Manic Depression and Seasonal Affective Disorder (SAD)

Bipolar (manic depression) is a psychological mood disorder characterized by difficulty in regulating emotions. Those with the disorder often swing between an abnormally elevated, manic mood and the depths of depression. The winter months provide an additional challenge to those trying to maintain a stable mood-seasonal affective disorder, also known as SAD.

What Is Seasonal Affective Disorder?

Seasonal affective disorder is a form of depression that cycles annually, with symptoms becoming more pronounced in the winter months. In those who fall victim to SAD, decreased day length appears to affect the activity of serotonin, a neurotransmitter known to influence mood, appetite, sleep and metabolism. Recent research also suggests the rods and cones in the retina of those who suffer from SAD are less sensitive to light than in patients who do not have the disorder. Seasonal affective disorder can be a problem both for those with unipolar depression and or bipolar patients.

Special Risks of SAD in Bipolar Patients

People who have bipolar disorder walk an emotional tightrope in the management of their illness. Pharmaceuticals, such as mood regulators and antidepressants are often used to help prevent the moods swings from becoming too extreme.

Psychiatrists commonly make seasonal adjustments to the medications that their bipolar patients are taking. In patients using both mood regulating drugs (like atypical antipsychotics or anticonvulsants) and antidepressants to manage symptoms, psychiatrists may recommend a reduction in the amount of antidepressants taken in the spring and summer, since the months with more light seem to foster a mood trending towards mania. Then, in the fall and winter, antidepressants may be increased to prevent a plunge into depression.

Bright-light therapy is considered to be the gold standard in effective treatment for reducing symptoms of SAD, and antidepressant medication is also commonly prescribed. However, those with bipolar depression need to be cautious in using additional mood elevating treatments, as these treatments may make the pendulum swing too far in the opposite direction, towards mania.

Tips for Those with Bipolar and Seasonal Depression

See Your Psychiatrist: The first, and most important, suggestion for bipolar patients is to always stay in close communication with your mental healthcare provider. Keep all appointments and let your psychiatrist know if you are experiencing problems regulating your mood between visits.

Stay On Your Meds: At the recommended dosage and intervals, take all medications that are being prescribed to regulate your mood. Never stop medication cold turkey or make dosage changes without discussing this decision first with your psychiatrist.

Watch for Seasonal Fluctuations in Depression: Be aware that problems with your depression may become worse in fall and winter, and be vigilant for symptoms of depression emerging seasonally.

Watch for Seasonal Fluctuations in Mania: Be aware that problems with mania may become worse in the spring and summer, and be vigilant for symptoms of mania emerging seasonally.

Light Therapy May Bring on Manic Symptoms: If you are prescribed additional antidepressants and / or light therapy to treat SAD, contact your psychiatrist if these therapies seem to be launching you into a hypomanic or manic state.

Light Therapy May be Incompatible with Some Medications: Make sure that all of your health care providers are aware of all medications that you are taking. This is especially important if you are using bright-light therapy, as some medications react with light.

Sources

Krauss S.; Depue R.; Arbisi P.; Spoont M. (1992) "Behavioral engagement level, variability, and diurnal rhythm as a function of bright light in bipolar II seasonal affective disorder: an exploratory study." Psychiatry Res, Vol.43, Iss.2; p.147-60.

Lavoie M.; Lam R.; Bouchard G.; Sasseville A.; Charron M.; Gagné A.; Tremblay P. ;Filteau M.; Hébert M. (2009) "Evidence of a biological effect of light therapy on the retina of patients with seasonal affective disorder."
Biol Psychiatry,Vol.66, Iss.3; p.253-8.

Partonen T. & Lonnqvist J. (1998) "Seasonal affective disorder.(Seminar)." The Lancet, p1369(1).

Sohn C. ;Lam R. (2004) "Treatment of seasonal affective disorder: unipolar versus bipolar differences." Curr Psychiatry Rep, Vol.6, Iss.6; p.478-85.

Thompson, C. (1990) "Seasonal affective disorder and season-dependent abnormalities of melatonin suppression by light." The Lancet ,Vol.336, Iss.8717; p.703(4).