonal affective disorder , 2000, Acta psychiatrica Scandinavica.

[48]  M. Hébert,et al.  Electrophysiological evidence suggesting a seasonal modulation of retinal sensitivity in subsyndromal winter depression. , 2002, Journal of affective disorders.

[49]  A. Wirz-Justice,et al.  Winter and summer outdoor light exposure in women with and without seasonal affective disorder. , 1999, Journal of affective disorders.

[50]  M. Harrington,et al.  Let there be “more” light: enhancement of light actions on the circadian system through non-photic pathways , 2004, Progress in Neurobiology.

[51]  M. Rollag,et al.  A missense variant (P10L) of the melanopsin (OPN4) gene in seasonal affective disorder. , 2009, Journal of affective disorders.

[52]  R. Bagby,et al.  Negative attributional style in seasonal and nonseasonal depression. , 1998, The American journal of psychiatry.

[53]  Dietmar Winkler,et al.  Enhanced Serotonin Transporter Function during Depression in Seasonal Affective Disorder , 2008, Neuropsychopharmacology.

[54]  Bengt Winblad,et al.  SEASONAL AND CIRCADIAN MONOAMINE VARIATIONS IN HUMAN BRAINS EXAMINED POST MORTEM , 1980, Acta psychiatrica Scandinavica.

[55]  T. Paunio,et al.  Seasonal Affective Disorder and Serotonin-Related Polymorphisms , 2001, Neurobiology of Disease.

[56]  C. Eastman,et al.  The circadian rhythm of temperature during light treatment for winter depression , 1993, Biological Psychiatry.

[57]  D. Goldman,et al.  Role of serotonin transporter promoter repeat length polymorphism (5-HTTLPR) in seasonality and seasonal affective disorder , 1998, Molecular Psychiatry.

[58]  D. Oren,et al.  Effects of season on electro-oculographic ratio in winter seasonal affective disorder , 1995, Psychiatry Research.

[59]  R. Lam,et al.  Seasonal depression: the dual vulnerability hypothesis revisited. , 2001, Journal of affective disorders.

[60]  R. Lam,et al.  A Birth-Season/DRD4 Gene Interaction Predicts Weight Gain and Obesity in Women with Seasonal Affective Disorder: A Seasonal Thrifty Phenotype Hypothesis , 2006, Neuropsychopharmacology.

[61]  R. Lam,et al.  Update on the Biology of Seasonal Affective Disorder , 2005, CNS Spectrums.

[62]  M. Young,et al.  Ruminative Response Style and the Severity of Seasonal Affective Disorder , 2003, Cognitive Therapy and Research.

[63]  D. Goldman,et al.  Association between seasonal affective disorder and the 5-HT2A promoter polymorphism, −1438G/A , 1999, Molecular Psychiatry.

[64]  L. P. Morin,et al.  Retinal ganglion cell projections to the hamster suprachiasmatic nucleus, intergeniculate leaflet, and visual midbrain: Bifurcation and melanopsin immunoreactivity , 2003, The Journal of comparative neurology.

[65]  M. Terman,et al.  Photopic and scotopic light detection in patients with seasonal affective disorder and control subjects , 1999, Biological Psychiatry.

[66]  P. Vacek,et al.  Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment. , 2009, Behavior therapy.

[67]  J. Booker,et al.  Prevalence of seasonal affective disorder in Alaska. , 1992, The American journal of psychiatry.

[68]  A. Beck Depression : clinical, experimental, and theoretical aspects , 1967 .

[69]  J. Emens,et al.  The circadian basis of winter depression. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[70]  T. Paunio,et al.  Circadian Clock-Related Polymorphisms in Seasonal Affective Disorder and their Relevance to Diurnal Preference , 2003, Neuropsychopharmacology.