• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
 Page 1 of 29
TITLE: Phototherapy for the Treatment of Seasonal Affective Disorder (SAD)AUTHOR: Mitchell D. Feldman, MD, M.Phil.Professor of MedicineDivision of General Internal MedicineDepartment of MedicineUniversity of CA, San FranciscoPUBLISHER NAME: California Technology Assessment ForumDATE OF PUBLICATION: June 11, 2003PLACE OF PUBLICATION: San Francisco, CA
 
 Page 2 of 29
PHOTOTHERAPY FOR THE TREATMENT OFSEASONAL AFFECTIVE DISORDER
“In the dark time of the year the soul’s sap quivers” 
TS Eliot
INTRODUCTION
The California Assessment Technology Forum has received requests toreview the published data regarding the efficacy and safety of phototherapy for treatment of seasonal affective disorder (SAD).
BACKGROUND
Depression is common, disabling and often unrecognized or inadequatelytreated in general medical practice. Epidemiological studies demonstrate alifetime prevalence of major depression in 7-12% of men and 20-35% of women. The point prevalence of major depression in a community sampleis 2.3-3.2% for men and 4.5-9.3% in women. Numerous studies report a 5-10% prevalence of major depression in primary care settings with asubstantially higher rate (20-40%) in patients with co-existing medicalproblems (Cole et al 2003). It is clear that depression has a significantadverse impact on patient’s functioning and well-being. In addition, thesocietal cost of depression—including cost of impaired job performance,direct cost of medical, psychiatric, and pharmacological care, and coststemming from depression related suicide—has been estimated at morethan $43 billion in the United States (Feldman 2000).The most severe form of depression, major depression, is associated withconsiderable disability, morbidity and mortality. In fact, it is associatedwith as much, and often more, physical and social disability as otherchronic illnesses such as diabetes, coronary artery disease and arthritis.Major depression represents a heterogeneous group of disorders, mostprobably arising from a host of etiological determinants. Because no clearanatomic, biochemical or physiological lesions have been found to explainmajor depression, most investigators agree that it is a complexpsychobiological syndrome that can be diagnosed only on clinical,syndromal criteria. Some promising studies, however, suggest etiologicalpossibilities as well as therapeutic interventions.
 
 Page 3 of 29
BACKGROUND
, continuedFor example, it is increasingly recognized that both genetic makeup andfamily experiences contribute to an individual’s vulnerability todeveloping major depression. In addition, numerous biological markers of depression have been identified. These biological markers (e.g. cortisol,norepinephrine and serotonin) can reliably differentiate groups with andwithout major depression, but no marker is specific enough to be useddiagnostically (Cole et al 2003).The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition, 1994) criteria are listed below. Five of nine symptomsmust be present most of the day nearly every day for at least a two week period; one of these symptoms must be a either a depressed mood orpervasive anhedonia (loss of interest or pleasure in usual activities).DSM-IV Criteria for Major DepressionFive or more of the following symptoms—one of which must bedepressed mood or anhedonia—must be present for at least two weeks.1.
 
Depressed mood2.
 
Anhedonia (loss of pleasure in usual activities)3.
 
Feelings of worthlessness or inappropriate guilt4.
 
Inability to concentrate5.
 
Fatigue or loss of energy6.
 
Sleep disorder (insomnia or hypersomnia)7.
 
Psychomotor retardation of agitation8.
 
Significant weight loss or gain9.
 
Recurrent thoughts of death or suicideDepression is often a chronic problem with remissions and recurrence overthe patient’s lifetime. About one-third of patients with a single episode of major depression will have another episode within one year of discontinuing treatment and more than half will have another episode intheir lifetime. Patients with 3 or more episodes have a 90% risk of recurrence (Whooley and Simon 2000). Other mood disorders includechronic depression or dysthymia, minor depression, adjustment disorderwith depressed mood, mood disorders due to a general medical conditionand bipolar disorder. Other mental disorders often present with symptomssimilar to depression and may, therefore, lead to misdiagnosis. In addition,depression often presents in combination with other mental disorders.
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...