Seasonal Affective Disorder

Seasonal affective disorder (SAD), also known as winter depression or winter blues, is a mood disorder in which people who have normal mental health throughout most of the year, experience depressive symptoms in the winter or, less frequently, in the summer,spring or autumn, repeatedly, year after year. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), SAD is not a unique mood disorder, but is "a specifier of major depression". Once regarded skeptically by the experts, seasonal affective disorder is now well established. Epidemiological studies estimate that its prevalence in the adult population of the US ranges from 1.4 percent (Florida) to 9.7 percent (New Hampshire). Social Worker Continuing Education
The US National Library of Medicine notes that "some people experience a serious mood change when the seasons change. They may sleep too much, have little energy, and may also feel depressed. Though symptoms can be severe, they usually clear up." The condition in the summer is often referred to as reverse seasonal affective disorder, and can also include heightened anxiety.

SAD was first formally described and named in 1984 by Norman E. Rosenthal and colleagues at the National Institute of Mental Health.

There are many different treatments for classic (winter-based) seasonal affective disorder, including light therapy with sunlight or bright lights, antidepressant medication, cognitive-behavioral therapy, ionized-air administration,and carefully timed supplementation of the hormone melatonin.

Symptoms

Symptoms of SAD may consist of difficulty waking up in the morning, morning sickness, tendency to oversleep as well as to overeat, and especially a craving for carbohydrates, which leads to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. All of this leads to the depression, pessimistic feelings of hopelessness, and lack of pleasure which characterize a person suffering from this disorder.

Diagnostic criteria

According to the American Psychiatric Association DSM-IV criteria, Seasonal Affective Disorder is not regarded as a separate disorder. It is called a "course specifier" and may be applied as an added description to the pattern of major depressive episodes in patients with major depressive disorder or patients with bipolar disorder. The "Seasonal Pattern Specifier" must meet four criteria: depressive episodes at a particular time of the year; remissions or mania/hypomania at a characteristic time of year; these patterns must have lasted two years with no nonseasonal major depressive episodes during that same period; and these seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime. The Mayo Clinic describes three types of SAD, each with its own set of symptoms. In the popular culture, sometimes the term "seasonal affective disorder" is applied inaccurately to the normal shift to lower energy levels in winter, leading people to believe they have a physical problem that should be addressed with various therapies or drugs.

Physiology

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright-light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%. Cloud cover may contribute to the negative effects of SAD.

The symptoms of SAD mimic those of dysthymia or even major depressive disorder. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness. At times, patients may not feel depressed, but rather lack energy to perform everyday activities.

Various proximate causes have been proposed. One possibility is that SAD is related to a lack of serotonin, and serotonin polymorphisms could play a role in SAD, although this has been disputed. Mice incapable of turning serotonin into N-acetylserotonin (by Serotonin N-acetyltransferase) appear to express "depression-like" behavior, and antidepressants such as fluoxetine increase the amount of the enzyme Serotonin N-acetyltransferase, resulting in an antidepressant-like effect. Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland.

Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% (vs. 6.1% SAD) of the U.S. population. The blue feeling experienced by both SAD and SSAD sufferers can usually be dampened or extinguished by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure. Connections between human mood, as well as energy levels, and the seasons are well documented, even in healthy individuals. Mutation of a gene expressing melanopsin has been implicated in the risk of having Seasonal Affective Disorder.

The American Social Worker’s Code of Ethics

Social Worker Continuing Education is vital to ongoing responsible professional clinical practice. This includes but is not limited to LCSW Continuing Education, ASW Continuing Education, and LSW Continuing Education.
The social work profession established roots within a set of core values. These core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective:

• service
• social justice
• dignity and worth of the person
• importance of human relationships
• integrity
• competence

NASW Code of Ethics

Professional ethics are integral to the practice of social work. Social Workers have a responsibility to articulate core values and ethics. The NASW Code of Ethics was designed to help define these values and ethics. The Code of Ethics impacts all social workers and social work students in guiding their professional conduct.
The NASW Code of Ethics has several purposes including:
The Code identifies core values on which social work’s mission is based.
The Code summarizes broad ethical principles that reflect the profession’s core values and establishes a set of specific ethical standards that should be used to guide social work practice.

The Code is designed to help social workers identify relevant considerations when professional obligations conflict or ethical uncertainties arise.
The Code provides ethical standards to which the general public can hold the social work profession accountable.

The Code socializes practitioners new to the field to social work’s mission, values, ethical principles, and ethical standards. The Code articulates standards that the social work profession itself can use to assess whether social workers have engaged in unethical conduct. NASW has formal procedures to adjudicate ethics complaints filed against its members.* In subscribing to this Code, social workers are required to cooperate in its implementation, participate in NASW adjudication proceedings, and abide by any NASW disciplinary rulings or sanctions based on it.

Code of Ethics Summary
The Social Worker's Conduct as a Social Worker
• Propriety. The social worker maintains high standards of conduct in the capacity or role as a social worker.
• Competence and Professional Development. The social worker should strive to remain proficient in professional practice and professional functions.
• Service. The social worker should regard as primary the service obligation of the social work profession.
• Integrity. The social worker should act in accordance with the highest standards of professional integrity.
• Scholarship and Research. The social worker engaged in study and research should be guided by the conventions of scholarly inquiry.

The Social Worker's Ethical Responsibility to Clients
• Primacy of Clients' Interests. The social worker's primary responsibility is to clients.
• Rights and Prerogatives of Clients. The social worker should make every effort to foster maximum self-determination on the part of clients.
• Confidentiality and Privacy. The social worker should respect the privacy of clients and hold in confidence all information obtained in the course of professional service.
• Fees. When settling fees, the social worker should ensure that they are fair, reasonable, considerate and commensurate with the service performed and with due regard for the clients' ability to pay.

The Social Worker's Ethical Responsibility to Colleagues
• Respect, Fairness, and Courtesy. The social worker should treat colleagues with respect, courtesy, fairness, and good faith.
• Dealing with Colleagues' Clients. The social worker has the responsibility to relate to the clients of colleagues with full professional consideration.
The Social Worker's Ethical Responsibility to Employers and Employing Organizations
• Commitments to Employing Organizations. The social worker should adhere to commitments made to the employing organizations.
The Social Worker's Ethical Responsibility to the Social Work Profession
• Maintaining the Integrity of the Profession. The social worker should uphold and advance the values, ethics, knowledge, and mission of the profession.
• Community Service. The Social Worker should assist the profession in making social services available to the general public.
• Development of Knowledge. The social worker should take responsibility for identifying, developing, and fully utilizing knowledge for professional practice.

The Social Worker's Ethical Responsibility to Society
• Promoting the General Welfare. The social worker should promote the general welfare of society.

For more information on Social Work Ethics, visit Social Worker Continuing Education