Winter Depression: Clinical, Psychosocial and Biochemical Characteristics

Sammanfattning: Seasonal Affective Disorder with depressive episodes during the autumn/winter seasons (winter depression) is common. Outpatients with winter depression were studied regarding temperament, psychopathology, social characteristics, psychosocial functioning and the neuropeptides corticotropin - releasing hormone (CRH) and neuropeptide Y (NPY), which are known to be involved in stress-regulation. The temperamental factors were measured by the Karolinska Scales of Personality and the Marke-Nyman Temperament questionnaire, the psychopathology was assessed by the Comprehensive Psychopathological Rating Scale, the social network by the Interview Schedule for Social interaction, the social adjustment by the Social Adjustment Scale, Self-Rating version and the psychosocial functioning by the Global Assessment of Function scale. The neuropeptides were analyzed by using immunoreactive ligands. Comparisons were made with patients with nonseasonal depression who were inpatients after attempting suicide, healthy controls, and data retrieved from the published literature. Patients with winter SAD displayed a specific, asthenic and hostile temperamental state compared to the healthy controls but less anxiety and hostility than the nonseasonal suicide attempters. SAD patients were found to have a severe, multisymptomatic psychopathology. They had higher ratings than the nonseasonal suicide attempters on the reported psychopathological items while the ratings on the observed items were similar. The social situation and the clinical background of SAD and suicide attempters were similar and both groups had equally weak social networks. SAD patients also displayed significantly lower concentrations of CRH and NPY than those of healthy controls. The CRH and NPY deviations in SAD were not significantly different from those of suicide attempters. It is concluded that patients with SAD have a specific temperamental constitution, a severe, multisymptomatic psychopathology, considerable social impairments and neuropeptide deviations which are similar to those of suicide attempters with non-seasonal major depression. Thus, the results of the studies included in this thesis reveal that SAD-patients are troubled by relatively serious symptoms. These findings oblige us to re-examine the common notion that SAD is a trivial disorder.