Depression can have a recurrent seasonal pattern known as seasonal affective disorder (SAD). The most common pattern occurs in the fall or winter, and remits in the spring or summer. That is, people with wintertime depression experience symptoms such as lethargy; loss of energy; increases in appetite, sleep, and weight; and a craving for carbohydrates and sugar.
Other individuals experience depression in the spring or summer, which remits in the fall or winter. Their symptoms are the opposite of wintertime depression. Individuals lose their appetite, lose weight, are agitated or anxious, and sleep less. They also might have more suicidal ideation.
Treatment varies depending on which seasonal pattern you have. The first line treatment for mild to moderate wintertime depression is light therapy. Individuals with more severe wintertime depression symptoms typically need medication, along with light therapy.
Light therapy does not work for summertime depression. Instead, medication and psychotherapy are recommended. Specifically, cognitive behavioral therapy may be helpful for both wintertime and summertime depression.
In addition to the particular seasonal pattern you have and the severity of the episodes, treatment might vary based on what’s worked for you in the past and what medication you can tolerate, and of course, your personal preference.
Medication for SAD
As mentioned previously, whether you start taking medication really depends on the severity of your symptoms: Typically, individuals with moderate to severe seasonal affective disorder (SAD) will be prescribed an antidepressant.
Currently, the only medication approved by the U.S. Food and Drug Administration for SAD is extended release bupropion (Wellbutrin XL). Specifically, it’s approved for the prevention of the condition. This means that if you struggle with SAD in the wintertime, according to UpToDate.com, your doctor might prescribe bupropion about 4 weeks before your symptoms typically start (this information will be based on your prior history of SAD), and you’ll likely stop taking it in the spring or summer.
However, bupropion doesn’t work for everyone. A 2015 Cochrane review found that in high-risk populations who have recurrent episodes of SAD, four out of five people didn’t benefit from preventative treatment.
The same review found that the most common and bothersome side effects of bupropion were headaches, insomnia, and nausea.
Selective serotonin reuptake inhibitors (SSRIs) also are prescribed for SAD. While the research is limited, it suggests that SSRIs—particularly sertraline (Zoloft) and fluoxetine (Prozac)—are effective in reducing symptoms when compared to placebo. Also, SSRIs are the first line pharmacological treatment for clinical depression. Since SAD is a subtype of depression, these medications seem to be an appropriate choice. Side effects of SSRIs include weight gain, sexual dysfunction, drowsiness, and nausea.
You might need to try several antidepressants before you find the right medication for you.
Overall, it’s common practice to begin medication when you are well—weeks before your symptoms usually start—and to continue taking it until the start of the new season. Some people also continue taking medication yearlong—particularly individuals who relapsed right after stopping their medication or have severe seasonal episodes.
Light Therapy for SAD
Light therapy helps individuals with wintertime SAD boost their energy and mood and reduce sleepiness. There are two kinds of light therapy: bright light therapy and dawn simulation.
Bright light therapy is administered through a light box, which emits artificial light that mimics natural sunlight. The most effective light boxes emit 10,000 lux, which is a measure of light intensity.
The best approach is to use your light box for 30 minutes every day at the same time of day (early morning seems to work much better than late morning or evening). You can purchase a light box, and use it at home while doing other activities, such as writing, reading, eating, watching TV, talking on the phone, or working on your computer. The key is to keep your eyes open, but don’t look directly into the light. You should sit about 16 to 24 inches away from the light box.
Bright light therapy is safe, and doesn’t affect the health of your eyes. However, as a precaution, UpToDate.com recommends seeing an ophthalmologist before you start light therapy and every year after that if you have a pre-existing eye condition, such as cataracts or macular degeneration; systemic disease that involves the retina, or makes your eyes vulnerable, such as diabetes; or a family history of ophthalmological conditions.
Regular check-ups also are important if you’re taking medication that makes you extra sensitive to sunlight, such as lithium, tricyclic antidepressants, antibiotics (e.g., tetracycline).
When looking for a light box, psychiatrist Norman Rosenthal, MD, who first described SAD and coined the term in 1984, suggests buying a bigger box that has fluorescent (instead of LED light), and white light (instead of blue).
Bright light therapy does have some mild side effects, such as headaches, eye strain, irritability, and insomnia (if it’s used too late or too early in the day).
The second form of light therapy is dawn simulation, which you can use in combination with bright light therapy. Dawn simulation uses less intense light than bright light therapy, and starts working while you’re asleep in the early morning. The device gradually emits light that mimics the gradual rising of the sun. In other words, it’s as if you’re waking up to a spring or summertime sunrise.
It’s important to use light therapy under the supervision of a health professional, because every person is different (e.g., you might only need to use your light box for 20 minutes). Also, light therapy can trigger hypomania or mania in individuals with bipolar disorder. And light therapy doesn’t work for everyone, which is why taking medication and seeing a therapist can be invaluable (along with engaging in healthy habits).
The psychosocial treatment of choice is cognitive behavioral therapy (CBT) that’s specifically tailored for seasonal affective disorder (SAD). CBT-SAD focuses on changing maladaptive thoughts and problematic behaviors to reduce symptoms and prevent SAD from recurring.
For instance, if you have wintertime depression, you might challenge and change your negative views on winter, and engage in enjoyable activities. Because lethargy and fatigue can be all-consuming, you also start small—such as 10 minutes of a specific activity. Plus, you and your therapist will discuss possible obstacles that prevent you from engaging in different enjoyable activities, and brainstorm how to overcome these obstacles.
CBT-SAD also includes psychoeducation, which teaches individuals about SAD and how it manifests.
In a 2015 study, researchers found that CBT-SAD worked better than light therapy two winters after initial treatment for individuals with wintertime SAD. That is, individuals had fewer recurrences and less severe depression symptoms. The format of this treatment was 90-minute sessions twice a week for 6 weeks in a group setting.
Self-Help Strategies for SAD
- Practice good sleep hygiene. Try to go to bed and wake up at the same time every day. Avoid electronics a few hours before your bedtime, which tend to activate the brain. Create a relaxing environment in your bedroom. Spray or diffuse essential oils that are known for their calming effects, such as lavender. If you have summertime depression, turn up the air conditioner, use darkening shades, and don’t use night lights.
- Get outside as much as possible. If you have wintertime depression, take daily walks. Spend your lunch hour sitting on a park bench. Sit by an open window as sunlight streams in. Try to participate in outdoor wintertime activities, such as skiing or snowshoeing.
- Minimize stress. Stress can deepen depression. Dr. Rosenthal, who first described SAD in the 1980s, suggests minimizing stress as much as possible (e.g., don’t take on projects with a spring deadline if you struggle with wintertime depression). He also suggests practicing meditation. Rosenthal has personally found Transcendental Meditation (TM) to help him in managing his own SAD symptoms. There are many types of meditation practices, so consider trying different options when you’re well, so one becomes part of your daily routine.
- Exercise is critical in boosting your energy and mood and in reducing stress. If you have wintertime depression, you might take your exercise outside. If you have summertime depression, you might exercise indoors: Take a dance class, do a yoga DVD at home, or join a gym (if you actually want to). The key is to find enjoyable ways to move your body.
- Limit sunlight. For individuals with summertime depression, limiting sunlight, especially in the late afternoons and evenings, may help to reduce symptoms. You can do simple things such as wear sunglasses, and again exercise indoors.
- Be consistent. If you’re using a light box, make sure you’re using it daily at the same time. If you’re seeing a therapist, make sure you’re attending all your sessions. If you’re taking medication, make sure to take it every day as prescribed—and raise any questions or concerns you might have with your prescribing physician. Never stop taking medication without first consulting your doctor.
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