2024年02月27日 11:25 發布
編輯：Editor
Seasonal Affective Disorder (SAD)
季節性情緒失調
Seasonal affective Disorder or SAD is a type of depression that mainly affects people during certain times of the year and is more prevalent in certain areas of the world.
季節性情緒失調（SAD）是一種抑鬱症，主要在一年中的某些時間影響人們，並且在世界某些地區更為普遍。
As the name suggests, it is an illness that comes and goes with the seasons and is more prevalent during the autumn and winter periods but this is not always the case. This illness is actually fairly rare in Australia and it is more common in countries the further away they are from the equator but like any illness it can still happen to anyone regardless of age or location but generally it is more commonly seen in women and in both men and women between the ages of 20-30.
顧名思義，這是一種隨著季節變化而出現的疾病，在秋冬季節更為流行，但情況並非總是如此。這種疾病實際上在澳大利亞相當罕見，在離赤道越遠的國家中就越常見，但就像任何疾病一樣，無論年齡或地點如何，它仍然可能發生在任何人身上，但通常在女性和更常見年齡在20-30歲之間的男性和女性。
It is commonly referred to as “winter blues” and you will find that the colour blue is used quite a lot to describe a lot of depressive or sad emotions such as the “baby blues” that was mentioned last week or more common is the term “Monday blues”
它通常被稱為“冬季憂鬱”，你會發現藍色經常被用來描述許多憂鬱或悲傷的情緒，例如上周提到的“嬰兒憂鬱”或更常見的是這個術語——“周一憂鬱”
So what is SAD? Our current understanding of SAD is still a bit limited but simply put it is a type of depression that occurs roughly the same time each year in sufferers during the colder months and symptoms will begin to resolve during the transition to spring and summer months.
那麼什麼是季節性情緒失調？我們目前對季節性情緒失調的瞭解仍然有限，但簡單地說，它是一種抑鬱症，患者每年在寒冷的月份中大約在同一時間發生，症狀將在春季和夏季過渡期間開始緩解。
People that suffer from SAD may experience symptoms similar to major depression such as feeling listlessness and sad most of the day, nearly every day. Losing interest and motivation, low energy, constant state of sleepiness, difficulty concentrating, feelings of hopeless and worthlessness, suicidal thoughts. On top of this there is also some differences between SAD in autumn and winter than SAD in spring and summer.
患有 SAD 的人可能會經歷類似於重度抑鬱症的症狀，例如幾乎每天大部分時間都感到無精打采和悲傷。失去興趣和動力、精力不足、持續昏昏欲睡、難以集中注意力、感到絕望和無價值、有自殺念頭。除此之外，秋季和冬季的 SAD 與春季和夏季的 SAD 也存在一些差異。
During periods of winter depression additional symptoms such as:
1. Oversleeping
2. Craving carbohydrates
3. Weight gain
4. Constant fatigue
在冬季抑鬱症期間，還會出現其他症狀，例如：
1、睡過頭
2、渴望碳水化合物
3、體重增加
4、持續疲勞
While those with summer depression may experience:
1. Insomnia
2. Poor appetite
3. Weight loss
4. Agitation and anxiety
5. Increased irritability
患有夏季抑鬱症的人可能會經歷：
1、失眠
2、食欲不佳
3、體重下降
4、煩躁和焦慮
5、煩躁情緒增加
So what causes SAD? As mentioned earlier the exact causes is unknown but some common factors have been identified. In autumn and winter, we experience a decrease in the level of sunlight and it is said that this decrease disrupts our body’s internal clock and circadian rhythm leading to a disruption of normal body functions such as hormonal balances. The drop in sunlight is also linked to reduction of serotonin levels in the brain which as we have discussed previously is the neurotransmitter that affects our mood. As our circadian rhythm is disrupted, our melatonin levels may also become imbalanced which further affects our sleep and mood. Also worth mentioning is vitamin D levels. When we are exposed to sunlight we produce vitamin D in our skin and vitamin D can boost serotonin activity if we are not getting enough vitamin D either from the sun or from food then it may also contribute to SAD and depression in general.
那麼是什麼原因導致季節性情緒失調呢？如前所述，確切原因尚不清楚，但已經確定了一些常見因素。在秋季和冬季，我們會經歷陽光水平的減少，據說這種減少會擾亂我們身體的內部時鐘和晝夜節律，導致荷爾蒙平衡等正常身體功能被破壞。陽光的減少也與大腦中血清素水平的降低有關，正如我們之前討論的，血清素是影響我們情緒的神經遞質。當我們的晝夜節律被打亂時，我們的褪黑激素水平也可能變得不平衡，從而進一步影響我們的睡眠和情緒。另外值得一提的是維生素 D 水平。當我們暴露在陽光下時，我們的皮膚會產生維生素 D，而維生素 D 可以增強血清素活性，如果我們沒有從陽光或食物中獲取足夠的維生素 D，那麼它也可能導致 SAD 和抑鬱症。
As with most depressive disorders we can treat it by being prescribed anti-depressants such as Prozac, although effective, it also carries a risk of side effects such as headaches, nausea, insomnia and nervousness.
與大多數抑鬱症一樣，我們可以通過服用百憂解等抗抑鬱藥來治療它，雖然有效，但它也存在產生頭痛、惡心、失眠和緊張等副作用的風險。
Alternatively, an effective treatment commonly used to treat winter SAD is light therapy. As one of the major factors of developing SAD is lack of sunlight, this treatment involves daily exposure to very bright light for 30-45mins generally during the morning until spring. Unfortunately this has no effect on summer SAD.
另外，通常用於治療冬季季節性情緒失調的有效治療方法是光療。由於形成 SAD 的主要因素之一是缺乏陽光，這種治療方法通常是從早上開始，每天暴露在非常明亮的光線下 30-45 分鐘，直到春天。不幸的是，這對夏季 SAD 沒有影響。
Other treatments include vitamin D supplements and increasing outdoor activity to maximise exposure to sunlight as well as improving general wellbeing and mental health through exercise.
其他治療方法包括補充維生素 D 和增加戶外活動以最大限度地接觸陽光，以及通過鍛煉改善總體健康和心理健康。
Now let’s look at SAD from a TCM perspective. According to TCM theory, everything has a yin and yang aspect. Fire and water, hot and cold, bright and dark etc. Things that are Yang are very active and warm and bright. They are also lifting and dispersing in movement. Conversely, things that are Yin in nature are more slow and cold and dark. They are also descending and contracting in movement.
現在我們從中醫的角度來看待SAD。根據中醫理論，一切事物都有陰陽兩面。火與水，熱與冷，明與暗等。陽的東西非常活躍，溫暖而明亮。陽氣的運行也會升騰和擴散。相反，陰的事物則更加緩慢、寒冷和黑暗。它也在運行中呈現下降和收縮。
The movement of the seasons also follow a yin yang cycle. The yin cycle begins in autumn where the summer daylight fades and gradually decreases in intensity and duration. The temperature also begins to get colder as it transitions into winter. There is a tendency of negative emotions such as sadness and grieving. As the yin cycle ends the yang cycle begins with the start of spring. It is the season for growth and energy and as it transitions into summer our yang Qi increases, warming our body and mood. We see this up and down cycle in those that are affected by SAD.
季節的變化也遵循陰陽循環。陰周期從秋季開始，夏季日光逐漸減弱，強度和持續時間逐漸減少。隨著進入冬季，氣溫也開始變冷。有悲傷、悲痛等負面情緒的傾向。隨著陰循環的結束，陽循環隨著春天的開始而開始。這是生長和精力充沛的季節，進入夏季，我們的陽氣增強，溫暖了我們的身體和情緒。我們在受季節性情緒失調影響的人群中看到了這種上下循環。
We can also use TCM to explain some of the symptoms that occur. During the winter months it is important to boost the Kidney Qi. The Kidney is associated with winter and water and its emotions is fear. The Kidneys Shen is the Zhi or Will. Poor Kidney Qi can affect our mental functions and memory. When the Kidney Qi is weak it will also affect the Lungs and this can lead to feelings of grief and sadness. During the winter months it is common to crave foods that are high in nutrient and energy as the extra calories can help the body stay warm – hence the craving for carbohydrates. Our body expends energy and vital Qi to keep warm and expel the cold so there tends to be a feeling of lethargy and sluggishness as the Qi retreats inwards and the movement contracts. The lack of Yang Qi will also impair circulation as well as imbalances of Kidney and Lung function can result in emotional distress which combined with symptoms such as poor sleep and lack of vitamin D can result in depressive feelings.
我們還可以用中醫理論來解釋季節性情緒失調出現的一些症狀。冬季補腎氣很重要。腎主冬、水，其情志為畏。腎神是志或意志。腎氣不好會影響我們的精神功能和記憶力。當腎氣虛弱時，肺也會受到影響，從而導致悲傷、悲痛的情緒。在冬季，人們通常會渴望富含營養和能量的食物，因為額外的熱量可以幫助身體保持溫暖，因此渴望碳水化合物。我們的身體需要消耗精氣和正氣來保暖、驅寒，所以氣內斂、運動收縮時，就會出現昏睡、呆滯的感覺。陽氣不足也會損害血液循環，腎和肺功能失衡會導致情緒困擾，再加上睡眠不佳和缺乏維生素D等，會導致抑鬱情緒。
Interestingly not much can really be said for summer SAD from both Western medicine and TCM other than the shift in seasons affecting the body in some way. It is possible that the change in the day night cycle affects the circadian rhythm just like in winter. The heat and humidity can also irritate the emotions. In TCM we may say that the Heart Qi is too exuberant causing the Heart Shen to become overactive which results in irritability and manic symptoms. Over time this imbalance can turn into lack of enthusiasm and vitality, insomnia and depressive moods.
有趣的是，除了季節變化以某種方式影響身體之外，西醫和中醫對於夏季季節性情緒失調確實沒有什麼很好的解釋。晝夜周期的變化可能會影響晝夜節律，就像冬天一樣。炎熱和潮濕也會刺激情緒。中醫認為，心氣太旺，心神過度活躍，就會出現煩躁、狂躁的症狀。隨著時間的推移，這種不平衡會變成缺乏熱情和活力、失眠和抑鬱情緒。
如有疑問想咨詢吳宇琛中醫師，可以在微信或whatsapp搜索0404836368，加吳宇琛中醫師微信或whatsapp，也可以發短信或致電0404836368作語音留言，吳宇琛中醫師有空就會回復。
（吳宇琛中醫師，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，悉尼好事圍松轩药行主治中医师，本文僅供參考，具體診療應諮詢專業人士。）
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