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While depression is common in Cushing's syndrome from whatever cause (pituitary, adrenal, or ectopic adrenocorticotropic hormone-secreting tumor or hyperplasia, or exogenous administration of glucocorticoids) and hypercortisolemia is prevalent in major depression, any association between seasonal affective disorder and Cushing's syndrome is unknown. We present a case of seasonal bipolar disorder, gradually worsening for more than 9 years (1985-1994), accompanied by increasing osteoporosis, mild weight gain, and slight truncal obesity in a middle-aged woman. In January 1991, her seasonal affective disorder was successfully treated with light therapy, but in the following year, bipolar mood swings with a seasonal pattern emerged, which were refractory to light therapy and antidepressants but responsive to lithium. In August 1992, she became depressed despite a 1500-mg lithium daily dosage along with light therapy, and, in 1993, a diagnosis of Cushing's disease (Cushing's syndrome as a result of a pituitary adrenocorticotropic hormone-secreting tumor) was made. The pituitary tumor was removed in February 1994, and pituitary function was fully restored by 1996. While the symptoms of Cushing's syndrome subsided, her bipolar illness continued to require maintenance treatment with low doses of lithium but did not require light therapy.

Seasonal changes in mood and behavior (seasonality) may be closely related to alcoholism. Some patients with alcoholism have a seasonal pattern to their alcohol misuse. They may be self-medicating an underlying seasonal affective disorder (SAD) with alcohol or manifesting a seasonal pattern to alcohol-induced depression. Both genetic and environmental factors play a role in the etiology and pathogenesis of alcoholism and SAD, operating, at least in part, through the brain serotonergic system. Family and molecular genetic studies suggest that there may be a genetic link between seasonality and alcoholism. Certain environmental and social factors may contribute to the development of seasonality in patients with alcoholism. The fact that SAD and alcoholism may be comorbid shows the importance of a thorough diagnostic interview. Both mental health and drug and alcohol professionals should be provided with education to assist with appropriate identification, management, and referral of patients presenting with comorbid alcoholism and SAD.

The study objective was to determine the effect of winter bright light therapy on binge and purge frequencies and depressive symptoms in subjects with bulimia nervosa. Thirty-four female bulimic outpatients were treated with either 10,000 lux bright white light or 50 lux dim red light (placebo control) during the winter months. In this double-blind study, the placebo group (n = 18) and the bright light group (n = 16) were matched for age, degree of seasonality (measured by the Seasonal Patterns Assessment Questionnaire [SPAQ]), and concurrent depression (measured by Structured Clinical Interview for DSM-IV [SCID]). Three weeks of baseline data collection were followed by 3 weeks of half-hour daily morning light treatment and 2 weeks of follow-up evaluation. There was a significant light-treatment by time interaction (Wilks' lambda = .81, F(2,28) = 3.31, P = .05). The mean binge frequency decreased significantly more from baseline to the end of treatment for the bright light group (F(1,29) = 6.41, P = .017) than for the placebo group. The level of depression (measured by daily Beck Depression Inventory [BDI] scores) did not significantly differ between the groups during any phase, and neither depression nor seasonality affected the response to light treatment. In this double-blind study, bulimic women who received 3 weeks of winter bright light treatment reported a reduced binge frequency between baseline and the active treatment period in comparison to subjects receiving dim red light.

The personality trait of neuroticism has been found to be associated with a polymorphism in the regulatory region of the serotonin (5-HT) transporter gene (5-HTTLPR). This same genetic polymorphism has also been associated with seasonal changes in mood and behavior, or seasonality. The purpose of the current study was to determine whether seasonality and neuroticism are actually the same construct given that they are both associated with the same genetic polymorphism. We administered the Seasonal Pattern Assessment Questionnaire (SPAQ), which measures the severity of seasonality, and the Revised NEO Personality Inventory (NEO-PI-R), which measures the severity of neuroticism, to 45 subjects diagnosed with seasonal affective disorder (SAD). SAD is a clinical expression of seasonality in which patients develop a major depressive disorder in the winter that remits in the summer and can be treated with light therapy. No significant correlation was found between neuroticism and seasonality. We conclude that seasonality and neuroticism are not the same construct, even though the 5-HTTLPR polymorphism is a genetic risk factor for each.

There is evidence from clinical, epidemiological, and neuroimaging studies that attention-deficit hyperactivity disorder (ADHD) and seasonal affective disorder (SAD) may have several features in common. To assess seasonal affective symptoms in adults with ADHD, 115 individuals attending an adult ADHD clinic in Toronto, Ontario, Canada were asked to complete the Seasonal Pattern Assessment Questionnaire (SPAQ). From this clinic population of 115, a total of 56 completed SPAQs were returned. Assuming that all individuals failing to complete the SPAQ were nonseasonal and depending on which case-finding criteria were used, the rate of SAD in the overall clinic sample was estimated at either 10.4% (Terman criteria) or 19.1% (criteria of Kasper et al.). These prevalence rates are significantly greater than the rates reported in large population surveys at similar latitudes. There was an apparent relationship between female gender, impulsive-subtype ADHD, and seasonality. Future studies to examine whether core symptoms of ADHD fluctuate across the seasons and to assess the efficacy of light therapy in "seasonal" ADHD patients would be of great theoretical and clinical interest.

This study of primary care patients sought to estimate the prevalence of and functional impairment associated with winter-seasonal depression. Three hundred three patients visiting a primary care clinic in January or February were assessed for seasonal patterns of health change, current DSM-III-R major depressive disorder (MDD), and current functional status. Approximately 9% of patients met criteria for MDD with winter-seasonal pattern, and an additional 29% reported seasonal mood changes without meeting criteria for current MDD. Multivariate analysis revealed that the functional impairment associated with such winter seasonality exceeded that associated with any of the common chronic medical conditions measured, and that such dysfunction was evident even in the absence of a diagnosable depressive disorder (MDD). Winter-seasonal pain was reported by one quarter of the overall sample and by half of those with current MDD, supporting preliminary reports that pain may be a common presenting symptom in seasonal affective disorder. The findings suggest that efforts at detection and treatment of such syndromes in primary care settings would be justified.

Twenty-six patients diagnosed as having seasonal affective disorder (SAD) completed weekly depression self-ratings for at least 2.5 and up to 8.25 years. Seasonal recurrence of depression persisted in nine patients, seven remitted, four were chronically depressed, and six showed a diffuse pattern. The age at SAD onset and duration of SAD history before entry into this prospective study could not be identified as predictors of the subsequent course of the disease. Short-lasting, recurrent periods of depression could be identified in many of the long-term records. They were found primarily in autumn and winter in patients with either a persistent seasonal or a remitted pattern. In the core group of patients with persistent seasonal pattern, the onset and offset of depressive periods (DPs) were more variable than the DSM-III-R 60-day window criterion for seasonal pattern allows.

During the acute depressive episode, seasonal affective disorder (SAD) patients (N = 24) differ significantly from non-SAD major depressives (N = 17) on five of 13 personality variables measured, although severity of depression appears to be similar. SAD patients score significantly lower on the self-criticism and dependency dimensions of the Depressive Experiences Questionnaire (DEQ) and significantly higher on three personality trait scales (including schizotypal, narcissistic, and avoidant) of the Millon Clinical Multiaxial Inventory (MCMI). Our data suggest that those with seasonal depression may represent a psychologically distinct subgroup of depressives.

Data are reviewed regarding the validity of seasonal pattern (SP), according to DSM-III-R, as a modifier for recurrent mood disorders. The relationship of the DSM-III-R formulation of SP is compared with that of seasonal affective disorder (SAD) as used by the bulk of researchers in the area. Both definitions are evaluated against the criteria for validity suggested by Robins and Guze, by Kendell, and by Spitzer and Williams. While the two definitions are similar and available data support a distinct clinical syndrome of recurrent winter decrements of mood and energy, it is not yet clear whether what is identified as SP or SAD represents a distinct affective syndrome, a subtype of recurrent affective illness, or the most severe form of a widely distributed population trait. Several options for operationalized criteria sets are discussed.

We examined data from 44 women with seasonal affective disorder (SAD) to determine whether any demographic, diagnostic, or symptomatic characteristics would be predictive of a favorable response to phototherapy. Preexistent hypersomnia was particularly associated with lessening of depression after phototherapy. In contrast to a report elsewhere, both "typical" and "atypical" depressive symptoms correlated with improvement after phototherapy.

Mood and appetite disturbances are commonly found in bulimia nervosa and seasonal affective disorder (SAD). To investigate seasonality of mood symptoms, we administered the Seasonal Pattern Assessment Questionnaire (SPAQ) to 38 consecutive bulimic patients, 38 age- and sex-matched SAD patients, and 25 age- and sex-matched normal controls. The SPAQ is a reliable, retrospective, self-rated questionnaire that assesses seasonal changes in mood, sleep, weight, and social activity. The SAD patients had significantly higher Global Seasonality Scores (GSS) than the bulimic patients, who had higher scores than the control group (F = 78.6, df = 2.98, P less than .0001). Forty-two percent of bulimics met case-finding SPAQ criteria for SAD, compared with none of the control group (chi 2 = 14.1, df = 1, P less than .0005). These data suggest that a significant number of unselected bulimic patients have seasonal mood symptoms as severe as that seen in SAD. We propose that a common neurobiologic abnormality, such as serotonergic dysfunction, may underlie the common symptoms found in bulimia and SAD.