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CNS Drugs

, Volume 21, Issue 11, pp 901–909 | Cite as

Long-Term and Preventative Treatment for Seasonal Affective Disorder

  • Åsa Westrin
  • Raymond W. LamEmail author
Therapy In Practice

Abstract

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.

Keywords

Preventative Treatment Bupropion Depressive Episode Light Treatment Bright Light 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

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.

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington,DC: American Psychiatric Association, 1994Google Scholar
  2. 2.
    Rosenthal NE, Sack DA, Gillin JC, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41(1): 72–80PubMedCrossRefGoogle Scholar
  3. 3.
    Magnusson A, Partonen T. The diagnosis, symptomatology, and epidemiology of seasonal affective disorder. CNS Spectr 2005; 10(8): 625–34PubMedGoogle Scholar
  4. 4.
    Blazer DG, Kessler RC, Swartz MS. Epidemiology of recurrent major and minor depression with a seasonal pattern. The National Comorbidity Survey. Br J Psychiatry 1998; 172: 164–7CrossRefGoogle Scholar
  5. 5.
    Levitt AJ, Boyle MH, Joffe RT, et al. Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample. Can J Psychiatry 2000; 45(7): 650–4PubMedGoogle Scholar
  6. 6.
    Levitt AJ, Boyle MH. The impact of latitude on the prevalence of seasonal depression. Can J Psychiatry 2002; 47(4): 361–7PubMedGoogle Scholar
  7. 7.
    Sohn CH, Lam RW. Update on the biology of seasonal affective disorder. CNS Spectr 2005; 10(8): 635–46PubMedGoogle Scholar
  8. 8.
    Lam RW, Levitan RD. Pathophysiology of seasonal affective disorder: a review. J Psychiatry Neurosci 2000; 25(5): 469–80PubMedGoogle Scholar
  9. 9.
    Schlager D, Froom J, Jaffe A. Winter depression and functional impairment among ambulatory primary care patients. Compr Psychiatry 1995; 36(1): 18–24PubMedCrossRefGoogle Scholar
  10. 10.
    Pendse BP, Ojehagen A, Engstrom G, et al. Social characteristics of seasonal affective disorder patients: comparison with suicide attempters with non-seasonal major depression and other mood disorder patients. Eur Psychiatry 2003; 18(1): 36–9PubMedCrossRefGoogle Scholar
  11. 11.
    Michalak EE, Wilkinson C, Hood K, et al. Seasonally, negative life events and social support in a community sample. Br J Psychiatry 2003; 182: 434–8PubMedCrossRefGoogle Scholar
  12. 12.
    McElroy SL, Kotwal R, Malhotra S, et al. Are mood disorders and obesity related? A review for the mental health professional. J Clin Psychiatry 2004; 65(5): 634–51PubMedCrossRefGoogle Scholar
  13. 13.
    Terman M, Terman JS. Light therapy for seasonal and non-seasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005; 10(8): 647–63PubMedGoogle Scholar
  14. 14.
    Pjrek E, Winkler D, Kasper S. Pharmacotherapy of seasonal affective disorder. CNS Spectr 2005; 10(8): 664–9PubMedGoogle Scholar
  15. 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
  16. 16.
    Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162(4): 656–62PubMedCrossRefGoogle Scholar
  17. 17.
    Lam RW, Gorman CP, Michalon M, et al. Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder. Am J Psychiatry 1995; 152(12): 1765–70PubMedGoogle Scholar
  18. 18.
    Moscovitch A, Blashko CA, Eagles JM, et al. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. Psychopharmacology(Berl) 2004; 171(4): 390–7CrossRefGoogle Scholar
  19. 19.
    Hilger E, Willeit M, Praschak-Rieder N, et al. Reboxetine in seasonal affective disorder: an open trial. Eur Neuropsy-chopharmacol 2001; 11(1): 1–5CrossRefGoogle Scholar
  20. 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
  21. 21.
    Dilsaver SC, Qamar AB, Del Medico VJ. The efficacy of bupropion in winter depression: results of an open trial. J Clin Psychiatry 1992; 53: 252–5PubMedGoogle Scholar
  22. 22.
    Partonen T, Lonnqvist J. Moclobemide and fluoxetine in treatment of seasonal affective disorder. J Affect Disord 1996; 41(2): 93–9PubMedCrossRefGoogle Scholar
  23. 23.
    Lam RW, Levitt AJ, Levitan RD, et al. The Can-SAD Study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry 2006; 163(5): 805–12PubMedCrossRefGoogle Scholar
  24. 24.
    Frank E, Prien RF, Jarrett RB, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991; 48: 851–5PubMedCrossRefGoogle Scholar
  25. 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. 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. 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. 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
  29. 29.
    Pjrek E, Winkler D, Konstantinidis A, et al. Agomelatine in the treatment of seasonal affective disorder. Psychopharmacology (Berl) 2006; 190(4): 575–9CrossRefGoogle Scholar
  30. 30.
    Terman M, Terman JS, Quitkin FM, et al. Light therapy for seasonal affective disorder: a review of efficacy. Neuropsychopharmacology 1989; 2(1): 1–22PubMedCrossRefGoogle Scholar
  31. 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]
  32. 32.
    Thorell LH, Kjellman B, Arned M, et al. Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up. Int Clin Psychopharmacol 1999; 14Suppl. 2: S7–11PubMedGoogle Scholar
  33. 33.
    Martiny K, Lunde M, Simonsen C, et al. Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy: a placebo-controlled study. Acta Psychiatr Scand 2004; 109(3): 230–4PubMedCrossRefGoogle Scholar
  34. 34.
    Leonhardt G, Wirz-Justice A, Krauchi K, et al. Long-term follow-up of depression in seasonal affective disorder. Compr Psychiatry 1994; 35(6): 457–64PubMedCrossRefGoogle Scholar
  35. 35.
    Sakamoto K, Nakadaira S, Kamo K, et al. A longitudinal follow-up study of seasonal affective disorder. Am J Psychiatry 1995; 152(6): 862–8PubMedGoogle Scholar
  36. 36.
    Thompson C, Raheja SK, King EA. A follow-up study of seasonal affective disorder. Br J Psychiatry 1995; 167(3): 380–4PubMedCrossRefGoogle Scholar
  37. 37.
    Graw P, Gisin B, Wirz-Justice A. Follow-up study of seasonal affective disorder in Switzerland. Psychopathology 1997; 30(4): 208–14PubMedCrossRefGoogle Scholar
  38. 38.
    Meesters Y, Jansen JH, Beersma DG, et al. Early light treatment can prevent an emerging winter depression from developing into a full-blown depression. J Affect Disord 1993; 29(1): 41–7PubMedCrossRefGoogle Scholar
  39. 39.
    Terman JS, Terman M, Amira L. One-week light treatment of winter depression near its onset: the time course of relapse. Depression 1994; 2: 20–31CrossRefGoogle Scholar
  40. 40.
    Meesters Y, Jansen JH, Beersma DG, et al. An attempt to prevent winter depression by light exposure at the end of September. Biol Psychiatry 1994; 35(4): 284–6PubMedCrossRefGoogle Scholar
  41. 41.
    Partonen T, Lonnqvist J. Prevention of winter seasonal affective disorder by bright-light treatment. Psychol Med 1996; 26(5): 1075–80PubMedCrossRefGoogle Scholar
  42. 42.
    Meesters Y, Beersma DG, Bouhuys AL, et al. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Biol Psychiatry 1999; 46(2): 239–46PubMedCrossRefGoogle Scholar
  43. 43.
    Modell JG, Rosenthal NE, Harriett AE, et al. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biol Psychiatry 2005; 58(8): 658–67PubMedCrossRefGoogle Scholar
  44. 44.
    Lingaerde O, Foreland AR, Magnusson A. Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial. Acta Psychiatr Scand 1999; 100(1): 62–6PubMedCrossRefGoogle Scholar
  45. 45.
    Rohan KJ, Lindsey KT, Roecklein KA, et al. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. J Affect Disord 2004; 80(2-3): 273–83PubMedCrossRefGoogle Scholar
  46. 46.
    Pjrek E, Winkler D, Stastny J, et al. Bright light therapy in seasonal affective disorder: does it suffice? Eur Neuropsy-chopharmacol 2004; 14(4): 347–51CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Department of Clinical Sciences, Division of PsychiatryLund University HospitalLundSweden
  2. 2.Division of Clinical Neuroscience, Department of PsychiatryUniversity of British Columbia (UBC)VancouverCanada

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