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Feeling SAD As the Days Grow Shorter?

It Could Be Seasonal Affective Disorder

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Updated January 23, 2014

Light Therapy

Light therapy using a device that give off bright, white light is considered the best form of treatment for SAD at this time.

In fall 1998, a group of 13 Canadian specialists issued a set of professional consensus guidelines for the treatment of SAD. Among their conclusions:

  • The starting "dose" for light therapy using a fluorescent light box is 10,000 lux for 30 minutes per day.
  • Alternatively, light boxes emitting 2,500 lux require two hours of exposure per day.
  • Light therapy should be started in the early morning, upon awakening, to maximize treatment response.
  • Response to light therapy often occurs within one week, but some patients may require up to four weeks to show a response.
  • Common side effects of light therapy include headache, eyestrain, nausea and agitation, but these effects are generally mild and transient, or disappear with reducing the dose of light.

According to Dr. Michael Terman, head of the Winter Depression Program at Columbia-Presbyterian University, the consensus in the U.S. is that post-awakening bright light therapy, using a broad-spectrum white light source at 10,000 lux, is the first-line intervention. Drugs should be brought in as adjuvants only if the light therapy is insufficient. Optimum dosing of light is crucial, since if done wrong it can produce no improvement, partial improvement or even worsening of symptoms.

Drug Treatments

On June 12, 2006 Wellbutrin XL (bupropion hydrochloride) became the first drug approved specifically for SAD in the U.S. The effectiveness of Wellbutrin XL for the prevention of SAD episodes was established in three double-blind, placebo-controlled trials in adults with a history of major depressive disorder in fall and winter. Treatment began in the September through November timeframe, prior to the onset of symptoms. Treatment ended the first week of spring. In these trials, the percentage of patients who were depression-free at the end of treatment was significantly higher for those on Wellbutrin XL than for those on placebo. For all three studies combined, the overall rate of patients depression-free at the end of treatment was 84 percent for those on Wellbutrin XL, compared to 72 percent for those on placebo.

There is no conclusive evidence from randomized trials to support the use of SSRIs in the treatment of SAD.

Self-Assessment Quizzes

The Center for Environmental Therapeutics (CET), a non-profit organization which provides educational materials about SAD, offers free self-assessment questionnaires that you can download from their site, as well as interpretation guides, to help you determine if you should seek professional advice. Among the quizzes available are the AutoPIDS and AutoMEQ (presented as a pair; AutoPIDS helps you determine you have the symptoms of SAD and what your natural bedtime is, and the AutoSIGH tracks your current state of depression).

Learn More About SAD

You can read Light on Winter Darkness to learn the latest news about SAD from Columbia-Presbyterian Medical Center researchers Michael Terman and Jamie Rifkin.

Sources:

American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994.

“FDA News.” FDA Approves the First Drug for Seasonal Depression. June 12, 2006. U.S. Food and Drug Administration. October 16 2006 <http://www.fda.gov/bbs/topics/NEWS/2006/NEW01388.html>.

Feldman, Mitchell D. "Seasonal Affective Disorder." Ferri's Clinical Advisor: Instant Diagnosis and Treatment (2006). MDConsult. <http://www.mdconsult.com/>.

Lam, R.W., and A.J. Levitt. "Canadian consensus guidelines for the treatment of seasonal affective disorder: a summary of the report of the Canadian Consensus Group on SAD." Canadian Journal of Diagnosis 15 Suppl. (1998): S1-S15.

Miller, A.L. “Epidemiology, etiology, and natural treatment of seasonal affective disorder.” Alternative Medicine Review 10.1 (2006): 5-13. MDConsult. <http://www.mdconsult.com/>

Postolache, Teodor T. and Dan A. Oren. “Circadian Phase Shifting, Alerting and Antidepressant Effects of Bright Light Treatment.” Clinic in Sports Medicine 24.2 (2005). MD Consult. <http://www.mdconsult.com/>.

Saeed, M.D., S. Atezaz and Timothy J. Bruce, Ph.D.. "Seasonal Affective Disorders." American Family Physician March 15, 1998 October 15, 2006. <http://www.aafp.org/afp/980315ap/saeed.html>

Terman, Michael. "A Quick Question." E-mail to Author. October 15 2006.

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