What are the treatment options for Seasonal Affective Disorder (SAD)?

From the Guidelines

Treatment for Seasonal Affective Disorder (SAD) should prioritize bright light therapy as the first-line treatment, as it has been shown to be effective in reducing depressive symptoms, regardless of seasonal pattern or seasonal component. According to the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1, bright light therapy can be used in combination with other treatments or as monotherapy for treatment. This recommendation is based on evidence from a systematic review of 1200 patients, as well as 2 RCTs that showed similar results in patients without a seasonal element.

Key Treatment Options

• Bright Light Therapy: Daily exposure to a light box (10,000 lux) for about 20-30 minutes, typically in the morning, has been shown to be effective in reducing depressive symptoms.
• Psychotherapy: Cognitive-behavioral therapy (CBT) and other forms of psychotherapy, such as acceptance and commitment therapy, behavioral therapy, and interpersonal psychotherapy, can be effective in reducing depressive symptoms and achieving remission 1.
• Medication: Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed, particularly for patients with more severe symptoms.
• Lifestyle Changes: Increasing natural sunlight exposure, regular exercise, maintaining social connections, and following a balanced diet can also help alleviate symptoms of SAD.

Considerations

• Patient preferences, past experience with treatment, and provider training should be considered when selecting specific approaches to treatment.
• Telemedicine may be a viable option for patients who are underserved or homebound, although the evidence base is currently insufficient to make a clear recommendation 1.
• Vitamin D supplements may be beneficial for some individuals, although the evidence is mixed.

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) The efficacy of bupropion hydrochloride extended-release tablets in the prevention of seasonal major depressive episodes was established in 3 placebo-controlled trials in adult outpatients with a history of MDD with an autumn-winter seasonal pattern as defined in the DSM
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.

Treatment Options for 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 SAD.
• The recommended starting dose for SAD is 150 mg once daily, which can be increased to a target dose of 300 mg once daily in the morning after 7 days of dosing.
• 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 2.

From the Research

Treatment Options for Seasonal Affective Disorder (SAD)

• Light therapy is a first-line treatment option for SAD, which involves exposure to visible light of at least 2500 lux intensity at eye level 3, 4.
• The effects of light therapy are thought to be mediated exclusively by the eyes, not the skin, although this assumption has not yet been verified 4.
• Morning light therapy has proven to be superior to treatment regimens in the evening 4.
• Response rates to light therapy are about 80% in selected patient populations, with atypical depressive symptoms being the best predictor of a favorable treatment outcome 4.
• Commercial devices are available for administering light therapy or dawn simulation, with a typical effective dose of 2,500 to 10,000 lux for 30 to 60 minutes at the same time every day 3.
• Antidepressants, such as sertraline and fluoxetine, are also effective in the treatment of SAD, and may be used alone or in combination with light therapy 5, 4.
• Cognitive behavioral therapy has also been demonstrated to be effective in SAD 5.
• Lifestyle interventions, such as increasing exercise and exposure to natural light, are also recommended 3.
• Bupropion appears to have the strongest evidence supporting long-term use for the prevention of SAD recurrence 3.

Alternative Treatment Options

• Short exposure to light treatment, as short as 20 minutes, can improve depression scores in patients with SAD 6.
• BROAD (Bright, whole-ROom, All-Day) light therapy, which involves illuminating a room with 100,000 lumens, is a feasible and potentially effective treatment option for SAD 7.
• Exploratory analyses indicate that a higher illuminance (lux) is associated with a larger symptom improvement in the BROAD light therapy group 7.

Considerations for Treatment

• Patients with seasonal depressive symptoms should be thoroughly evaluated for any cues of bipolarity, and their treatment should be planned accordingly 5.
• Continuing light therapy or other antidepressants is likely beneficial for the long-term management of SAD, although evidence is inconclusive 3.
• Evidence is also inconclusive for psychotherapy and vitamin D supplementation as treatment options for SAD 3.