Seasonal Affective Disorder (SAD)

winter blues

Seasonal Affective Disorder, properly appellated with an acronym SAD, is a type of depression that occurs at the same season each year.  Winter is the most common time for SAD and that is why this emotional phenomenon is also known as winter depression or the winter blues.

The symptoms of depression usually begin sometime during late autumn when days become shorter and continue toward winter.  This low mood takes an upturn when  spring and summer come along.  Unfortunately, SAD may return the next autumn or winter season to begin its cycle.

Causes of SAD

Scientists are not sure what causes Seasonal Affective Disorder but the theory is that the lack of sunlight during autumn and winter’s shortened periods may have some effect on the brain’s hypothalamus which in turn has something to do with:

  • upsetting one’s circadian rhythm which throws your sleep-wake pattern off-kilter
  • lowering the levels of serotonin in the brain.  Serotonin is a hormone that affects one’s mood, sleep, and appetite
  • increasing the production of the hormone, melatonin, which makes one more drowsy than usual

Symptoms of SAD

SAD is a subtype of major depression, the only difference is that it comes and goes with the trigger season.  The symptoms can range from mild to severe, in which case the symptoms may hamper the person’s day-to-day activities.  Symptoms of SAD include:

  • chronic low mood or sadness
  • irritability
  • feelings of hopelessness, despair, guilt
  • plunging self-esteem
  • anxiety
  • lethargy and drowsiness during daytime
  • disinterest in day-to-day activities or even hobbies.  A person with SAD may suddenly take no pleasure from his usual interests
  • sleeping longer hours and still feeling exhausted upon waking
  • insomnia
  • carbohydrate cravings
  • weight gain
  • weakened immune system

Who are Most at Risk?

There seems to be more women patients of SAD than there are men.  People who live far from the equatorial region which have shorter daylight hours are prone to the condition.  It is however interesting to know that Iceland has a very low incidence of seasonal affective disorder.  The theory is that Icelanders eat a voluminous of fish, about 90 kg.  per year, compared to Canadians who average only 24 kg. per year and have a high incidence level of SAD.

SAD is also hereditary so people with the genes may develop the condition.

Additionally, age is a factor for susceptibility as well.  People between the ages of 15-55 are at higher risk of developing SAD than other age groups.

Treatment for SAD

Different treatment strategies are available for Seasonal Affective Disorder.  These are:light therapy

  • Light therapy – a light box is employed for the patient’s needed exposure to light.  This special lamp is made of fluorescent lights that are brighter than indoor bulbs but not as bright as
    natural sunlight.  UV lights, tanning lights, and heat lamps cannot be used to substitute for light boxes.
  • Cognitive Behavioural Therapy (CBT) or other talking therapies.  Counselling can help one understand SAD, manage its symptoms, and help prevent future recurrences.
  • Lifestyle modifications – implementing an exercise regimen, changes in diet, adjustment in sleeping schedules, and the like to maximise exposure to sunlight and manage stress
  • Antidepressant Medication – these include SSRIs such as Paxil and Zoloft or bupropion (Wellbutrin) and venlafaxine (Effexor).
  • Vitamin D supplementation – Another theory of cause for SAD is that the sufferer may not have enough Vitamin D because of insufficient absorption of Ultraviolet-B by the skin.  In this case, Vitamin D supplements may then be included as part of the therapy.
  • Negative air ionization — Releasing a sufficient density of negatively charged particles into the air while a patient is asleep has led to almost a 50% improvement in the condition.

Clinical Negligence

Inspector. Graphics are my artwork. Thanks. Red leather Clinical Negligence law book with gold embossed type and stylised syringe logo, with a judge’s gavel.

What is Clinical Negligence?

Under the laws of the U.K., clinical negligence, also referred to as medical negligence, occurs when a healthcare professional has been found in breach of a duty of care which has caused the patient to suffer physical or psychological injury or even death.  Healthcare professionals do not just refer to medical practitioners such as surgeons, cardiologists, and gynaecologists.  The term also encompasses dentists, midwives, nurses, physical therapists, psychiatrists, and other people with occupations under the healthcare profession.

In order for clinical negligence to be recognized in court, there are three things that must be proven:

  • Liability or Breach of Duty
  • Causation
  • Damage

Breach of Duty

If a healthcare professional’s care for a patient has fallen below the standards of care required by his field and can be proven in the court of law as such, then he is guilty of a breach of duty.  A certain test used by the court, “The Bolam Test” serves as a scrutiny on whether the defendant’s patient care actions have been subpar and clearly have not met the standards known to a body of practitioners also skilled in the same field.

Breach of Duty may arise from:

  • wrong diagnosis or failure of diagnosing condition
  • failure of warning or giving proper information about the risks of treatment suggested
  • failure to get proper consent to treatment
  • prescribing or giving the wrong medications
  • careless surgical procedures; mistakes while doing a procedure or operation
  • delayed referral to other specialists

Causation

It is not enough to prove that the healthcare professional has not been meeting his field’s standards of practice.  It must also be proven that the damage or injury to the patient has arisen from the practitioner’s negligence or breach of duty.  In practice, this is more difficult to establish than the fact that the accused professional has not met his field’s standards in patient care.

For instance, the aggrieved patient may be able to prove that his psychiatrist made a wrong diagnosis but he may find that he may have to work harder to prove that his worsening depression is a direct result of that error and not part of an already existing mental illness.  In this case, the court may agree that there has been a breach of duty but no causation or resulting damage; thereby, no compensation may be given.

In rare cases where the healthcare provider may admit a breach of duty, this is not enough to neither establish a clinical negligence case nor expect the accused to be liable for any damages.  It must be proven first that damage clearly arose from that breach of duty before liability can be established.

Damage

When breach of duty and causation has been proven, the claimant must prove the existence of the damage against which a claim can be made.  Damage refers to physical injuries, psychiatric injuries, and financial losses such as loss of income.  Psychiatric injury refers to a recognised psychiatric impairment such as PTSD (post traumatic stress disorder), clinical depression, and anxiety disorder.  Normal emotional upsets and grief are not psychiatric disorders and are therefore not considered damages for which claim can be made.

Other Factors to Consider When Pursuing a Claim

Clinical negligence is not easy to establish and court proceedings may take some time to resolve the issue.  A High Court claim may take as long as six years.

There is a time limit for applying legal action for clinical negligence.  The time limit is 3 years unless stipulated in the Limitation Act 1980.  Getting your solicitor’s services way before the three year application period is over will give him time to review your case properly and gather the necessary documentation.

The cost for a clinical negligence case is prohibitive so one has to be financially prepared when filing this particular lawsuit.  Most clinical negligence cases can no longer claim the benefits of legal aid under the Legal Aid, Sentencing, and Punishment of Offenders Act 2012.  Legal aid is only available in clinical negligence cases where a child suffers from a neurological damage which results in her being severely disabled during childbirth, pregnancy, or the 8-week postnatal period.