The two most widely accepted treatments for SAD are light therapy and pharmacotherapy. Because these interventions are similar in efficacy, other clinical factors, including patient preference, should guide selection of first-line treatment. 9
Light therapy has been demonstrated effective in numerous systematic reviews and meta-analyses and is a well-established first-line treatment.3 The Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder offers several recommendations for effective use of light therapy:10
- Use a fluorescent light box (10,000 lux) for 30 minutes per day.
- Patients should sit about 12 to 18 inches from the light source.
- Patients should avoid looking directly into the light.
- Light boxes should use white fluorescent light with the ultraviolet wavelengths filtered out. Incandescent halogen lights should be avoided.
- The optimal time of day for light therapy is early morning upon awakening, but exposure at other times of day may be effective for some patients.
- Typical response time is one week, but some patients require two to four weeks to show a response.
- There are no absolute contraindications to light therapy, and there is no evidence that light therapy is associated with ocular or retinal damage.
Although light therapy is generally well tolerated, there can be transient adverse effects, such as headache, eye strain, nausea, agitation, and blurred vision.3 To ensure adequate response to light therapy, patients should use units that are specifically designed to treat SAD.7
Pharmacotherapy is recommended by several guidelines, including the CANMAT Guidelines,10 which recommend sertraline and fluoxetine as effective first-line pharmacologic treatments for SAD. Antidepressants should be used in doses similar to those used in the treatment of nonseasonal depression. An adequate trial of antidepressants involves at least six weeks of treatment.10 Bupropion has been found to be effective prophylaxis for SAD, if administered in early autumn.11
CBT has been widely studied and empirically validated for use in nonseasonal depression.3 It has also shown modest efficacy in both treatment and prophylaxis of SAD.3 Additional interventions include exercise, relaxation and stress management techniques, spending more time outdoors, and visiting sunnier, warmer climates.3
1. Saeed SA, Bruce TJ. Seasonal affective disorder. Up to Date. Available at: http://www.uptodate.com/contents/seasonal-affective-disorder. Accessed: December 19, 2012.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Fourth edition. Washington. DC: American Psychiatric Association, Washington, DC 1994.
3. Kurlansik SL, Ibay AD. Seasonal affective disorder. Am Fam Physician. 2012;86(11):1037-1041.
4.Tefft N. Mental health and employment: the SAD story. Econ Hum Biol. 2012;10(3):242-255.
5. Cheung A, Dewa C, Michalak EE, et al. Direct health care costs of treating seasonal affective disorder: a comparison of light therapy and fluoxetine.
6. Lewy AJ, Rough JN, Songer JB, et al. The phase shift hypothesis for the circadian component of winter depression. Dialogues Clin Neurosci. 9(3): 291–300.
7. Thompson C, Thompson S, Smith R. The Seasonal Health Questionnaire is more effective at detecting seasonal affective disorder than the Seasonal Pattern Adjustment Questionnaire. J Affect Disord. 2004;78:219-236.
8. Lurie AJ, Gawinski B, Pierce D, Rousseau SJ. Seasonal affective disorder. Am Fam Physician. 2006;74(9):1521-1524.
9. Lam RW, Levitt AJ, Levitan RD, et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry. 2006;163(5):805-12.
10. Lam RW, Levitt AJ. Canadian Consensus Guidelines for the treatment of seasonal affective disorder. 1999 Clinical & Academic Publishing. Available at: http://www.ubcmood.ca/sad/CCG%20SAD%201999.pdf/ Accessed: December 19, 2012.
11. Modell JG, Rosenthal NE, Harriett AE, et al. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biol Psychiatry. 2005;58(8): 658-667.