Impaired Risk Review...
Seasonal Affective Disorder
Robert Goldstone
February 2013

With winter firmly upon us, depression is an increasingly diagnosed disease. The lack of sunlight in shorter days, cold weather, and otherwise dreary settings limit mobility and increase one particular form of depression called seasonal affective disorder (aptly abbreviated SAD).

SAD is considered a serious mental health problem by the American Psychiatric Foundation and may affect as many as one in ten people living in northern areas.

Seasonal affective disorder is both recurrent and significant in its duration, and symptoms can last up to half of the year. It can have a serious effect on an individual’s health (neglect of self-care), on families and on maintaining employment. SAD is more prevalent in females by a ratio of about four to one. Children can also be susceptible to seasonal affective disorder, with high depression rates and poor performance in school.

SAD has been well studied, and several biologic mechanisms are thought to play a part. The circadian rhythm phase delay or advance appears to be the number one cause implicated, but differences in retinal sensitivity to light, serotonin levels, neurotransmitter dysfunction and genetic variations are also prominently mentioned. Many sufferers are thought to be more vulnerable to stress than others; and the lack of outside stimulation, cold weather and decreased sunlight compounds this weakness.

SAD is classified as a major depressive disorder, similar to bipolar disorder. It is differentiated by its pattern of seasonality and somewhat regular recurrence at a specific time of year. Depression is quite serious—particularly when  major and recurrent—and can lead to changes in health or morbidity and mortality when severe and untreated. Other diagnoses that could be considered when  SAD is entertained include manic depressive disorder (bipolar), chronic fatigue syndrome, drug or alcohol use and even hypothyroidism.

SAD is now taken quite seriously, and treatment instituted promptly will often have favorable consequences. A light therapy box is used for one to two hours a day with good results, although relapse is shown to occur when the treatment is stopped. It should be continued throughout the season until a normal remission of symptoms happens in either spring or summer. Antidepressants have been shown to have good outcomes, and ones that work on serotonin receptors are particularly effective. Favorable results have recently been shown with cognitive behavioral therapy and, when combined with light therapy, have high rates of success.

Most cases of SAD are successfully treated and don’t lead to life-altering consequences or adverse underwriting decisions. Since it is a severe form of depression, however, underwriters look to success of therapy, stability of job and working history, and continued good care of any concurrent illness which can become worse through neglect due to depression. 

Author's Bio
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and An­nu­ity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endo­­­crinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by ­telephone at 949-943-2310. Emaill:

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