Long-Term and Preventative Treatment for Seasonal Affective Disorder
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Recurrent major depressive disorder with regular seasonal patterns, commonly known as seasonal affective disorder (SAD), has evoked substantial research in the last two decades. It is now recognised that SAD is a common condition with prevalence rates between 0.4% and 2.9% of the general population, and that patients with SAD experience significant morbidity and impairment in psychosocial function.
There is good evidence that bright light therapy and antidepressant medications are effective for the short-term treatment of SAD; however, given that SAD is characterised by recurrent major depressive episodes, long-term and maintenance treatment must be considered. Unfortunately, there are few studies of longer term (>8 weeks) and maintenance (preventative) treatments for SAD. The weight of evidence suggests that light therapy usually needs to be continued daily throughout the winter season because of rapid relapse when light is stopped too early in the treatment period. However, some studies support the use of antidepressants to continue the response from a brief (1–2 weeks) course of light therapy early in the depressive episode, as soon as the first symptoms emerge in autumn. Only small studies have examined preventative treatment (before onset of symptoms) with light therapy, all of which have methodological limitations. The best evidence for preventative treatment in SAD comes from antidepressant studies. Three large, randomised, placebo-controlled studies have shown that preventative treatment with bupropion XL reduces the recurrence rate of depressive episodes in patients with SAD.
Given the limitations in the evidence base and the inconsistent recurrence rate of winter depressive episodes, clinical recommendations for long-term and preventative treatment must individualise treatment choices and weigh potential benefits against possible adverse effects.
KeywordsPreventative Treatment Bupropion Depressive Episode Light Treatment Bright Light
Dr Westrin is funded by a fellowship award from Lund University Medical Faculty, Region Skåne and Ellen och Henrik Sjöbrings Minnesfond, and has no conflicts of interest that are directly relevant to the content of this review. Dr Lam is on speaker/advisory boards for, or has received research funds from, ANS, Inc., AstraZeneca, Biovail, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Eli Lilly, GlaxoSmithKline, GreatWest Life, Janssen, Litebook Company, Inc., Lundbeck, Sanofi-Aventis, Servier, VGH and UBC Hospital Foundation, and Wyeth. He has stock options in Litebook Company, Inc. No sources of funding were used to assist in the preparation of this review.
- 1.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington,DC: American Psychiatric Association, 1994Google Scholar
- 15.Thompson C. Evidence-based treatment. In: Partonen T, Magnusson A, editors. Seasonal affective disorder: practice and research. New York; Oxford University Press, 2001: 151–8Google Scholar
- 20.Lingjaerde O, Reichborn-Kjennerud T, Haggag A, et al. Treatment of winter depression in Norway: II. A comparison of the selective monoamine oxidase A inhibitor moclobemide and placebo. Acta Psychiatr Scand 1993; 88: 372–80Google Scholar
- 25.Parikh SV, Lam RW. Clinical guidelines for the treatment of depressive disorders: I. Definitions, prevalence, and health burden. Can J Psychiatry 2001; 46Suppl.1: 13–20SGoogle Scholar
- 26.Kennedy SH, Lam RW, Cohen NL, et al. Clinical guidelines for the treatment of depressive disorders: IV. Medications and other biological treatments. Can J Psychiatry 2001; 46Suppl.1: 38–58SGoogle Scholar
- 27.American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157(4 Suppl.): 1–45Google Scholar
- 28.Bauer M, Whybrow PC, Angst J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders (Pt 1): acute and continuation treatment of major depressive disorder. World J Biol Psychiatry 2002; 3: 5–43PubMedCrossRefGoogle Scholar
- 31.Lam RW, Levitt AJ, editors. Canadian consensus guidelines for the treatment of seasonal affective disorder. Vancouver (BC); Clinical and Academic Publishing, 1999 [online]. Available from URL: http://www.ubcsad.ca [Accessed 2007 Jul 24]