Medications

Antidepressant medications are commonly prescribed for Seasonal Affective Disorder, and because most depressive disorders are worse in the wintertime, prescriptions and doses increase during the Autum/winter. Two studies using Prozac (Fluoxitine) showed SAD patients responded well, but required 8-12 weeks for full response. Response rates in Seasonal Affective Disorder studies were similar to response rates for major depression.

Disadvantages

Antidepressants are not as successful as light therapy in treating SAD; not as many people respond, and response times are much longer. Antidepressants also pose problems with short and long-term side effects. However, some patients respond to medications who do not respond to light therapy.

Side Effects

Side effects from antidepressant medications may include weight gain, loss of sexual interest, headaches, nausea and insomnia. Antidepressants may also cause a rebound depression when discontinued.

Light Therapy and Medication

In Seasonal Affective Disorder cases where a patient does not respond well to light or medication alone, he/she may respond well to a combination of light and medication. In one study, over 50% who did not respond to light or medication responded to a combination of both. Additionally, since the discovery of wake therapy, light and medication may prove even more effective. Most studies comparing the benefits of combinations of light and medications, especially for non-seasonal major depression, note the positive benefits of using both light and medication. Most patients respond quickly, within 2 weeks, and the quality of the response is greater than with light or medication alone.

These results have led researchers to conclude that light and medication produce a synergistic response and should be considered when either treatment outcome is less than desired. When determining whether a patient should be considered for combined treatment, past history of major depression and tolerance of medication should be considered.

Disadvantages

Combination therapy should only be considered if the patient does not respond well to light therapy. Because treatments are combined, caution should be exercised to not over prescribe medication or light dosage.

Side Effects

Side effects are the same as those listed for light therapy and medication.

Cognitive Behavioral Therapy

CBT or talk therapy has gained inroads in the treatment of depressive disorders, and is noted particularly for its long-term success. These studies probed the possibility that more than the lack of light may be affecting SAD patients, and that the onset of winter also precipitates negative thinking and behavior. Some smaller studies have shown CBT to be helpful in dealing with Seasonal Affective Disorder, and one pilot study showed CBT participants more willing to continue talk therapy in the long run. Studies comparing light therapy and talk therapy showed greater improvement with CBT and light therapy than with either treatment alone.

When considering CBT or a combination of light therapy and CBT, therapists should evaluate the patient’s willingness and ability to continue in the program. If improvement is not measured within a few weeks, a different protocol or therapist should be recommended in order to avoid worsening symptoms.

Disadvantages

Talk therapy may cost hundreds of dollars per month and usually requires several months to a year to be successful. Talk therapy can be expensive when compared to light therapy or even medication. Some researchers have also questioned the validity of such non-placebo controlled trials, noting that participants may have been unduly influenced by the therapist and unable to continue the therapy by themselves.

Side Effects

There are no long-term side effects from talk therapy.

Self Medication

The vast majority of Seasonal Affective Disorder sufferers use light therapy on their own without the aid of a physician. This is because light therapy products are now readily available over the Internet and in several pharmacy related stores. In most cases, SAD symptoms can be easily managed without any side effects. Seasonal Affective Disorder is the result of a neurochemical disturbance and as such is different from other depressive disorders. However, SAD sufferers should always consult with their physicians because depressive symptoms could be hiding other more serious physical ailments, and the physician should always be aware of and mark ones progress.

Warnings With Self-Medication

Caveat Emptor (Buyer beware): The Society for Light Treatment and Biological Rhythms (SLTBR), the medical research body, has received several documented complaints from researchers and manufacturers concerning false claims, ineffectiveness and safety of several ‘light box companies,’ particularly from companies who market mainly via the Internet.

In 2000, a survey of light therapy companies showed that most non-research affiliated companies grossly exaggerated their product’s performance, while some openly advocated the use of UV light to treat Seasonal Affective Disorder. Unfortunately no policing organization regulates the production and sale of light therapy equipment. Ineffective equipment can cause patients to turn to antidepressants and lead physicians to become skeptical about light therapy’s effectiveness. Unsafe equipment can lead to ocular damage. In order to avoid this problem, the potential light therapy user should consider companies, which support and participate in published light therapy studies.

Other Concerns

Light therapy causes hormonal shifts, which should be monitored by a physician. Light therapy not only resets circadian rhythms, but it produces serotonin and suppresses melatonin and other sleep hormones—substances implicated in mood and depression. Although light has been found to be very safe, overuse can cause an over reaction, another reason to keep the physician informed.