Prevention of winter seasonal affective disorder by bright-light treatment. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Hypericum in the treatment of seasonal affective disorders. Treatment of seasonal affective disorder (SAD) with hypericum extract. Effects of rapid tryptophan depletion in patients with seasonal affective disorder in remission after light therapy. Controlled trial of bright light and negative air ions for chronic depression. Seasonal depression: the dual vulnerability hypothesis revisited. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial Follow-up study of seasonal affective disorder in Switzerland. Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Light visor treament for seasonal affective disorder: A multicenter study An attempt to prevent winter depression by light exposure at the end of September Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment. Effects of morning phototherapy on circadian markers in seasonal affective disorder. A Multicenter Study of the Light Visor for Seasonal Affective Disorder: No Difference in Efficacy Found Between Two Different Intensities Bright light therapy: side effects and benefits across the symptom spectrum. Effects of bright light on mood in normal elderly women A controlled trial of light therapy for the treatment of pediatric seasonal affective disorder. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure [Sleep deprivation as a predictor of response to light therapy in major depression]. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study. Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo‐controlled study Prediction of outcome of bright light treatment in patients with seasonal affective disorder: Discarding the early response, confirming a higher atypical balance, and uncovering a higher body mass index at baseline as predictors of endpoint outcome.
In patients with winter seasonal affective disorder ( SAD ) the onset of a depressive episode is probably associated with the decreasing amount of light during the autumn . A highly predictable onset of a recurrent depressive episode with seasonal pattern provides a rationale for testing the efficacy of bright-light treatment as a preventive measure . Twelve out- patients with winter SAD were assigned to start bright light treatment either when they were well , or not to start it until the first symptoms of depression had already emerged . The severity of depressive symptoms was prospect ively rated for a parallel r and omized comparison . Bright light given well in advance of the emerging symptoms prevented a depressive episode . Clinical remission was significantly more frequent in the former subgroup of the patients in January and in March . To sum up , bright light can be successfully administered as prophylactic treatment for the prevention of winter SAD BACKGROUND Thirty-eight patients with SAD participated in a light visor study addressing two questions . 1 . Can the development of a depressive episode be prevented by daily exposure to bright light started before symptom onset in early fall and continued throughout the winter ? 2 . Does the light have to be visible in order to have beneficial effects ? METHODS Three groups participated in the study : I ( n = 14 ) received bright white light ( 2500 lux ) ; II , ( n = 15 )  received infrared light ( 0.18 lux ) ; III ( n = 9 ,  control group ) did not receive any light treatment at all . RESULTS Infrared light is just as effective as bright white light . Both are more effective than the control condition . CONCLUSIONS Light visors can be effectively used to prevent the development of SAD . The fact that exposure to infrared light was as effective as exposure to bright white light questions the specific role of visible light in the treatment of SAD Seasonal affective disorder ( SAD ) represents a subgroup of major depression with a regular occurrence of symptoms in autumn/winter and full remission in spring/summer . Light therapy ( LT ) has become the st and ard treatment of this type of depression . Apart from this , pharmacotherapy with antidepressants also seems to provide an improvement of SAD symptoms . The aim of this controlled , single-blind study was to evaluate if hypericum , a plant extract , could be beneficial in treating SAD patients and whether the combination with LT would be additionally advantageous . Patients who fulfilled DSM-III-R criteria for major depression with seasonal pattern were r and omized in a 4-week treatment study with 900 mg of hypericum per day combined with either bright ( 3000 lux , n = 10 ) or dim ( < 300 lux , n = 10 ) light condition . Light therapy was applied for 2 hours daily . We found a significant ( MANOVA , P < .001 ) reduction of the Hamilton Depression Scale score in both groups but no significant difference between the two groups . Our data suggest that pharmacologic treatment with hypericum may be an efficient therapy in patients with seasonal affective disorder Seasonal affective disorder ( SAD ) is a subgroup of major depression and characterized by a regular occurrence of symptoms in autumn/winter and full remission or hypomania in spring/summer . Light therapy ( LT ) and recently pharmacotherapy with specific antidepressants have been shown to be beneficial . Within the array of pharmacotherapy hypericum extract has also been found to be effective in a single-blind study ( Martinez et al. , 1994 ) . In this 4 weeks treatment study 900 mg of hypericum was associated with a significant reduction in the total score of the Hamilton Depression Rating Scale . There was no significant difference when bright light therapy was combined with hypericum , compared to the situation without bright light therapy . Overall , hypericum was well tolerated and therefore the data suggest that pharmacological treatment with hypericum may be an efficient therapy in patients with SAD , which needs to be substantiated in further controlled studies BACKGROUND Previous studies show that rapid tryptophan depletion reverses the effects of therapy with serotonergic , but not noradrenergic , antidepressant drugs in patients with remitted nonseasonal depression . The objective of this study was to investigate the effects of rapid tryptophan depletion in patients with seasonal affective disorder ( SAD ) that was in clinical remission after light therapy .  METHODS Patients who met DSM-III-R criteria for recurrent major depressive episodes , seasonal ( winter ) pattern ( equivalent to SAD ) , were treated with a st and ard course of light therapy .  Ten patients with SAD in clinical remission after light therapy  underwent rapid tryptophan depletion in a placebo-controlled , double-blind crossover study . Behavioral ratings and plasma tryptophan levels were obtained before and after rapid tryptophan depletion . RESULTS Plasma total and free tryptophan levels were significantly reduced to 20 % of normal levels by the rapid tryptophan depletion . The depletion session result ed in significant increases in depression scores compared with the sham control session . Six of 10 patients had a clinical ly significant relapse of their depression following the tryptophan depletion session . CONCLUSIONS Rapid tryptophan depletion appears to reverse the antidepressant effect of bright light therapy in patients with SAD . This suggests that the therapeutic effects of bright light in SAD may involve a serotonergic mechanism BACKGROUND This r and omized controlled trial investigates the efficacy of two non-pharmacologic treatments , bright light and high-density negative air ions for non-seasonal chronic depression .  Both methods have shown clinical success for seasonal affective disorder ( SAD ) . METHOD Patients were 24 ( 75 % ) women and 8 ( 25 % ) men , ages 22 - 65 years ( mean age + /- S.D. , 43.7 + /- 12.4 years ) , with Major Depressive Disorder , Single Episode ( DSM-IV code , 296.2 ) , Chronic ( episode duration > or = 2 years ) . Patients were entered throughout the year and r and omly assigned to exposure to bright light ( 10 000 lux , n = 10 ) , or high-density ( 4.5 x 10(14 ) ions/s flow rate , n = 12 ) or low-density ( 1.7 x 10(11 ) ions/s , n = 10 , placebo control ) negative air ions . Home treatment sessions occurred for 1 h upon awakening for 5 weeks . Blinded raters assessed symptom severity weekly with the Structured Interview Guide for the Hamilton Depression Rating Scale -- Seasonal Affective Disorder ( SIGH-SAD ) version . Evening saliva sample s were obtained before and after treatment for ascertainment of circadian melatonin rhythm phase . RESULTS SIGH-SAD score improvement was 53.7 % for bright light and 51.1 % for high-density ions v. 17.0 % for low-density ions . Remission rates were 50 % , 50 % and 0 % respectively . The presence or severity of atypical symptoms did not predict response to either treatment modality , nor were phase advances to light associated with positive response . CONCLUSIONS Both bright light and negative air ions are effective for treatment of chronic depression . Remission rates are similar to those for SAD , but without a seasonal dependency or apparent mediation by circadian rhythm phase shifts . Combination treatment with antidepressant drugs may further enhance clinical response OBJECTIVE In DSM-IV , winter seasonal affective disorder ( SAD ) is classified as a seasonal pattern of recurrent major depressive episodes in winter with full remission of symptoms in summer . However , other groups with " winter depression " have been identified , including patients with incomplete summer remission ( ISR ) and subsyndromal SAD ( sub-SAD , winter depressive symptoms that do not meet criteria for major depression ) . In this study , we compare the clinical characteristics of these three seasonal groups and their response to light therapy . METHOD 558 patients assessed at a specialized SAD Clinic were diagnosed using DSM-III-R or DSM-IV criteria . Clinical information was recorded using a checklist at index assessment . A subset of patients ( N=192 ) were treated with an open , 2 week trial of light therapy using a 10000 lux fluorescent light box for 30 min per day in the early morning . Patients were assessed before and after treatment with the 29 item modified Hamilton Depression Rating Scale and clinical response was defined as greater than 50 % improvement in scores . RESULTS The rates of some melancholic symptoms , anxiety , panic , suicidal ideation , and family history of mood disorder were lowest in the sub-SAD group . The clinical response rates to light therapy  were highest in the sub-SAD group ( N=32 , 78 % ) , intermediate in the SAD group ( N=113 , 66 % ) , and lowest in the ISR group ( N=47 , 51 % ) . LIMITATIONS This was a retrospective study of patients seen in a specialty clinic , although information was obtained in a st and ardized format . The light therapy trial had an open design so that placebo response could not be determined . CONCLUSIONS There are differences in both the patterns of clinical symptoms and the response to light therapy  in these three groups with winter depression . These results are consistent with a dual vulnerability hypothesis that considers these groups to result from interaction of separate factors for seasonality and depression BACKGROUND The need to develop supplementary or alternative treatments for seasonal affective disorder ( SAD ) is underscored by the significant minority ( 47 % ) of SAD patients that is refractory to light therapy , the persistence of residual symptoms despite light treatment , and poor long-term compliance with light use . Because preliminary studies suggest that cognitive and behavioral factors are involved in SAD , cognitive-behavioral therapy ( CBT ) warrants investigation as a possible treatment option . METHODS We piloted a 6-week r and omized clinical trial to compare a st and ard light therapy protocol ; a novel , SAD-tailored , group CBT intervention ; and their combination in ameliorating and remitting a current SAD episode and as prophylaxis against episode recurrence . Depressive symptom severity and remission rates were assessed at post-treatment and at a 1-year follow-up visit to examine long-term treatment durability . RESULTS CBT , light therapy , and their combination all demonstrated significant reductions in depressive symptoms on two different outcome measures . Remission rates varied by measure , but did not reach statistical significance . During the subsequent winter , CBT , particularly in combination with light therapy , appeared to improve long-term outcome regarding symptom severity , remission rates , and relapse rates . No CBT-treated participant , with or without light , experienced a full SAD relapse compared to over 60 % of those treated with light alone . LIMITATIONS These results should be viewed as preliminary and are limited by the small sample size ( n=23 ) and lack of a control group . CONCLUSIONS The nearly half of SAD patients who do not remit with light alone may benefit from CBT as an adjunct or alternative treatment , especially as a prophylaxis against episode recurrence Background Seasonal affective disorder ( SAD ) is a subtype of recurrent depression involving major depressive episodes during the fall and /or winter months that remit in the spring . The central public health challenge in the management of SAD is prevention of winter depression recurrence .  Light therapy ( LT ) is the established and best available acute SAD treatment . However , long-term compliance with daily LT from first symptom through spontaneous springtime remission every fall/winter season is poor . Time-limited alternative treatments with effects that endure beyond the cessation of acute treatment are needed to prevent the annual recurrence of SAD . Methods / design This is an NIMH-funded R01-level r and omized clinical trial to test the efficacy of a novel , SAD-tailored cognitive-behavioral group therapy ( CBT ) against LT in a head-to-head comparison on next winter outcomes . This project is design ed to test for a clinical ly meaningful difference between  CBT and LT on depression recurrence in the next winter ( the primary outcome ) . This is a concurrent two-arm study that will r and omize 160 currently symptomatic community adults with major depression , recurrent with seasonal pattern , to CBT or LT .  After 6 weeks of treatment in the initial winter , participants are followed in the subsequent summer , the next winter , and two winters later . Key method ological issues surround timing study procedures for a predictably recurrent and time-limited disorder with a focus on long-term outcomes . Discussion The chosen design answers the primary question of whether prior exposure to CBT is associated with a substantially lower likelihood of depression recurrence the next winter than LT . This design does not test the relative contributions of the cognitive-behavioral treatment components vs. nonspecific factors to CBT ’s outcomes and is not adequately powered to test for differences or equivalence between cells at treatment endpoint . Alternative design s addressing these limitations would have required more patients , increased costs , and reduced power to detect a difference in the primary outcome .Trial registration Clinical trials.gov identifier Of 39 diagnosed Seasonal Affective Disorder ( SAD ) patients who were interviewed 2 - 5 years after participation in a light therapy trial , 10 continued to have recurrent  major depressive episodes  in winter , and 17 manifested sub-syndromal SAD ( 2 patients also had recurrent brief depression , seasonal type ) . 8 patients had recovered , and 4 had shifted in symptomatology . Thus , over a number of years , the clinical diagnosis changed for the better in 64 % of the patients , suggesting that SAD is not a prodromal form of a more chronic major affective disorder , and that light therapy ( and perhaps also light-oriented behaviour ) reduced the incidence and depth of subsequent depressive episodes . Further evidence for this was the large reduction in use of conventional antidepressant drugs ( from 17 to 1 ) during the follow-up period . Diagnosis of SAD was stable and reliable Seasonal affective disorder ( SAD ) is a syndrome characterized by recurrent depressions that occur annually at the same time each year . We describe 29 patients with SAD ; most of them had a bipolar affective disorder , especially bipolar II , and their depressions were generally characterized by hypersomnia , overeating , and carbohydrate craving and seemed to respond to changes in climate and latitude . Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave ( delta ) sleep . Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect The effectiveness of light therapy in seasonal affective disorder ( SAD ) was evaluated in 105 subjects across five centers . Three intensities of light ( 60 lux , 600 lux , and 3500 lux ) were used in a 2-week r and omized , parallel design . There was no significant difference in antidepressant efficacy of the three intensities of light . All three intensities produced a similar frequency of antidepressant response to each other and to that reported in previous studies . There were site differences in the severity of depression during light treatment , but diagnosis and medication status did not affect antidepressant response . These findings suggest that light therapy has an antidepressant action by a nonspecific effect or that light is biologically active in the treatment of SAD across a wide range of intensities Seasonal affective disorder ( SAD ) , winter type , is characterized by the occurrence of depression in autumn/winter , followed by a complete recovery in spring/summer . In SAD patients , some atyp- ical symptoms are highly characteristic , such as hypersomnia , carbohydrate craving , weight gain , fatigue , and loss of social inter- actions ( Rosenthal et ai 1984 ) . The repeated occurrence of symp- toms during successive winters is one of the diagnostic criteria , l ~ lot every SAD patient becomes depressed every year , however . In prospect i ve studies it was found that 70,4 % of the SAD diagnosed subjects who were followed from a symptom-free moment at the end of September , became depressed during the following winter ( Meesters et al 1991 ; 1993a ) , In a previous study it was found that severe winter depression can be prevented by light treatment administered at the first signs of an emerging winter depression , that is , the moment subjects reported complaints of slight depression ( Meesters et al 1991 ; 1993a ) . In the present study , the question was raised whether light exposure given at the beginning of the winter season , when sub- jeers are still free of symptoms , could be successful in preventing the development of a winter depressmn during the rest of the season . Such a ueatment , which might prevent depression alto- gether , would be highly advantageous The central public health challenge in the management of  seasonal affective disorder ( SAD ) is prevention of depression recurrence each fall/winter season . The need for time-limited treatments with enduring effects is underscored by question able long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year . We previously developed a SAD-tailored group cognitive-behavioral therapy ( CBT ) and tested its acute efficacy in 2 pilot studies . Here , we report an intent-to-treat ( ITT ) analysis of outcomes during the subsequent winter season ( i.e. , approximately 1 year after acute treatment ) using participants r and omized to CBT , light therapy , and combination treatment across our pilot studies ( N=69 ) . We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment , were withdrawn from protocol , or were lost to follow-up . The CBT ( 7.0 % ) and combination treatment ( 5.5 % ) groups had significantly smaller proportions of winter depression recurrences than the light therapy group ( 36.7 % ) . CBT alone , but not combination treatment , was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone . Among completers who provided 1-year data , all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy , antidepressants , and psychotherapy . If these findings are replicated , CBT could represent a more effective , practical , and palatable approach to long-term SAD management than light therapy BACKGROUND The suppression of melatonin by light at 00.30 hours has been shown to be greater in winter than in summer on patients with seasonal affective disorder ( SAD ) but not in matched normal controls . METHOD In this study 12 patients with SAD and 12 matched normal controls were exposed to morning light therapy in the winter .  Melatonin profiles and sensitivity to light were measured before and after treatment . RESULTS The SAD but not the normal group showed a phase advance of melatonin rhythms in response to phototherapy . There was an association between phase position and phase shift in the SAD but not in the normal group . CONCLUSIONS There may be instability of circadian rhythms in SAD mediated by a high-amplitude phase response curve , rather than a fixed phase abnormality as had been previously suggested . This instability may be secondary to impaired serotoninergic function in the afferent pathways to the suprachiasmatic nuclei Fifty-five patients with winter seasonal affective disorder ( SAD ) were treated with a light visor , a newly developed portable light-delivery system , in a controlled parallel design . A dim ( 400 lux ) visor was compared with a bright ( 6000 lux ) visor for either 30 or 60 minutes in the morning for 1 week . Response rates for these two treatments were 36 % and 56 % , respectively ; the duration of treatment sessions did not affect outcome . There was no evidence that the brighter visor was superior in efficacy to the dimmer one . Significantly greater relapse occurred following withdrawal of the dimmer visor . Alterative explanations for these findings are that the light visor is acting as a placebo or that it is equally effective over a wide range of intensities BACKGROUND Bright light therapy has been established for treatment of winter depression , or seasonal affective disorder ( SAD ) . Analysis of side effects most often have focused on a narrow set of suspected symptoms , based on clinical observation ( e.g. , headache , eyestrain , nausea , insomnia , and hyperactivity ) . This study broadens the purview to a set of 88 physical and subjective symptoms that might emerge , remit , or remain unchanged relative to baseline , thus reducing bias toward assessment of presumed side effects . METHOD Eighty-three patients with SAD ( DSM-III-R criteria for mood disorders with seasonal pattern [ winter type ] and National Institute of Mental Health criteria for SAD ) received bright light therapy at 10,000 lux for 30 minutes daily in the morning or evening for 10 to 14 days . They completed a question naire ( Systematic Assessment for Treatment Emergent Effects ) , rating symptom severity before and after treatment . Results were compared for morning or evening treatment and for responders and nonresponders . RESULTS Several side effects emerged -- mostly mildly -- including jumpiness/jitteriness ( 8.8 % ) , headache ( 8.4 % ) , and nausea ( 15.9 % ) , mirroring findings of past studies with a less inclusive scope . In most cases , remission rate equalled or exceeded emergence rate . Several nondepressive symptoms also showed large improvement , including poor vision and skin rash/itch/irritation . Being overactive/excited/elated showed greater emergence under morning light and greater remission under evening light . Emergence of nausea was greater than remission in responders . CONCLUSION The dominant effect of light treatment was improvement in bothersome symptoms . Although patients should be advised of side effects and guided in dose manipulations to reduce them , attention also should be drawn to the substantial benefit-to-risk ratio . Improvement of symptoms outside the depressive cluster , seen in both responders and nonresponders , may point to new therapeutic uses of light therapy Reduced light appears to be a key factor in seasonal affective disorder ( SAD ) . This study asks whether the reduced levels of light experienced by elderly persons might result in depression and other SAD symptoms , and how normal elderly persons might respond to bright light interventions similar to those used to treat SAD . In interviews with 140 senior citizens , we found virtually no seasonal variation in mood and behavior and very little depressed affect .  Seventeen of these seniors who had good mental and physical health , with no major eye problems , participated in a crossover study of the effects of bright light on both positive and negative affect and sleep . Although sleep did not appear to be affected , the bright light intervention tended to make these normal elderly persons feel worse -- more irritable , anxious , and agitated . These findings confirm earlier reports that bright light is not beneficial for normal individuals who are unaffected by seasonal changes OBJECTIVE To evaluate the efficacy of light therapy for the treatment of pediatric seasonal affective disorder ( SAD ) . METHOD 28 children ( aged 7 to 17 years ) at two geographically distinct sites were enrolled in a double-blind , placebo-controlled , crossover trial of bright-light treatment . Subjects initially entered a week-long baseline period during which they wore dark glasses for an hour a day . They were then r and omly assigned to receive either active treatment ( 1 hour of bright-light therapy plus 2 hours of dawn simulation ) or placebo ( 1 hour of clear goggles plus 5 minutes of low-intensity dawn simulation ) for 1 week . The treatment phase was followed by a second dark-glasses phase lasting 1 to 2 weeks . After this phase , the children received the alternate treatment . Response was measured using the parent and child versions of the Structured Interview Guide for the Hamilton Depression Rating Scale , Seasonal Affective Disorders version ( SIGH-SAD ) . RESULTS Data were analyzed as change from baseline . SIGH-SAD-P total depression scores were significantly decreased from baseline during light therapy compared with placebo ( one-way analysis of variance , rho = .009 ) , and no differences were found between the placebo and control phases . Subscores of atypical and typical depression were also significantly decreased during the active treatment ( rho = .004 and .028 , respectively ) . A similar trend was noted with the SIGH-SAD-C , but this did not reach significance . At the end of the study , 78 % of the parents question ed and 80 % of the children question ed rated light therapy as the phase during which the child " felt best . " CONCLUSION Light therapy appears to be an effective treatment for pediatric SAD OBJECTIVE Light therapy and antidepressants have shown comparable efficacy in separate studies of seasonal affective disorder treatment , but few studies have directly compared the two treatments . This study compared the effectiveness of light therapy and an antidepressant within a single trial . METHOD This double-blind , r and omized , controlled trial was conducted in four Canadian centers over three winter seasons . Patients met DSM-IV criteria for major depressive disorder with a seasonal ( winter ) pattern and had scores > or = 23 on the 24-item Hamilton Depression Rating Scale . After a baseline observation week , eligible patients were r and omly assigned to 8 weeks of double-blind treatment with either 1 ) 10,000-lux light treatment and a placebo capsule , or 2 ) 100-lux light treatment ( placebo light ) and fluoxetine , 20 mg/day . Light treatment was applied for 30 minutes/day in the morning with a fluorescent white-light box ; placebo light boxes used neutral density filters . RESULTS A total of 96 patients were r and omly assigned to a treatment condition . Intent-to-treat analysis showed overall improvement with time , with no differences between treatments . There were also no differences between the light and fluoxetine treatment groups in clinical response rates ( 67 % for each group ) or remission rates ( 50 % and 54 % , respectively ) . Post hoc testing found that light-treated patients had greater improvement at 1 week but not at other time points . Fluoxetine was associated with greater treatment-emergent adverse events ( agitation , sleep disturbance , palpitations ) , but both treatments were generally well-tolerated with no differences in overall number of adverse effects . CONCLUSIONS Light treatment showed earlier response onset and lower rate of some adverse events relative to fluoxetine , but there were no other significant differences in outcome between light therapy and antidepressant medication . Although limited by lack of a double-placebo condition , this study supports the effectiveness and tolerability of both treatments for seasonal affective disorder and suggests that other clinical factors , including patient preference , should guide selection of first-line treatment Objective : Bright light therapy in seasonal affective disorder ( SAD ) has been studied extensively . However , little attention has been given to subsyndromal seasonal affective disorder ( SSAD ) or the use of bright light in the workplace . Many patients using bright light boxes  complain of the inconvenience of use . Much of this inconvenience involves the often‐recommended early timing of the bright light therapy .  Patients , who already have difficulty awakening , often have difficulty using the bright light therapy soon after awakening before going to work . If bright light could be used effectively in the workplace , the treatment would be more convenient ; the improved convenience would probably improve compliance . In this study , we studied the effectiveness of bright light therapy  in subjects with SSAD in the workplace , comparing morning bright light with afternoon bright light Light  therapy ( LT ) is regarded as the treatment of choice for seasonal affective disorder ( SAD ) . In nonseasonal depression the results of light therapy are nonconclusive .  Sleep deprivation ( SD )  , however , is effective in 50 - 60 % of the patients with major depression . The predictive value of  Total Sleep Deprivation ( TSD ) for the treatment outcome of antidepressiva has been already examined . Purpose of the present study was to test whether  light therapy  is more beneficial in TSD responders than in TSD nonresponders . 40 in patients with major depressive disorder completed one night of TSD . Twenty TSD responders and 20 TSD nonresponders were r and omly assigned to 14 days of bright light therapy ( 2500 lux , 7 - 9 a.m. ) or 14 days of dim light therapy ( red light 50 lux , 7 - 9 a.m. ) . Manova with repeated measurements revealed a significant difference in the course of depression over the time between TSD responders and nonresponders , but no significant difference between bright and dim light . Questions of  placebo effect , of SAD and of personality variables as predictors of response to  SD and LT  are being discussed Rationale Seasonal affective disorder ( SAD ) is a relatively common cyclical depressive illness characterized by seasonal depressions during winter . The disorder is commonly responsive to light therapy , but antidepressant drug efficacy has not been definitely established . Serotonin selective re-uptake inhibitors are potentially efficacious treatments for SAD . Objectives The objective of this study was to evaluate the efficacy , tolerability and safety of sertraline treatment for SAD . Methods One hundred and eighty seven out patients with seasonal pattern recurrent winter depression ( DSM-III-R defined ) and a minimum 29-item Hamilton depression scale ( SIGH-SAD version ) score of 22 were r and omized to 8 weeks treatment with either sertraline or placebo in a double-blind , multi-country , multi-center , parallel-group , flexible dose ( 50–200 mg once daily ) study . Efficacy was investigated using physician and patient-rated scales measuring depression , anxiety and symptoms characteristic of seasonal affective disorder . Results Sertraline produced a significantly greater response than placebo at endpoint as measured by changes in the 29-item and 21-item Hamilton depression scales , the clinical global impression ( CGI ) severity scale , the Hamilton anxiety scale , and the hospital anxiety and depression scale . The proportion of sertraline-treated subjects achieving a response on the CGI improvement rating ( ratings of 1 or 2 ) at endpoint ( last observation carried forward ) was significantly greater than that of the placebo group . Overall sertraline was well tolerated with the most frequent placebo adjusted adverse events , being nausea , diarrhea , insomnia and dry mouth . Adverse events were mostly mild to moderate and transient . Conclusions Sertraline pharmacotherapy has been demonstrated to be an effective and well-tolerated therapy for out patients with SAD . As such , sertraline offers an important pharmacological option in the clinical management of this condition BACKGROUND The best available treatment for seasonal affective disorder ( SAD ) is light therapy . Yet , this treatment does not prevent recurrence of depression in subsequent seasons . The aim of the study is to gain preliminary insight in the efficacy of Mindfulness Based Cognitive Therapy ( MBCT ) in the prevention of SAD recurrence . METHODS This is a r and omized controlled pilot study , in which SAD patients in remission were r and omly allocated to an individual format of MBCT or a control condition ( i.e. treatment as usual ) . MBCT was given between May and June 2011 , when there was no presence of depressive symptoms . The Inventory for Depressive Symptomatology Self-Report ( IDS-SR ) , which patients received on a weekly basis from September 2011 to April 2012 , was used to assess moment of recurrence ( ≥20 ) and severity at moment of recurrence . RESULTS 23 SAD patients were r and omized to MBCT and 23 to the control condition . Kaplan-Meier survival curve showed that the groups did not differ in moment of recurrence ( χ²(1).41 , p=.52 ) . T-tests showed no group difference in mean IDS-SR scores at moment of recurrence ( t(31)=-.52 , p=.61 ) . LIMITATIONS The results are limited by small sample size ( n=46 ) and missing data of weekly IDS-SR assessment s. CONCLUSION The findings of this pilot RCT suggest that individual MBCT is not effective in preventing a SAD recurrence when offered in a symptom free period ( i.e. spring ) Objective : We have tested the relapse‐preventive effect of citalopram when compared with placebo in 282 patients with Seasonal Affective Disorder ( SAD ) responding to 1 week of light therapy BACKGROUND We tested the hypothesis that the early improvement in mood after the first hour of bright light treatment compared to control dim-red light would predict the outcome at six weeks of bright light treatment for depressed mood in patients with Seasonal Affective Disorder ( SAD ) . We also analyzed the value of Body Mass Index ( BMI ) and atypical symptoms of depression at baseline in predicting treatment outcome . METHODS Seventy-eight adult participants were enrolled . The first treatment was controlled crossover , with r and omized order , and included one hour of active bright light treatment and one hour of control dim-red light , with one-hour washout .  Depression was measured on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD version ( SIGH-SAD ) . The predictive association of depression scores changes after the first session . BMI and atypical score balance with treatment outcomes at endpoint were assessed using multivariable linear and logistic regressions . RESULTS No significant prediction by changes in depression scores after the first session was found . However , higher atypical balance scores and BMI positively predicted treatment outcome . LIMITATIONS Absence of a control intervention for the six-weeks of treatment ( only the first session in the laboratory was controlled ) . Exclusion of patients with comorbid substance abuse , suicidality and bipolar I disorder , and patients on antidepressant medications , reducing the generalizability of the study . CONCLUSION Prediction of outcome by early response to light treatment was not replicated , and the previously reported prediction of baseline atypical balance was confirmed . BMI , a parameter routinely calculated in primary care , was identified as a novel predictor , and calls for replication and then exploration of possible mediating mechanisms
Overall , both forms of preventive light therapy reduced the incidence of SAD numerically compared with no light therapy .
BACKGROUND Seasonal affective disorder ( SAD ) is a seasonal pattern of recurrent major depressive episodes that most commonly occurs during autumn or winter and remits in spring .
The prevalence of SAD ranges from 1.5 % to 9 % , depending on latitude .
The predictable seasonal aspect of SAD provides a promising opportunity for prevention .
This review - one of four review s on efficacy and safety of interventions to prevent SAD - focuses on light therapy as a preventive intervention .
Light therapy is a non-pharmacological treatment that exposes people to artificial light .
Mode of delivery ( e.g. visors , light boxes ) and form of light ( e.g. bright white light ) vary .
OBJECTIVES To assess the efficacy and safety of light therapy ( in comparison with no treatment , other types of light therapy , second-generation antidepressants , melatonin , agomelatine , psychological therapies , lifestyle interventions and negative ion generators ) in preventing SAD and improving patient-centred outcomes  among adults with a history of SAD .