Lam R W, Tam E M, Yatham L N, Shiah I S, Zis A P
Division of Mood Disorders, Department of Psychiatry, University of British Columbia Hospital, Vancouver Hospital and Health Sciences Centre, 2255 Wesbrook Mall, BC, Canada V6T 2A1.
J Affect Disord. 2001 Mar;63(1-3):123-32. doi: 10.1016/s0165-0327(00)00196-8.
In DSM-IV, winter seasonal affective disorder (SAD) is classified as a seasonal pattern of recurrent major depressive episodes in winter with full remission of symptoms in summer. However, other groups with "winter depression" have been identified, including patients with incomplete summer remission (ISR) and subsyndromal SAD (sub-SAD, winter depressive symptoms that do not meet criteria for major depression). In this study, we compare the clinical characteristics of these three seasonal groups and their response to light therapy.
558 patients assessed at a specialized SAD Clinic were diagnosed using DSM-III-R or DSM-IV criteria. Clinical information was recorded using a checklist at index assessment. A subset of patients (N=192) were treated with an open, 2 week trial of light therapy using a 10000 lux fluorescent light box for 30 min per day in the early morning. Patients were assessed before and after treatment with the 29 item modified Hamilton Depression Rating Scale and clinical response was defined as greater than 50% improvement in scores.
The rates of some melancholic symptoms, anxiety, panic, suicidal ideation, and family history of mood disorder were lowest in the sub-SAD group. The clinical response rates to light therapy were highest in the sub-SAD group (N=32, 78%), intermediate in the SAD group (N=113, 66%), and lowest in the ISR group (N=47, 51%).
This was a retrospective study of patients seen in a specialty clinic, although information was obtained in a standardized format. The light therapy trial had an open design so that placebo response could not be determined.
There are differences in both the patterns of clinical symptoms and the response to light therapy in these three groups with winter depression. These results are consistent with a dual vulnerability hypothesis that considers these groups to result from interaction of separate factors for seasonality and depression.
在《精神疾病诊断与统计手册》第四版（DSM-IV）中，冬季季节性情感障碍（SAD）被归类为冬季复发性重度抑郁发作的季节性模式，且症状在夏季完全缓解。然而，已识别出其他患有“冬季抑郁症”的群体，包括夏季症状未完全缓解（ISR）的患者和亚综合征性SAD（亚SAD，即不符合重度抑郁症标准的冬季抑郁症状）患者。在本研究中，我们比较了这三个季节性群体的临床特征及其对光疗法的反应。
在一家专门的SAD诊所接受评估的558名患者，根据DSM-III-R或DSM-IV标准进行诊断。在首次评估时使用清单记录临床信息。一部分患者（N = 192）接受了一项开放性的为期2周的光疗法试验，使用10000勒克斯的荧光灯箱，每天清晨照射30分钟。在治疗前后使用29项改良汉密尔顿抑郁量表对患者进行评估，临床反应定义为得分改善超过50%。
亚SAD组中某些抑郁症状、焦虑、惊恐、自杀观念以及情绪障碍家族史的发生率最低。亚SAD组对光疗法的临床反应率最高（N = 32，78%），SAD组居中（N = 113，66%），ISR组最低（N = 47，51%）。
这是一项对专科诊所患者的回顾性研究，尽管信息是以标准化格式获取的。光疗法试验采用开放性设计，因此无法确定安慰剂反应。
这三个患有冬季抑郁症的群体在临床症状模式和对光疗法的反应方面均存在差异。这些结果与双重易感性假说一致，该假说认为这些群体是由季节性和抑郁症的独立因素相互作用导致的。
