Seasonal affective disorder and alcohol abuse disorder in a population-based study
Introduction
Seasonal affective disorder (SAD) is a recurrent major depressive disorder with a seasonal pattern, usually beginning in fall and continuing into winter months. Symptoms center on sad mood, low energy, longer sleep duration and carbohydrate craving (Melrose, 2015). Nevertheless, SAD is not considered being a unique diagnostic entity. Rather, it is a type of recurrent major depression with a seasonal pattern. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the criteria for mood disorder with a seasonal pattern include a) having a major depressive episode that begins and ends during a particular period (season) every year, with full remission for the remaining period, for at least two years, and b) having more seasons of depression than seasons without depression over a lifetime (APA, 2013). Seasonal pattern disorders occur most frequently in winter although they can also occur in summer. Symptoms of winter seasonal pattern disorders center on sad mood and low energy. Information for the lay public identifies that people with SAD can feel sad, irritable, and may cry frequently. In addition to this, they feel tired and lethargic, have difficulty concentrating, sleep more than normal, are lack of energy, decrease their activity levels, withdraw from social situations, crave carbohydrates and sugars, and tend to gain weight due to overeating (Forneris et al., 2015). Interestingly, seasonal changes in mood and behavior may be closely related to alcoholism, and certain environmental and social factors may contribute to the development of seasonality in patients with alcoholism (Sher, 2004a). Previous data suggest that some patients with alcoholism have a seasonal pattern associated to their alcohol-induced depression (Sher, 2002), and more specifically alcohol dependence has been found to consistently deteriorate during the fall and winter months in previous research (McGrath and Yahia, 1993). In addition, patients with alcoholism may be self-medicating and underlying depression with alcohol, especially given the carbohydrate craving associated with SAD. Nevertheless, other studies on healthy subjects suggest that annual seasonality in alcohol use excluding drinking behavior in December, is highest in the summer (Uitenbroek, 1996).
Alcohol use disorder (AUD) continues to be a concerning issue worldwide (Wackernah et al., 2014), and it can be described as a problematic pattern of using alcohol that results in impairment in daily life or noticeable distress. The DSM-5th edition (DSM-5) states that in order for a person to be diagnosed with a disorder due alcohol, they must display 2 of the following 11 symptoms within 12-months (APA, 2013): consuming more alcohol than originally planned; worrying about stopping or consistently failed efforts to control one's use; spending a large amount of time using alcohol, or doing whatever is needed to obtain them; use of the substance results in failure to “fulfill major role obligations” such as at home, work, or school; “craving” the substance (alcohol); continuing the use of a substance despite health problems caused or worsened by it; continuing the use of a substance despite its having negative effects in relationships with others; repeated use of the substance in a dangerous situation; giving up or reducing activities in a person's life because of the drug/alcohol use; building up a tolerance to the alcohol or drug; and/or experiencing withdrawal symptoms after stopping use.
Regarding SAD, few studies have assessed the relationship between daily variation in weather and human mood and cognition. Nevertheless, several findings about seasonal effect suggest that exposure to sunlight immediately affects mood and cognition (Kent et al., 2009). More specifically, there are findings suggesting that during northern spring the time that is spent outdoors increases the relationships of temperature and barometric pressure with mood, digit span, and openness to new information. Light has been shown to also affect brain blood flow. Cerebral blood flow has specifically been found to improve after phototherapy in pre-term infants (Dani et al., 2004) and SAD patients (Matthew et al., 1996) and has repeatedly been found to be associated with cognitive functions, such as memory. Therefore, both the time spent outdoors and the current season appear to moderate the effects of weather conditions on mood and cognition.
Regarding AUD, chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory and visuospatial capacities related to multiple brain lesions (Bernardin et al., 2014). Therefore, cognitive impairments in patients with AUD may be a core issue when studying these patients.
Finally, few studies have attempted to study the relationship between alcohol abuse and seasonal affective disorders and its effect on cognitive functioning. Previous research found that cognitive dysfunction in alcohol dependence is not more pronounced in those with a comorbid affective disorder (Lee et al., 2015). Nevertheless, further studies should focus on the effects that alcohol abuse and SAD may exert on cognition. In addition to this, other interfering variables such as age, gender, civil status, education or region might influence cognitive performance in these specific patients. To sum up, SAD and AUD are conditions that could be highly correlated to each other, and in addition to this, many other variables might be interfering in these comorbid disorders.
The aim of this study was to examine the relationship between SAD and AUD patients’ prevalence, and how cognitive functioning might be related to these variables.
Section snippets
Participants
The Health 2011 Survey was conducted by the National Institute for Health and Welfare (THL) in Finland in the years of 2011–2012. The invitation to take part in the Health 2011 Survey was sent to all persons who had been included in the Health 2000 Survey. The Health 2000 Survey (http://www.terveys2000.fi/) was conducted in the years of 2000–2001 as a representative study of the Finnish population based on a sample of 9922 adults (Heistaro, 2008), consisting of a personal interview, self-report
Results
Table 1 provides the mean values and standard deviations for each significant difference between the groups of this study.
Discussion
The results of this study demonstrate that there is a relationship between SAD and alcohol disorders, as well as between SAD and some cognitive domains. More specifically, SAD was linked to ADD during lifetime and to deficits in short-term memory. Nevertheless, and in contrast to previous studies, no relationship was found between alcohol disorders and cognitive functioning. Moreover, we found significant differences between patients and controls. In specific, patients with SAD showed more
Conflict of interest
The authors have no conflict of interest to declare.
Acknowledgments
Dr. Morales-Muñoz was funded by Yrjo Jahnsson Foundation (Grant 6859). We thank the participants of this study.
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