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December 8, 1993

Diagnosis and Treatment of Seasonal Affective Disorder

Author Affiliations

From the Section on Environmental Psychiatry, Clinical Psychobiology Branch, National Institute of Mental Health, Bethesda, Md.

JAMA. 1993;270(22):2717-2720. doi:10.1001/jama.1993.03510220073037

SELECTED CASE  A 39-year-old novelist presented in October complaining of increasing fatigue and severe "writer's block." For a month she had found it increasingly hard to wake up and get going in the morning. Her energy level was low; she was unable to concentrate on her writing and had trouble meeting deadlines. She had gained 2.25 kg and had difficulty avoiding desserts and high-calorie snacks. Whenever possible, she would nap at her desk or "vegetate" in front of the television. Bills went unpaid, and laundry piled up. She felt "disgusted" at her "incompetence" and pessimistic about the future.A review of her history revealed that from her college years she had had similar difficulties, beginning in fall and winter and lasting until spring. For the last few winters, these episodes had been getting worse. During the spring, she would feel "alive again"—unusually energetic and euphoric, highly productive, and needed little