Seasonal Affective Disorder Therapies

Introduction

Seasonal affective disorder (SAD) can be defined as “a type of recurring major depression with a seasonal pattern” (Melrose, 2015, p. 1). Its occurrence is frequently related to sunlight decrease during the winter season, but there are other patterns as well. Depending on latitude, SAD prevalence varies from 1.5% to 9% (Nussbaumer et al., 2015). Due to the predictable seasonal character of this disorder, it can be successfully prevented. Still, in case preventive measures were not taken, there are several alternatives for SAD therapy. This paper is dedicated to the analysis of SAD and some of its treatments.

Diagnosing Seasonal Affective Disorder

Successful treatment of any disorder is a consequence of timely and correct diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (as cited in Melrose, 2015, p. 1), depression with a seasonal pattern is characterized with the beginning and ending annually during a specific season, while in other seasons, full remittance is observed. To be diagnosed as SAD, the symptoms should last for at least two years. Moreover, there should be more seasons with depression than seasons without it during a lifetime. The observations provide evidence that disorders following a seasonal pattern are most frequently observed in winter (Melrose, 2015). Nevertheless, they can happen during other seasons as well.

Symptoms typical of SAD usually include a sad mood and a lack of energy (Melrose, 2015). Thus, individuals with SAD can experience sadness, irritation; they may cry or be tired and lethargic. Also, they frequently observe problems with concentration, sleep longer than usual, feel low energy, experience a general decrease in their activity, quit their social activities, feel the need for carbohydrates and sugars, which frequently results in gaining weight (Melrose, 2015).

Therapy Alternatives and their Effectiveness

The research by Rohan et al. (2015) presents the results of a randomized control trial comparing the opportunities of cognitive-behavioral therapy (CBT) for SAD as compared to light therapy. In this case, CBT-SAD was an adapted cognitive therapy traditionally used for depression. It implies “behavioral activation and cognitive restructuring to improve coping with winter, thereby alleviating depression and fortifying against relapse and recurrence” (Rohan et al., 2015, p. 863). The therapy also includes the identification of pleasant events and experiences and their fortification as a tool to resist winter anhedonia. One of the core components of CBT-SAD was the early identification of symptoms such as depressive thoughts and behaviors typical of SAD with further implementation of CBT to prevent recurrence of SAD.

Light therapy in this research was provided with the use of the “23×15½x3¼-in. SunRay” (produced by SunBox Company, Gaithersburg, Md.), “which emits 10,000 lux of cool white fluorescent light through an ultraviolet filter” (Rohan et al., 2015, p. 863). Considering the higher effectiveness of morning light therapy, the initial dose was estimated at 30 minutes just after awakening, with the further increase by 15 minutes on a weekly basis in case there were no side effects. The maximum dose was fixed at two hours per day.

The sample for the study by Rohan et al. (2015) consisted of 177 patients. Eighty-eight patients were randomly assigned to CBT-SAD, and 89 to light therapy. The research provided the following evidence for the use of light therapy and CBT for treating SAD. Both therapies had a positive impact on SAD within this study. Thus, depression severity reduced over six weeks of trial, and there was no meaningful difference between CBT-SAD and light therapy.

Moreover, the remission status was not statistically different between these two therapies (Rohan et al., 2015). The only differences revealed between the outcomes of treatments were in post-treatment depression scores and the proportions in remission. Another observation is that patients who had any comorbid diagnosis in addition to SAD demonstrated less progress in overcoming a depressive condition after the 6-week treatment than those without comorbidities. The effectiveness of light therapy is supported by other studies (Melrose, 2015). Moreover, it is considered to have less severe adverse effects than antidepressant treatment.

Although frequently resulting in adverse effects, the use of antidepressant medications is another alternative treatment for SAD (Melrose, 2015). As a rule, second-generation antidepressants are prescribed since SAD is considered to be a consequence of serotonin activity dysfunction. Some investigations, for example, by Cheung, Qamar, and Del Medico (as cited in Melrose, 2015, p, 3), provide evidence that such antidepressant as fluoxetine is as well tolerated by patients as light therapy and is effective.

Conclusions

On the whole, the seasonal affective disorder is preventable. In case it is correctly diagnosed and the symptoms are revealed timely, preventive measures, such as light therapy, can be applied. However, even is not prevented, there is a choice of therapies able to improve the depressive condition and reduce unpleasant symptoms of SAD. For example, light therapy is used as the least invasive method with a minimum of adverse effects. Also, cognitive-based therapy is applicable for SAD, and it is as effective as light therapy. Finally, antidepressant treatment is possible, which is as well leads to more adverse effects.

References

Melrose, S. (2015). Seasonal affective disorder: An overview of assessment and treatment approaches. Depression Research and Treatment, 2015, article 178564, 1-6. Web.

Nussbaumer, B., Kaminski-Hartenthaler, A., Fornesis, C., Morgan, L., Sonis, J., Gaynes, B., … Gartlehner, G. (2015). Light therapy for preventing seasonal affective disorder. Cochrane Database of Systematic Reviews, 11, article CD011269, 1-53. Web.

Rohan, K., Mahon, J., Evans, M., Ho, S., Meyerhoff, J., Postolache, T., & Vacek, P. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute outcomes. American Journal of Psychiatry, 172(9), 862-869. Web.