7,9,79 Neuroimaging further points to decreased availability of striatal dopamine transporter binding sites in symptomatic patients with SAD.80 As both the D4 receptor and dopamine transporter are expressed in brain areas that comprise the

natural reward pathway,81 and given the fundamental role of dopamine in brain reward processes, it is reasonable to hypothesize that dopamine plays a unique role in the appetitive symptoms of SAD, distinct from those of serotonin. It is highly plausible that altered dopamine activity contributes to the rewarding aspects of highly palatable foods in SAD, while low serotonin activity contributes to overeating Inhibitors,research,lifescience,medical via effects on satiety mechanisms. Fatigue and low levels of subjective arousal are also highly characteristic of SAD patients, which could reflect hypoactivity of both dopamine and norepinephrine in the brain. One study has shown blunted norepinephrine responses to a pharmacological challenge in selleck chemical untreated SAD Inhibitors,research,lifescience,medical patients compared with normal controls,82 while another has found an increase in plasma levels of norepinephrine following light treatment for SAD.83 A negative

correlation between resting cerebrospinal fluid levels of norepinephrine metabolites, and depression ratings in SAD patients has also been described.84 Conclusion and Inhibitors,research,lifescience,medical future directions Significant progress has been made on delineating the chronobiology and neurobiology of SAD Inhibitors,research,lifescience,medical and seasonality, though much more work is needed to refine our understanding of this syndrome. In terms of chronobiological studies, much of the earlier work was limited by both small sample sizes and a tendency to consider SAD as a unitary disorder, both of which contributed to inconsistencies across studies. More recent work, which has implemented careful measurement

of circadian phase in larger samples, with a greater allowance for individual differences in the target phenotypes, has elucidated the picture of circadian dysregulation in significant subgroups of SAD patients. The importance Inhibitors,research,lifescience,medical of matching treatment protocols to a particular individual’s circadian Linifanib (ABT-869) pattern has been an important clinical advance that has further emerged from this work.34,37 Neurotransmitter studies support a role for both serotonin and dopamine in the affective and/or appetitive symptoms of SAD. In the case of serotonin, there is significant evidence for an intrinsic seasonal rhythm of serotonin metabolism and turnover that is likely to contribute to seasonality of mood and food intake, significant evidence for altered serotonin receptor and transporter activity in SAD patients during winter depressive episodes, and clear sensitivity of SAD patients to depletion of the serotonin precursor tryptophan when remitted following light therapy.