Seasonal Affective Disorder (SAD)

Treatment Overview

Treatment for seasonal affective disorder (SAD) doesn't cure the seasonal depression, but it can help relieve your symptoms. Light therapy is the main treatment for SAD, and research is continuing to determine the most effective way to use it. Medications and counselling may also be used to treat SAD.

Light therapy

Research has shown that light therapy is an effective treatment for SAD.²

There are two types of light therapy: bright light treatment, in which you sit in front of a "light box" for a certain amount of time (usually in the morning); and dawn simulation, which is done while you sleep. For dawn simulation, a low-intensity light is timed to go on at a certain time in the morning before you wake up, and it gradually gets brighter.

Light boxes are available commercially and use fluorescent lights that are brighter than indoor lights but not as bright as sunlight. Ultraviolet light, full-spectrum light, tanning lamps, and heat lamps should not be used. You place the light box at a specified distance from you on a desk or in front of a chair and use it while you read, eat breakfast, or work at a computer. Light therapy is usually prescribed for 30 minutes to 2 hours, depending on the intensity of the light used.³

Some people find dawn simulation light therapy more convenient because it works as they sleep. Light box therapy, which some studies have shown to be most effective if done in the morning, may be less convenient for people who have busy schedules.⁴ Yet some studies have found that dawn simulation therapy is not as effective as bright light (light box) therapy.³

It may take as little as 3 to 5 days or up to 2 weeks before you respond to light therapy. Stopping light therapy will likely cause you to relapse back into depression.³

Light therapy may work by resetting your "biological clock" (circadian rhythms), which controls sleeping and waking.

If you have eye problems or you take medications that make you light-sensitive, ask your health professional about whether light therapy is safe for you. Tell your health professional about any conditions you have and medications you are taking before you start treatment.

Light therapy will need to be continued for the entire time you are depressed. People who discontinue treatment usually lapse back into depression.⁵

Antidepressants

Antidepressants effectively treat episodes of depression in people with seasonal affective disorder. They can be used along with light therapy or alone.⁵ The most common antidepressants used to treat people with seasonal affective disorder include the following:

• Selective serotonin reuptake inhibitors (SSRIs). Examples include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), or sertraline (Zoloft) .
• Other antidepressants. Examples include bupropion (Wellbutrin or Zyban), desipramine, tranylcypromine (Parnate), or venlafaxine (Effexor).

SSRIs are usually the first type of antidepressants given to treat SAD. SSRIs often have less serious side effects than other antidepressants. These medications may take at least 3 to 4 weeks to start working. All antidepressant medications are started at low doses and increased gradually. When stopped, they should be decreased gradually to avoid side effects.

General side effects of antidepressant medications can include:

• Nausea, loss of appetite, or diarrhea.
• Anxiety or nervousness.
• Difficulty sleeping or drowsiness.
• Loss of sexual desire or ability.
• Headaches.

Bupropion can cause dry mouth. Bupropion should not be taken if you have seizures, severe problems with eating, or an eating disorder because it can cause seizures.

For more information on side effects, see:

Managing the side effects of antidepressants

Taking antidepressants wisely

For more information on drugs used to treat depression, see the topic Depression or see Drug Reference. (Drug Reference is not available in all systems.)

Counselling

Counselling, such as interpersonal therapy and cognitive-behavioural therapy, may help with your treatment for SAD. You may choose individual counselling, participate in group counselling, or seek family therapy. During counselling, you will learn about SAD, ways to handle the symptoms, and how to help prevent future depressive episodes. If you have had SAD for a long time, your family members may also benefit from counselling.

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Author:	Douglas Dana Sabra L. Katz-Wise	Last Updated: November 1, 2006
Medical Review:	Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Alfred Lewy, MD, PhD - Neurology, Psychiatry
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