(SAD), recurrent fall or winter depression characterized by excessive sleeping, social withdrawal, depression, overeating, and pronounced weight gain. SAD effects an estimated 6% of Americans; for reasons not yet understood, 80% of those affected are women. Most children who are affected have a close relative who also has SAD or another psychiatric condition. The disorder particularly affects people who live in the upper latitudes.
Although the mechanism of the disorder is not perfectly understood, it is known to be a reaction to the biological effects of light on the body (see rhythm, biological). Daily, or circadian, rhythms help animals keep track of the seasonal changes in the environment, such as the shortening of days in winter, so that they can make the adaptive changes necessary for their survival in each season. Two substances, the hormone melatonin and the neurotransmitter serotonin, are a part of this process and are being studied for a possible role in SAD. Melatonin is secreted by the pineal gland, which is in turn controlled by an area (the suprachiasmatic nuclei) of the hypothalamus; the hypothalamus, among other things, performs a clocklike function in the body. The eye's retinal nerves are connected to this area. Melatonin is secreted chiefly at night, and its secretion is suppressed by light. Secretion of the neurotransmitter serotonin declines in the winter and may undergo abnormal declines in those with SAD; concentrations of serotonin are increased by bright light. Serotonin is especially active in the hypothalamus. Decreased sensitivity of the retina has also been implicated as a cause of SAD.
Treatment with bright light (about five to twenty times brighter than normal lighting) often alleviates symptoms within a period of days. Unwieldy lighting paraphernalia has given way to smaller, portable light boxes and lighted visors. Doses range from 30 minutes to a few hours per day, often undergone in the morning to simulate the dawn.