What is the treatment for seasonal affective disorder?

From the Guidelines

Seasonal affective disorder (SAD) can be effectively treated with light therapy, involving daily exposure to a 10,000-lux light box for 20-30 minutes, typically in the morning, as recommended by the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1. The treatment of SAD should prioritize approaches that address the underlying causes of the disorder, including disruptions to circadian rhythms, serotonin and melatonin imbalances triggered by reduced sunlight exposure during winter months.

Key Treatment Approaches

• Light Therapy: The first-line treatment for SAD, which involves daily exposure to a 10,000-lux light box for 20-30 minutes, typically in the morning 1.
• Antidepressant Medications: Particular SSRIs like fluoxetine (Prozac), sertraline (Zoloft), or bupropion (Wellbutrin) are often prescribed at standard antidepressant doses and should be started before symptoms typically begin each year.
• Psychotherapy: Especially cognitive behavioral therapy (CBT), helps patients identify negative thought patterns and develop coping strategies, as supported by the evidence review 1.
• Lifestyle Modifications: Regular exercise, spending time outdoors, maintaining a consistent sleep schedule, and practicing stress management techniques can significantly improve symptoms.

Additional Considerations

• Vitamin D supplementation (1000-2000 IU daily) may benefit those with deficiencies.
• A combination approach often yields the best results, and treatment should begin before the difficult season and continue until spring when natural light increases. The updated guideline recommends bright light therapy for persons with mild to moderate MDD, regardless of seasonal pattern or seasonal component 1.

From the FDA Drug Label

1. 2 Seasonal Affective Disorder (SAD) Bupropion hydrochloride extended-release tablets (XL) are indicated for the prevention of seasonal major depressive episodes in patients with a diagnosis of seasonal affective disorder (SAD)
2. 3 Dosage for Seasonal Affective Disorder (SAD) The recommended starting dose for SAD is 150 mg once daily. After 7 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning.

The treatment for Seasonal Affective Disorder (SAD) is bupropion hydrochloride extended-release tablets (XL), with a recommended starting dose of 150 mg once daily, which may be increased to 300 mg once daily after 7 days of dosing 2.

• The dose should be individualized based on the patient's historical pattern of seasonal MDD episodes.
• Treatment should be initiated in the autumn, prior to the onset of depressive symptoms, and continued through the winter season.
• The dose should be tapered and discontinued in early spring.

From the Research

Treatment Options for Seasonal Affective Disorder

• Light therapy is a non-pharmacological treatment that exposes people to artificial light, and it has been shown to be effective in reducing the incidence of SAD 3, 4, 5.
• The most commonly used protocol for light therapy is > 2500 lux white light for 2 hours per day, but newer protocols using 10,000 lux for 30 minutes have comparable response rates 4.
• Cognitive-behavioral therapy (CBT) is also a promising treatment for SAD, and it has been shown to be comparable to light therapy in terms of efficacy 6, 7.
• Combination of CBT and light therapy may be more effective than either treatment alone, with a higher remission rate 6.
• Medications such as fluoxetine, d-fenfluramine, and propranolol have also been shown to be effective in treating SAD, but more research is needed to demonstrate their long-term efficacy 4.

Efficacy of Light Therapy

• A meta-analysis of randomized controlled trials found that bright light therapy was superior to placebo in reducing depression scores and improving response to treatment 5.
• The efficacy of light therapy has been consistently demonstrated across multiple studies, with a moderate-to-large effect size 3, 4, 5.
• However, the quality of evidence for light therapy is limited by the small sample size and methodological limitations of the included studies 3, 5.

Comparison of Treatment Options

• CBT and light therapy have been shown to be comparable in terms of efficacy, with no significant difference in remission rates 7.
• The combination of CBT and light therapy may be more effective than either treatment alone, but more research is needed to confirm this finding 6.
• Medications may be effective in treating SAD, but more research is needed to demonstrate their long-term efficacy and compare them to other treatment options 4.