Treatment of Seasonal Affective Disorder
Light therapy at 10,000 lux for 30 minutes each morning is the first-line treatment for seasonal affective disorder. 1
First-Line Treatment: Light Therapy
Light therapy should be administered using specific parameters that have been validated in clinical practice:
- Administer 10,000 lux for 30 minutes daily in the morning, which is the standard evidence-based regimen 1
- Alternatively, 2,500 lux for 2 hours daily can be used if the higher intensity device is unavailable 1
- Morning administration is superior to evening treatment and should be the standard timing 1
- Treatment response typically occurs within 1-2 weeks, and therapy should be modified if inadequate response occurs within 6-8 weeks 2
Safety Monitoring for Light Therapy
Light therapy has a favorable safety profile, but specific monitoring is required:
- Side effects are generally mild and include eyestrain, nausea, and agitation, with most resolving spontaneously 1
- The most significant risk is emergent hypomania, particularly in the first few days of treatment, requiring close monitoring 1
- Patients with pre-existing eye disease or those taking photosensitizing medications require periodic ophthalmologic and dermatologic monitoring 1
- Additional mild side effects may include jumpiness/jitteriness (8.8%), headache (8.4%), and nausea (15.9%), though symptom remission often equals or exceeds emergence 3
Alternative and Adjunctive Treatments
Pharmacotherapy
When light therapy alone is insufficient or not preferred:
- Antidepressants can be used as monotherapy or in combination with light therapy 4, 5
- Bupropion has the strongest evidence for long-term use and prevention of recurrence 4
- SSRIs are also effective options for SAD treatment 4
- Treatment should be continued for 4-9 months after satisfactory response 2
Cognitive Behavioral Therapy
- CBT has a positive therapeutic effect when combined with light therapy and may help prevent SAD in subsequent seasons 5
- CBT alone is an option for patients who prefer non-pharmacologic approaches 4
Lifestyle Interventions
- Increasing exercise and exposure to natural light are recommended adjunctive measures 4
Treatment Duration and Long-Term Management
- For recurrent SAD, long-term treatment or preventive intervention is typically indicated 4
- Successful treatment should be continued for 4-9 months after satisfactory response 2
- The predictable, repetitive nature of SAD makes preventive treatment feasible before symptom onset 6
- Monitor for high-stress periods or known risk periods for recurrence, such as winter months 7
Common Pitfalls to Avoid
- Do not use evening light therapy as first-line; morning administration is superior 1
- Do not discontinue treatment prematurely; continue for 4-9 months after response 2
- Do not overlook the risk of hypomania induction, especially in patients with bipolar disorder history 1
- Do not assume light therapy is ineffective if response doesn't occur within days; allow 1-2 weeks for initial assessment 2