The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 1, 1992
Seasonal Affective Disorder (SAD) with Non-24-Hour Sleep-Wake Rhythm during Depressive Phase
N o antidepressant proved to be effective. W e applied phototherapy2 in the morning for him to treat his autumn-winter depressive episode. Furthermore, we checked the total time of sunshine in a day (length of the photoperiod) from 1987 to 1991. W e then administered bright light (2,500 lux) on spontaneous awakening for 2 hours, and also alternatively at 6:OO for 2 hours. Both effectively treated his depressive symptoms. But his non-24-hour sleep-wake rhythm had only improved by the former. T h e rectal temperature rhythm was advanced by the phototherapy, and his depressive symptoms and non-24-hour sleep-wake rhythm have improved in proportion to the advancement of the rectal temperature rhythm. It seemed to be clear that the phototherapy caused the improvement in his depressive symptoms and the stabilization of his sleepwake via the advancement of the rectal temperature. Depressive episodes often returned after the photoperiod had been reduced. The effect of phototherapy may therefore depend o n the photoperiod in a day. His non-24-hour
Hikari Mizuma, Tatayu Kotorii and Yoichi Nakazawa Department of Neuropsychiatry, Kurume University School of Medicine, Kurume
We report a case of a 21-year-old male, who originally was of the “morning type” (the time of going to bed and of awakening was early). He had had a current history of depression for 5 years with a depressive phase beginning in autumn, and another during the rainy season. T h e symptoms in the depressive phase were characterized by social withdrawal, inability to study, carbohydrate craving, and daytime hypersomnia. The case corresponded with the Rosenthal’ and DSM-111-R criteria for a seasonal affective disorder (SAD). Of interest was that he showed a non-24-hour sleep-wake rhythm during his depressive phase. 09
215
12
00
12
QO
Aup.
sap.
Oct.
NOV.
Doc.
1091
Jan
Fob.
Fig. 1: Doubleplotted sleep-wake rhythm. Mesh on the left side shows the depressive phase and its intensity,
216
Proceeds. 6 Clin. Chronobiol.
sleep-wake rhythm appeared secondarily after falling into a depressive state. Because of his social withdrawal, he demonstrated a freerunning rhythm as if he lived in temporal isolation, perhaps due to a possible disorder in the entrainment mechanisms or t o an insensitivity to social Zeitgebers.
References
I . Rosenthal, N.E., Sack, D.A., Gillin, J.C. et d.: Seasonal affective disorder. Arch Gen Psychiat 41: 72-80, 1984. 2. L ~ A.J., ~ K ~ ~ H.A., , ~ R ~ ,~ ~N,E.~ et al.: Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. A m J Psychiat 139: 14961498, 1982.
~
~
Seasonal Affective Disorder (SAD) with Non-24-Hour Sleep-Wake Rhythm during Depressive Phase
N o antidepressant proved to be effective. W e applied phototherapy2 in the morning for him to treat his autumn-winter depressive episode. Furthermore, we checked the total time of sunshine in a day (length of the photoperiod) from 1987 to 1991. W e then administered bright light (2,500 lux) on spontaneous awakening for 2 hours, and also alternatively at 6:OO for 2 hours. Both effectively treated his depressive symptoms. But his non-24-hour sleep-wake rhythm had only improved by the former. T h e rectal temperature rhythm was advanced by the phototherapy, and his depressive symptoms and non-24-hour sleep-wake rhythm have improved in proportion to the advancement of the rectal temperature rhythm. It seemed to be clear that the phototherapy caused the improvement in his depressive symptoms and the stabilization of his sleepwake via the advancement of the rectal temperature. Depressive episodes often returned after the photoperiod had been reduced. The effect of phototherapy may therefore depend o n the photoperiod in a day. His non-24-hour
Hikari Mizuma, Tatayu Kotorii and Yoichi Nakazawa Department of Neuropsychiatry, Kurume University School of Medicine, Kurume
We report a case of a 21-year-old male, who originally was of the “morning type” (the time of going to bed and of awakening was early). He had had a current history of depression for 5 years with a depressive phase beginning in autumn, and another during the rainy season. T h e symptoms in the depressive phase were characterized by social withdrawal, inability to study, carbohydrate craving, and daytime hypersomnia. The case corresponded with the Rosenthal’ and DSM-111-R criteria for a seasonal affective disorder (SAD). Of interest was that he showed a non-24-hour sleep-wake rhythm during his depressive phase. 09
215
12
00
12
QO
Aup.
sap.
Oct.
NOV.
Doc.
1091
Jan
Fob.
Fig. 1: Doubleplotted sleep-wake rhythm. Mesh on the left side shows the depressive phase and its intensity,
216
Proceeds. 6 Clin. Chronobiol.
sleep-wake rhythm appeared secondarily after falling into a depressive state. Because of his social withdrawal, he demonstrated a freerunning rhythm as if he lived in temporal isolation, perhaps due to a possible disorder in the entrainment mechanisms or t o an insensitivity to social Zeitgebers.
References
I . Rosenthal, N.E., Sack, D.A., Gillin, J.C. et d.: Seasonal affective disorder. Arch Gen Psychiat 41: 72-80, 1984. 2. L ~ A.J., ~ K ~ ~ H.A., , ~ R ~ ,~ ~N,E.~ et al.: Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. A m J Psychiat 139: 14961498, 1982.
~
~
