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Seasonal Influences on Human Seasonal Influences on Human Physical and Mental PerformancePhysical and Mental Performance

Glenn BookerGlenn Booker

BMES 531BMES 531

June 7, 2007June 7, 2007

BMES 531BMES 531 Glenn BookerGlenn Booker 22

SAD DefinitionSAD Definition

Seasonal Affective Disorder (SAD) is Seasonal Affective Disorder (SAD) is a recurrent major depression which a recurrent major depression which generally results in lethargy and generally results in lethargy and depression symptoms during the depression symptoms during the Fall and Winter seasons Fall and Winter seasons – Measure with Global Seasonality Score (GSS) Measure with Global Seasonality Score (GSS)

from the Seasonal Pattern Assessment from the Seasonal Pattern Assessment Questionnaire (SPAQ). Questionnaire (SPAQ). (Rosenthal, 1987)(Rosenthal, 1987)

– Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Disorders, 4th edition (DSM-IV) (APA, 2000)(APA, 2000)


SAD DefinitionSAD Definition

– Structured Interview Guide for the Hamilton Structured Interview Guide for the Hamilton Depression Rating Scale: Seasonal Affective Depression Rating Scale: Seasonal Affective Disorder Version (SIGH-SAD) Disorder Version (SIGH-SAD) (Williams, 1988)(Williams, 1988)

– WHO “ICD-10 Classification of Mental and WHO “ICD-10 Classification of Mental and Behavioral Disorders” Behavioral Disorders” (WHO, 1992)(WHO, 1992)

SAD epidemiology favors age (young), SAD epidemiology favors age (young), gender (female), and latitude (far from gender (female), and latitude (far from equator), but not race or ethnicity equator), but not race or ethnicity (Sher, (Sher,

2001; Boehnert, 2003; Magnusson, 2000; Eagles, 20032001; Boehnert, 2003; Magnusson, 2000; Eagles, 2003 ))


SAD MechanismsSAD Mechanisms

Phase Shift Hypothesis Phase Shift Hypothesis (Lewy, 1989)(Lewy, 1989) – Phase delay in bodyPhase delay in body

Melatonin Dysregulation Melatonin Dysregulation (Malhotra, 2004; Arnedt, 2003; (Malhotra, 2004; Arnedt, 2003; Lam, 2000; Wehr, 2001)Lam, 2000; Wehr, 2001)

– Secretion is longer than normal in winterSecretion is longer than normal in winter

Serotonin Deficiency Serotonin Deficiency (Sher, 2001)(Sher, 2001) – L-tryptophan is a precursor of serotonin L-tryptophan is a precursor of serotonin

Genetic Abnormalities Genetic Abnormalities (Sher, 2004; Ebisawa, 2007)(Sher, 2004; Ebisawa, 2007) – Based on epidemiology studies; serotonin transporter Based on epidemiology studies; serotonin transporter

or clock gene defectsor clock gene defects


ComorbidityComorbidity

SAD also frequently found with SAD also frequently found with – Bulimia nervosa Bulimia nervosa (Levitan, 2004; Eagles, 2003)(Levitan, 2004; Eagles, 2003) – Premenstrual dysphoric disorder Premenstrual dysphoric disorder (Portella, 2006)(Portella, 2006) – Alcoholism Alcoholism (Sher, 2004) (Sher, 2004)

– Increased odor sensitivity Increased odor sensitivity (Postolache, 2002)(Postolache, 2002)

No diurnal preference (morningness vs No diurnal preference (morningness vs eveningness) eveningness) (Natale, 2005; Bernert, 2005)(Natale, 2005; Bernert, 2005)


SAD TreatmentSAD Treatment

Light therapy Light therapy (Wirz-Justice, 2005; Golden, 2005)(Wirz-Justice, 2005; Golden, 2005) – 2500 to 10,000 lux white light for 15-30 min2500 to 10,000 lux white light for 15-30 min– Wake therapy? Controlled sleep deprivation Wake therapy? Controlled sleep deprivation

SSRIs (Prozac, Zoloft) do as well as light SSRIs (Prozac, Zoloft) do as well as light (Blumberger, 2005)(Blumberger, 2005)

Dawn Simulators or Negative Ions Dawn Simulators or Negative Ions (Terman, (Terman,

2006)2006)


Reduce SAD SymptomsReduce SAD Symptoms

Vitamin D improves mood Vitamin D improves mood (Vieth, 2004)(Vieth, 2004)

Self-esteem and social support reduce Self-esteem and social support reduce symptoms’ severity symptoms’ severity (McCarthy, 2002)(McCarthy, 2002)

Good weather and being outside Good weather and being outside (Keller, (Keller,

2004)2004) – Measured time spent outdoors, outside Measured time spent outdoors, outside

temperature, and barometric pressuretemperature, and barometric pressure


Distill InformationDistill Information

Take all the previous information, and Take all the previous information, and turn it into two checkliststurn it into two checklists– One for background information which isn’t One for background information which isn’t

likely to change often; call it the Personal likely to change often; call it the Personal History FormHistory Form

– One for information which may change One for information which may change frequently (location, weather, etc.) and frequently (location, weather, etc.) and call it the Recent Habits Surveycall it the Recent Habits Survey


Personal History Form Personal History Form

What is your gender?What is your gender?

What is your What is your birthday?birthday?– Calculate ageCalculate age

Have you reached Have you reached puberty yet? If you puberty yet? If you don’t know, say no.don’t know, say no.

Have you completed Have you completed menopause?menopause?

Have you ever been Have you ever been diagnosed with diagnosed with Seasonal Affective Seasonal Affective Disorder (SAD)? Disorder (SAD)?

Have you ever been Have you ever been diagnosed with diagnosed with bulimia?bulimia?


Personal History FormPersonal History Form

Have you ever been Have you ever been diagnosed with diagnosed with premenstrual premenstrual dysphoric disorder dysphoric disorder (severe PMS)?(severe PMS)?Have you ever been Have you ever been diagnosed as an diagnosed as an alcoholic?alcoholic?Are you more Are you more sensitive to odors sensitive to odors than others? than others?

Do you have a twin?Do you have a twin?If yes, do they have If yes, do they have SAD?SAD?Does anyone in your Does anyone in your immediate family immediate family (other than your twin, (other than your twin, if you have one) have if you have one) have seasonal affective seasonal affective disorder?disorder?


Recent Habits Survey Recent Habits Survey

What is your location?What is your location?– Use to get latitude, Use to get latitude,

altitude, and weatheraltitude, and weather

What is today’s date?What is today’s date?– Or get automaticallyOr get automatically

What vitamin What vitamin supplements are you supplements are you taking?taking?

Do you feel good Do you feel good about yourself today? about yourself today?

Do you have friends Do you have friends you can talk to easily? you can talk to easily?

How much time per How much time per day have you spent day have you spent outdoors during the outdoors during the daytime?daytime?


AnalysisAnalysis

From the Personal History Form and From the Personal History Form and Recent Habits Survey, calculate risk Recent Habits Survey, calculate risk values from each answervalues from each answer– Typically, “yes” means a risk value of 1, Typically, “yes” means a risk value of 1,

and “no” means a risk value of 0and “no” means a risk value of 0– Add up the risk values for each formAdd up the risk values for each form– Possible range for the Personal History Form Possible range for the Personal History Form

is -1 to +8 ½, whereas for the Recent Habits is -1 to +8 ½, whereas for the Recent Habits Survey the possible range is -2 to +4 Survey the possible range is -2 to +4


ConclusionConclusion

The total risk value for the Personal The total risk value for the Personal History Form and Recent Habits Survey History Form and Recent Habits Survey help quantify the risk of having SAD, and help quantify the risk of having SAD, and the likely severity of symptoms if it occursthe likely severity of symptoms if it occurs

Can also help identify client actions to Can also help identify client actions to reduce symptoms, and point to effective reduce symptoms, and point to effective treatmentstreatments


ReferencesReferences

(APA, 2000) American Psychiatric Association. (2000) Diagnostic (APA, 2000) American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IVTR). Washington, DC: American Psychiatric Press.(DSM-IVTR). Washington, DC: American Psychiatric Press.(Arendt, 2003) J. Arendt (2003) Importance and Relevance of (Arendt, 2003) J. Arendt (2003) Importance and Relevance of Melatonin to Human Biological Rhythms. Melatonin to Human Biological Rhythms. Journal of Journal of Neuroendocrinology, Vol. 15Neuroendocrinology, Vol. 15, 427–431., 427–431.(Barinaga, 2002) Marcia Barinaga (8 Feb 2002) Circadian Clock: (Barinaga, 2002) Marcia Barinaga (8 Feb 2002) Circadian Clock: How the Brain's Clock Gets Daily Enlightenment. How the Brain's Clock Gets Daily Enlightenment. Science Vol. 295Science Vol. 295. . no. 5557, pp. 955–957.no. 5557, pp. 955–957.(Bernert, 2005) Rebecca A. Bernert (2005) A Circadian (Bernert, 2005) Rebecca A. Bernert (2005) A Circadian Vulnerability For Depression: Eveningness And Sleep Variability. Vulnerability For Depression: Eveningness And Sleep Variability. Master’s thesis for Florida State University. Master’s thesis for Florida State University. (Bhatia, 2007) Subhash C. Bhatia, Shashi K. Bhatia. (Bhatia, 2007) Subhash C. Bhatia, Shashi K. Bhatia. Diagnosis and Diagnosis and Treatment of Premenstrual Dysphoric Disorder. Downloaded on Treatment of Premenstrual Dysphoric Disorder. Downloaded on 6/5/2007 from 6/5/2007 from http://www.aafp.org/afp/20021001/1239.htmlhttp://www.aafp.org/afp/20021001/1239.html. .



(Bierman, 2005) Andrew Bierman, Terence R Klein and Mark S (Bierman, 2005) Andrew Bierman, Terence R Klein and Mark S Rea (2005) The Daysimeter: a device for measuring optical Rea (2005) The Daysimeter: a device for measuring optical radiation as a stimulus for the human circadian system. radiation as a stimulus for the human circadian system. Meas. Sci. Meas. Sci. Technol. (16)Technol. (16) 2292–2299. 2292–2299.(Blumberger, 2005) Daniel M. Blumberger, M.D., and Anthony J. (Blumberger, 2005) Daniel M. Blumberger, M.D., and Anthony J. Levitt (Oct 2005) The Light-er Side of Treating Seasonal Affective Levitt (Oct 2005) The Light-er Side of Treating Seasonal Affective Disorder. Disorder. Psychiatric Times Vol. 22Psychiatric Times Vol. 22 Issue 11. Issue 11.(Boehnert, 2003) Caryl E. Boehnert, Robert A. Alberts (Jan 2003) (Boehnert, 2003) Caryl E. Boehnert, Robert A. Alberts (Jan 2003) Seasonal Affective Disorder in Women How to identify and treat. Seasonal Affective Disorder in Women How to identify and treat. Women’s Health in Primary Care. Vol. 6Women’s Health in Primary Care. Vol. 6, No. 1., No. 1.(Eagles, 2003) John M. Eagles (2003) Seasonal affective disorder. (Eagles, 2003) John M. Eagles (2003) Seasonal affective disorder. British Journal of Psychiatry 182British Journal of Psychiatry 182, 174-176., 174-176.(Ebisawa, 2007) Takashi Ebisawa (2007) Circadian Rhythms in the (Ebisawa, 2007) Takashi Ebisawa (2007) Circadian Rhythms in the CNS and Peripheral Clock Disorders: Human Sleep Disorders and CNS and Peripheral Clock Disorders: Human Sleep Disorders and Clock Genes. Clock Genes. JJ Pharmacol Sci 103Pharmacol Sci 103, 150 – 154., 150 – 154.



(Golden, 2005) Robert N. Golden, Bradley N. Gaynes, R. David (Golden, 2005) Robert N. Golden, Bradley N. Gaynes, R. David Ekstrom, Robert M. Hamer, Frederick M. Jacobsen, Trisha Suppes, Ekstrom, Robert M. Hamer, Frederick M. Jacobsen, Trisha Suppes, Katherine L. Wisner, Charles B. Nemeroff, (2005) The Efficacy of Katherine L. Wisner, Charles B. Nemeroff, (2005) The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence. Meta-Analysis of the Evidence. Am J Psychiatry; 162Am J Psychiatry; 162, 656–662., 656–662.(Horne, 1976) Horne, J.A., & Östberg, O. (1976). (Horne, 1976) Horne, J.A., & Östberg, O. (1976). A self-A self-assessment questionnaire to determine morningness-eveningness. assessment questionnaire to determine morningness-eveningness. International Journal of Chronobiology, 4International Journal of Chronobiology, 4, 97-110., 97-110.(Keller, 2004) Matthew C. Keller, Barbara L. Fredrickson, Oscar (Keller, 2004) Matthew C. Keller, Barbara L. Fredrickson, Oscar Ybarra, Stephane Cote, Kareem Johnson, Joe Mikels, Anne Ybarra, Stephane Cote, Kareem Johnson, Joe Mikels, Anne Conway, Tor Wager (2004) A Warm Heart and a Clear Head The Conway, Tor Wager (2004) A Warm Heart and a Clear Head The Contingent Effects of Weather on Mood and Cognition. Contingent Effects of Weather on Mood and Cognition. Psychological Science (16)Psychological Science (16) 9, 724-731. 9, 724-731.(Lam, 2000) Raymond W. Lam, Robert D. Levitan (2000) (Lam, 2000) Raymond W. Lam, Robert D. Levitan (2000) Pathophysiology of seasonal affective disorder: a review. Pathophysiology of seasonal affective disorder: a review. J J Psychiatry Neurosci 25Psychiatry Neurosci 25(5) 469-80.(5) 469-80.


ReferencesReferences(Levitan, 2004) Robert D. Levitan, Mario Masellis, Vincenzo S. Basile, (Levitan, 2004) Robert D. Levitan, Mario Masellis, Vincenzo S. Basile, Raymond W. Lam, Allan S. Kaplan, Caroline Davis, Pierandrea Muglia, Raymond W. Lam, Allan S. Kaplan, Caroline Davis, Pierandrea Muglia, Bronwyn Mackenzie, Subi Tharmalingam, Sidney H. Kennedy, Fabio Bronwyn Mackenzie, Subi Tharmalingam, Sidney H. Kennedy, Fabio Macciardi, James L. Kennedy (2004) The Dopamine-4 Receptor Gene Macciardi, James L. Kennedy (2004) The Dopamine-4 Receptor Gene Associated with Binge Eating and Weight Gain in Women with Seasonal Associated with Binge Eating and Weight Gain in Women with Seasonal Affective Disorder: An Evolutionary Perspective. Affective Disorder: An Evolutionary Perspective. Biol Psychiatry 56Biol Psychiatry 56:665–:665–669.669.(Lewy, 1989) Lewy, A.J., Sack, R.L., Singer, C.M., White, D.M., Hoban, (Lewy, 1989) Lewy, A.J., Sack, R.L., Singer, C.M., White, D.M., Hoban, T.M., 1989. Winter depression and the phase-shift hypothesis for bright T.M., 1989. Winter depression and the phase-shift hypothesis for bright light’s therapeutic effects: history theory and experimental evidence. In: light’s therapeutic effects: history theory and experimental evidence. In: Rosenthal, N.E., Blehar, M.C. (Eds.), Seasonal Affective Disorders and Rosenthal, N.E., Blehar, M.C. (Eds.), Seasonal Affective Disorders and phototherapy. Guilford Press, New York, pp. 295–310.phototherapy. Guilford Press, New York, pp. 295–310.(Lewy, 2006) Alfred J. Lewy, Bryan J. Lefler, Jonathan S. Emens, and (Lewy, 2006) Alfred J. Lewy, Bryan J. Lefler, Jonathan S. Emens, and Vance K. Bauer.(2006) The circadian basis of winter depression. Vance K. Bauer.(2006) The circadian basis of winter depression. PNAS; PNAS; 103103; 7414-7419.; 7414-7419.(Magnusson, 2000) Magnusson A. (2000) An overview of epidemiological (Magnusson, 2000) Magnusson A. (2000) An overview of epidemiological studies on seasonal affective disorder. studies on seasonal affective disorder. Acta Psychiatr Scand 101Acta Psychiatr Scand 101: 176-184. : 176-184.



(Malhotra, 2004) Samir Malhotra, Girish Sawhney, Promila Pandhi (Malhotra, 2004) Samir Malhotra, Girish Sawhney, Promila Pandhi (2004) The Therapeutic Potential of Melatonin: A Review of the (2004) The Therapeutic Potential of Melatonin: A Review of the Science. Science. MedGenMed. 6MedGenMed. 6 (2): 46. (2): 46.(McCarthy, 2002) E. McCarthy, N. Tarrier, L. Gregg (2002) The (McCarthy, 2002) E. McCarthy, N. Tarrier, L. Gregg (2002) The nature and timing of seasonal affective symptoms and the influence nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: a longitudinal prospective study. of self-esteem and social support: a longitudinal prospective study. Psychological Medicine, 32Psychological Medicine, 32, 1425–1434. , 1425–1434. (Murray, 2006) Greg Murray, Erin E. Michalak, Anthony J. Levitt, (Murray, 2006) Greg Murray, Erin E. Michalak, Anthony J. Levitt, Robert D. Levitan, Murray W. Enns, Rachel Morehouse, Raymond Robert D. Levitan, Murray W. Enns, Rachel Morehouse, Raymond W. Lam. (2006) O sweet spot where art thou? Light treatment of W. Lam. (2006) O sweet spot where art thou? Light treatment of Seasonal Affective Disorder and the circadian time of sleep. Seasonal Affective Disorder and the circadian time of sleep. Journal of Affective Disorders (90)Journal of Affective Disorders (90) 227– 231. 227– 231.(Natale, 2005) Vincenzo Natale, Ana Adan, Paolo Scapellato (Natale, 2005) Vincenzo Natale, Ana Adan, Paolo Scapellato (2005) Are seasonality of mood and eveningness closely (2005) Are seasonality of mood and eveningness closely associated? associated? Psychiatry Research (136)Psychiatry Research (136) 51– 60. 51– 60.


ReferencesReferences(NINDS, 2007) National Institute of Neurological Disorders and Stroke, (NINDS, 2007) National Institute of Neurological Disorders and Stroke, NINDS Hypersomnia Information Page, downloaded on 6/3/2007 from NINDS Hypersomnia Information Page, downloaded on 6/3/2007 from http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htmhttp://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm. . (Portella, 2006) Portella, Amy T. Nguyen; Haaga, David A. F.; Rohan, Kelly (Portella, 2006) Portella, Amy T. Nguyen; Haaga, David A. F.; Rohan, Kelly J. (Nov 2006) The Association Between Seasonal and Premenstrual J. (Nov 2006) The Association Between Seasonal and Premenstrual Symptoms Is Continuous and Is Not Fully Accounted for by Depressive Symptoms Is Continuous and Is Not Fully Accounted for by Depressive Symptoms. Symptoms. Journal of Nervous & Mental Disease. 194Journal of Nervous & Mental Disease. 194 (11) 833-837. (11) 833-837.(Postolache, 2002) Postolache, TT, Wehr, TA, Doty, RL, Sher, L, Turner, (Postolache, 2002) Postolache, TT, Wehr, TA, Doty, RL, Sher, L, Turner, EH, Bartko, JJ, Rosenthal, NE. (2002) Patients with Seasonal Affective EH, Bartko, JJ, Rosenthal, NE. (2002) Patients with Seasonal Affective Disorder have Lower Odor Detection Thresholds than Control Subjects. Disorder have Lower Odor Detection Thresholds than Control Subjects. Arch Gen Psychiatry (59)Arch Gen Psychiatry (59) 1119-1122. 1119-1122.(Rosenthal, 1984) Rosenthal, N.E., Sack, D.A., Gillin, C., Lewy, A.J., (Rosenthal, 1984) Rosenthal, N.E., Sack, D.A., Gillin, C., Lewy, A.J., Goodwin, F.K., Davenport, Y., Mueller, P.S., Newsome, D.A., Wehr, T.A., Goodwin, F.K., Davenport, Y., Mueller, P.S., Newsome, D.A., Wehr, T.A., 1984. Seasonal Affective Disorder: a description of the syndrome and 1984. Seasonal Affective Disorder: a description of the syndrome and preliminary findings with light therapy. preliminary findings with light therapy. Arch. Gen. Psychiatry 41Arch. Gen. Psychiatry 41, , 72–80.72–80.(Rosenthal, 1987) Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern (Rosenthal, 1987) Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern Assessment Questionnaire. Washington, DC: National Institute of Mental Assessment Questionnaire. Washington, DC: National Institute of Mental Health; 1987.Health; 1987.



(Sher, 2001) Leo Sher (2001) Genetic Studies of Seasonal (Sher, 2001) Leo Sher (2001) Genetic Studies of Seasonal Affective Disorder and Seasonality. Affective Disorder and Seasonality. Comprehensive Psychiatry, Comprehensive Psychiatry, Vol. 42Vol. 42, No. 2 (March/ April): pp 105-110., No. 2 (March/ April): pp 105-110.(Sher, 2004) Leo Sher (Jan/Feb 2004) Alcoholism and Seasonal (Sher, 2004) Leo Sher (Jan/Feb 2004) Alcoholism and Seasonal Affective Disorder. Affective Disorder. Comprehensive Psychiatry, Vol. 45Comprehensive Psychiatry, Vol. 45, No. 1: pp , No. 1: pp 51-56.51-56.(Terman, 2006) Michael Terman, Jiuan Su Terman (Dec 2006) (Terman, 2006) Michael Terman, Jiuan Su Terman (Dec 2006) Controlled Trial of Naturalistic Dawn Simulation and Negative Air Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder. Ionization for Seasonal Affective Disorder. Am J Psychiatry Am J Psychiatry 163163:2126-2133.:2126-2133.(Tsuno, 2005) Tsuno, N, Besset, A, Ritchie, K (2005) Sleep and (Tsuno, 2005) Tsuno, N, Besset, A, Ritchie, K (2005) Sleep and Depression. Depression. J Clin Psychiatry (66)J Clin Psychiatry (66) 1254-1269. 1254-1269.(Vieth, 2004) Reinhold Vieth, Samantha Kimball, Amanda Hu, Paul (Vieth, 2004) Reinhold Vieth, Samantha Kimball, Amanda Hu, Paul G Walfish (2004) Randomized comparison of the effects of the G Walfish (2004) Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. biochemical responses and the wellbeing of patients. Nutrition Nutrition Journal, 3Journal, 3:8.:8.


ReferencesReferences(Wehr, 2001) Wehr, TA, Duncan, WC Jr, Sher, L, Aeschbach, D, Schwartz, (Wehr, 2001) Wehr, TA, Duncan, WC Jr, Sher, L, Aeschbach, D, Schwartz, PJ, Turner, EH, Postolache, TT, Rosenthal, NE (2001) A Circadian Signal of PJ, Turner, EH, Postolache, TT, Rosenthal, NE (2001) A Circadian Signal of Change of Season in Patients with Seasonal Affective Disorder. Change of Season in Patients with Seasonal Affective Disorder. Arch Gen Arch Gen Psychiatry. (58)Psychiatry. (58) 1108-1114. 1108-1114.(WHO, 1992) World Health Organization. (1992) The ICD-10 Classification (WHO, 1992) World Health Organization. (1992) The ICD-10 Classification of Mental and Behavioral Disorders. Diagnostic Criteria for Research. of Mental and Behavioral Disorders. Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization.Geneva, Switzerland: World Health Organization.(Williams, 1988) Williams, J. B. W., Link, M. J., Rosenthal, N. E. & Terman, (Williams, 1988) Williams, J. B. W., Link, M. J., Rosenthal, N. E. & Terman, M. (1988) Structured Interview Guide for the Hamilton Depression Rating M. (1988) Structured Interview Guide for the Hamilton Depression Rating Scale: Seasonal Affective Disorder Version (SIGH-SAD) (New York State Scale: Seasonal Affective Disorder Version (SIGH-SAD) (New York State Psychiatric Institute, New York).Psychiatric Institute, New York).(Winkler, 2005) D. Winkler, S. Kasper. (Winkler, 2005) D. Winkler, S. Kasper. (2005) Seasonal affective disorder: (2005) Seasonal affective disorder: from diagnosis to treatment. from diagnosis to treatment. Medicographia, Vol 27Medicographia, Vol 27, No. 3. , No. 3. (Wirz-Justice, 2005) Anna Wirz-Justice, Francesco Benedetti, Mathias (Wirz-Justice, 2005) Anna Wirz-Justice, Francesco Benedetti, Mathias Berger, Raymond W. Lam, Klaus Martiny, Michael Terman, Joseph C. Wu Berger, Raymond W. Lam, Klaus Martiny, Michael Terman, Joseph C. Wu (2005) Chronotherapeutics (light and wake therapy) in affective disorders. (2005) Chronotherapeutics (light and wake therapy) in affective disorders. Psychological Medicine, 35,Psychological Medicine, 35, 939–944. 939–944.

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