Comparative and Critical Study of Rubrics for Seasonal Affective Disorder (SAD)

SAD makes you sad, but homoeopathy makes you happy comparative and critical study of rubrics for seasonal affective disorder (SAD)

By Dr. R. Valavan, published in Homoeopathy For All, Vol. 11 No. 12 (132) December 15 2010

Season change affects our moods. Studies have proved that all living creatures react to such seasonal changes and humans are not an exception. The short days and long nights of winter usually make a person distressed and gloomy which is usually referred to as winter blues. But for some, the extent of this depression is severe enough to disturb their normal, routine life when it is called seasonal affective depression/disorder (SAD). SAD affects people more commonly in winter, which is mainly due to the alteration in the circadian rhythm resulting from lack of Sunlight. Rarely SAD affects people in summer too, called summer depression, which is characterised by increased anxiety and irritability. Homoeopathy has long been used in many mental disorders. This article tries to explore and examine the rubrics for the symptoms of SAD. Repertories of repute have no rubric for this disorder. Murphy’s repertory has given a rubric for Seasonal affective disorder under the section Mind. Pathophysiology, diagnostic criteria and tackling of SAD are being discussed for judging the rubrics.

Pathophysiology of SAD

The pathophysiology of SAD is interesting. Recent works have proved that light variation has an effect on brain chemistry. In our body, the circadian rhythm is maintained by the hypothalamus, and the pineal gland (sleep-wake cycle). This gland produces a neurohormone, melatonin, which induces sleep. The secretion of this hormone increases at night and decreases as the day breaks. Thus we are alert when the Sun shines and sleep when our world is dark. In contrast, serotonin, which is also called as the happiness hormone, increases with exposure to Sunlight and decreases in darkness. Its low level during winter also contributes to the SAD. Further, recent reports indicate the role of vitamin D in SAD. Supplement of this vitamin has enhanced mood in healthy subjects in winter.

How SAD is diagnosed?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it must meet four criteria viz. (i) depressive episodes at a particular season of the year, (ii) emissions of the symptoms at the characteristic time of the year, (iii) these episodes much have lasted at least two years consequently, and (iv) these depressive episodes outnumber other depressive episodes throughout the patients lifetime. Before coming to the final diagnostic conclusion, these points have to be remembered.

Tackling the SAD

Making certain changes in daily activity would help to tackle SAD. Since lack of Sunlight is one of the reasons, getting as much natural sunlight as possible could reduce the symptoms and refresh the affected person. Walking, outdoor exercises, making the environment light and bright, taking vitamin D supplements, avoiding stressful situations, well a balanced healthy diet, counselling and cognitive behavioural therapy are other ways to tackle it.

Symptoms and drugs

Symptoms tend to start as winter sets in and are at their worst as winter reaches its peak. There could be a tendency to oversleep, which is usually not refreshing. Overeating with a craving for carbohydrates leading to weight gain is common in people affected with SAD. Other symptoms include social withdrawal, lack of energy, enthusiasm and concentration, marked depression, despair, and gloominess. Behavioural problems in children are also noticed. This disorder mainly affects women, children and adolescents more than men. With these symptoms, a repertorisation is made to explore the drugs. Refer to Table 1 for the top 10 drugs, their symptoms coverage, degree for the individual rubric, the sum of degrees and number of rubrics covered.

Table 1
Rubrics for the symptoms of SAD	Drugs
Nux v.	Alum.	Nat. m.	Phos.	Sep.	Sulph.	Lyco.	Puls.	Bar. c.	Calc.
Generals, winter	3	2	1	2	2	1	1	1	1	2
Mind, sadness, mental depression	2	2	3	2	3	3	3	3	2	3
Sleep, sleepiness	3	3	2	3	2	3	2	3	2	2
Stomach, appetite, increased	3	2	3	3	2	3	3	3	2	3
Stomach, desires, starch	1	2	–	–	–	–	–	–	–	1
Mind, company, aversion to	3	1	3	1	2	2	2	2	3	1
Mind, concentration, difficult	3	2	1	3	3	2	3	2	3	–
Generals, weakness, enervation	1	2	3	3	3	3	2	2	3	3
Mind, irritability	3	3	3	3	3	3	3	3	2	3
Sum of degree	23	19	20	20	20	20	19	19	18	18
No. of rubrics covered	9	9	8	8	8	8	8	8	8	8

Discussion
Rubrics close to the symptoms are selected for analysis. A symptom of behavioural problems in children is omitted because that could be case specific. Nux vomica and Alumina are the drugs that cover all the rubrics. Among them, Nux vomica tops because of its total number of degrees 23. Alumina is 19 degree. Natrum muriaticum, Phosphorus, Sepia and Sulphur are equal in numbers, both in the sum of degree and number of rubrics covered. Both Lycopodium and Pulsatilla cover 8 rubrics with 19 sums of degrees. Both the carbonates, Baryta carbonica and Calcarea carbonica, are at the next places, with a total degree of 18 and covering 8 rubrics. Since only Kent’s repertory is used for analysis, rubrics from no other repertory are included, though some rubrics very close to SAD symptoms are available. For instance, as stated, Murphy’s repertory has given a rubric on Seasonal affective disorder. under the section Mind. It lists out the following remedies with degree mentioned in brackets: Aur. (2), Carc. (1), Phos. (1), Pinealis (1), Sol (1), Stram. (1) and Syph. (2).

Medicine and their symptoms

Many drugs cover almost all the symptoms of SAD. Table 2 explores the drugs and their covering symptoms as extracted from Kent’s repertory and 2 drugs (those with 2 degrees) from Murphy’s repertory. Along with these drugs in higher potencies like 30 or 200, drugs like Avena sativa, Bacopa monnieri, Ginkgo biloba, Ginseng and Withania somnifera in mother tincture or low potency would also help to improve mental functions and lower depression.

Table 2
Drugs	Symptoms
Nux vomica	Suited to thin, irritable and people with a sedentary lifestyle. They are usually hypochondriac, and suffer from want of exercise. Melancholic. Ravenous hunger.
Alumina	Craving for starch, deficient in animal heat (winter ailments), low spirited, variable mood, sleepy in the morning.
Natrum muriaticum	Mental affections like marked disposition to weep, sad weeping mood without cause, with consolation worsening the troubles. Great weakness and weariness. Irritable. Wants to be alone to cry. Hungry, but loose flesh.
Phosphorus	Lowness of spirit, easily vexed. Great weakness and prostration with nervous debility. Hunger soon after eating. Short naps and frequent waking.
Sepia	Predominantly a female remedy. Great sadness and weeping. Dread of men and of meeting friends. Indolent; does not want to do anything, either work or play; even an exertion to think. Feeling of goneness, not relieved by eating.
Sulphur	Irritable, depressed, difficult to think or concentrate. Increased appetite; weak, empty, gone feeling in the stomach about 11am, cannot wait for lunch.
Lycopodium	Melancholy especially in the morning on awakening. Hungry more; more he eats, more he craves. Drowsiness even after long sleep.
Pulsatilla	A women remedy with weeping tendency. Seeks sympathy, highly emotional. Always feeling hungry especially in tea drinkers. Irresistible sleepiness in the afternoon.
Baryta carbonica	Suitable to children and elderly. Sensitive to cold. Aversion to meet people. More hungry, but cannot eat food.
Calcarea carbonica	More indicated in young obese people. Extreme hunger, craving for egg. Sluggish, no mood to do work. Drowsiness in the evening.
Aurum metallicum	No love of life; horrible depression of spirit, absolute loss of enjoyment in everything. Increased appetite and thirst.
Syphillinum	Complaints are worse from Sunset to Sunrise. Depressed, hopelessness. The feeling of going insane.