Fast Five Quiz: Holidays and Mental Health

Stephen Soreff, MD

Disclosures

December 14, 2020

Available treatments for SAD include light therapy, pharmacotherapy, and psychotherapy, used either alone or in combination. No one treatment has been proven to be more efficacious than others, and treatments are often used in combination. Therefore, allowing patient preference and prior response to guide treatment is reasonable.

Various treatments used in patients with major depressive disorder may be effective in patients with SAD. Of note, if bipolar disorder is evident, winter depression should not be the only target of treatment. The full spectrum of the disorder should be treated, including mania or hypomania that may be evident during the spring and summer months.

Bright-light therapy (BLT) has an established role in the treatment of SAD and is often referred to as the treatment of choice. BLT for SAD is used at an intensity of 10,000 lux for 30-90 minutes daily, usually within 1 hour of arising in the morning. Like any effective antidepressant, BLT has the potential to precipitate a hypomanic or manic episode in susceptible individuals. Other common adverse effects include eye irritation, restlessness, and transient headaches. These lamps are not a significant source of ultraviolet light.

Cognitive-behavioral therapy (CBT) is effective in patients with SAD. In one study, 6 weeks of CBT provided in group format during two 90-minute sessions per week was as effective as 30 minutes of 10,000 lux of cool-white fluorescent light each morning. In regard to psychotherapy, patients with SAD who underwent CBT have shown a lower recurrence rate of depression the next winter than those who used BLT alone.

The data are limited in regard to psychoactive medications and their use in the treatment of SAD. At the present time, the SSRIs fluoxetine and sertraline have been the most studied and appear to be effective. Bupropion has been advocated as an effective medication in the treatment of SAD. One study found that bupropion XL (150-300 mg daily) started early in the season prevented recurrence of seasonal depressive episodes.

Read more about the treatment of SAD.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Seasonal Affective Disorder (SAD), Social Phobia, Depression, and Panic Disorder.

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