Seasonal Affective Disorder and Bipolar

Hello everyone! Happy Hump Day! Today I want to touch on the link between seasonal affective disorder (SAD) and bipolar disorder (BD). I myself have noticed changes in mood and activity with the changing seasons. In the warm summer months I am active and outdoors as much as possible. In the winter I sleep much much more and seldom go outside. My activity levels plummet.

 I found a wonderful article from the National Institute of Health that describes studies between individuals with major depressive disorder seasonal pattern (MDD SP) and those with bipolar disorder seasonal pattern (BD SP). One study found that BD SP patients reported a higher rate of psychiatric hospitalizations than MDD SP patients (28% vs 9.4%).  Manic episodes peaked in early spring, mixed episodes peaked in late summer or fall, and depressive episodes peaked in fall-winter. (This seems to be my pattern) In BD, life events that change social rhythms may disrupt circadian rhythms, triggering mood episodes.

Bright light therapy has been shown to be effective in treating major depressive disorder with seasonal pattern (MDD SP), and initial reports indicate that light also can improve depressive symptoms in bipolar disorder with seasonal pattern (BD SP). In an early case report, a patient with BD SP achieved remission of a depressive episode with a 4-day open trial of 2,000 lux of fluorescent light given daily between 6 and 9 AM and 4 and 7 PM.

Year-round mood-stabilizer treatment is indicated to minimize the risk of mood episodes in BD SP. When treating SAD, mood stabilizers with antidepressant effects—such as lamotrigine or lithium (for maintenance), and quetiapine or aripiprazole (for acute treatment)—are preferable to agents without an antidepressant effect in monotherapy. More-sedating mood stabilizers (such as valproate or carbamazepine) likely would not be as beneficial as less-sedating agents, considering that patients with SAD frequently experience fatigue.

Another article from John Hopkins website noted that some people with seasonal affective disorder can be successfully treated with exposure to bright light. In one study, 57 percent of 191 people with SAD responded to light therapy. In another study, bright-light therapy was comparable in effectiveness to antidepressant therapy but worked faster and caused fewer side effects. And in a major review of 173 published studies, bright-light therapy yielded substantial relief for both SAD and mild to moderate depression that was not linked to seasonal changes.

Bright-light therapy involves sitting in front of a bank of full-spectrum fluorescent lights for 30 to 60 minutes each day. Improvement in symptoms can often be seen within a few days, with symptoms disappearing after two to three weeks. Continued light therapy is needed to prevent a relapse.
 
They note that light therapy should be used only with your doctor's guidance, as it can cause side effects when used improperly. For instance, light therapy may trigger manic symptoms in people who have bipolar disorder. But a small study in the journal Bipolar Disorders found that bright-light therapy can ease symptoms of depression in some patients with bipolar disorder.

You can buy a light box over the counter, or your doctor may recommend a specific light box. Most health insurance plans do not cover the cost. Light boxes, available from stores and Internet retailers, come in different shapes and sizes and have varied features. They also produce different types and intensities of light. Light boxes are designed to be safe and effective, but they aren't approved or regulated by the Food and Drug Administration (FDA).

Personally, I used to go tan in the winter months while in college and that helped my mood greatly. Practically my entire dorm floor of girls would go at once. In fact, my bipolar symptoms didn't peak until years after I graduted from college. Maybe my tanning tamed my symptoms. I think I will look into tanning packages in town. :)  I always found it relaxing. Listening to music while soaking in some rays is a favorite pastime in the summer months.


I hope this blog was informative and helpful. Live everyday like it's your last.