Reboxetine in seasonal affective disorder: an open trial Seasonal depression: the dual vulnerability hypothesis revisited. Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial Hypericum in the treatment of seasonal affective disorders. Prevention of winter seasonal affective disorder by bright-light treatment. Prevalence of seasonal affective disorder at four latitudes An attempt to prevent winter depression by light exposure at the end of September 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. The circadian basis of winter depression. Follow-up study of seasonal affective disorder in Switzerland. Seasonality and circadian phase delay: prospective evidence that winter lowering of mood is associated with a shift towards Eveningness. Moclobemide and fluoxetine in treatment of seasonal affective disorder. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder Modafinil treatment in patients with seasonal affective disorder/winter depression: an open-label pilot study. Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL Effects of morning phototherapy on circadian markers in seasonal affective disorder. Vitamin D3 enhances mood in healthy subjects during winter Effects of Alpha-Methyl-Para-Tyrosine-Induced Catecholamine Depletion in Patients with Seasonal Affective Disorder in Summer Remission Controlled trial of bright light and negative air ions for chronic depression. Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment. Agomelatine in the treatment of seasonal affective disorder Melatonin Treatment of Winter Depression Following Total Sleep Deprivation: Waking EEG and Mood Correlates A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Separation anxiety disorder in childhood as a risk factor for future mental illness.
Seasonal affective disorder ( SAD ) , winter type , is a condition characterized by the annual recurrence of depressive episodes during fall/winter , alternating with spring/summer euthymia or hypomania . Various neurotransmitters have been implicated in the etiology of SAD , the strongest evidence involving serotonin . Recently , increasing attention has been paid to the potential role of catecholaminergic pathways in the pathophysiology of SAD . We investigated the efficacy and tolerability of  reboxetine  , a selective noradrenaline inhibitor , in patients with SAD . Eleven out of sixteen patients who were included in a 6-week drug surveillance during winter season experienced full remission of depressive symptoms . Nine patients reported a rapid relief of preexistent severe atypical depressive symptoms within the first treatment week . Reboxetine might therefore be an effective and well-tolerated treatment option for SAD patients . In conclusion , our preliminary results are in line with evidence from recent studies suggesting that catecholaminergic systems might also be involved in the pathophysiology of SAD 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 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 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 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 The Seasonal Pattern Assessment Question naire ( SPAQ ) was mailed to a sample population balanced for sex and r and omly selected from local telephone directories in four areas : Nashua , NH , New York , NY , Montgomery County , MD , and Sarasota , FL . On the basis of responses to this question naire , prevalence rates of winter seasonal affective disorder ( winter SAD ) , summer seasonal affective disorder ( summer SAD ) , and subsyndromal winter SAD were estimated for the four areas . Rates of winter SAD and subsyndromal SAD were found to be significantly higher at the more northern latitudes , while no correlation was found between latitude and summer SAD . The positive correlation between latitude and prevalence of winter SAD applied predominantly to the age groups over 35 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 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 The following test of the circadian phase-shift hypothesis for patients with winter depression ( seasonal affective disorder , or SAD ) uses low-dose melatonin administration in the morning or afternoon/evening to induce phase delays or phase advances , respectively , without causing sleepiness . Correlations between depression ratings and circadian phase revealed a therapeutic window for optimal alignment of circadian rhythms that also appears to be useful for phase-typing SAD patients for the purpose of administering treatment at the correct time . These analyses also provide estimates of the circadian component of SAD that may apply to the antidepressant mechanism of action of appropriately timed bright light exposure , the treatment of choice . SAD may be the first psychiatric disorder in which a physiological marker correlates with symptom severity before , and in the course of , treatment in the same patients . The findings support the phase-shift hypothesis for SAD , as well as suggest a way to assess the circadian component of other psychiatric , sleep , and chronobiologic disorders 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 BACKGROUND Lewy 's phase shift hypothesis ( PSH ) of seasonal affective disorder ( SAD ) asserts that winter depression is caused by an abnormal delay of circadian phase in winter . The aim of this study was to further investigate the PSH by testing the novel hypothesis that winter pattern seasonality of mood in the general population is associated with a phase delay of circadian rhythms in winter . METHODS Using a r and om community sample of 244 adults in Melbourne , seasonality of mood was measured prospect ively as the within-subject difference between self-reports of behavioural engagement in summer and winter across 3 years . The  Horne-Ostberg Morningness-Eveningness question naire ( MEQ )  was used as a  self-report estimate of circadian phase . Phase delay in winter was measured as the within-subject difference between summer and winter estimates of circadian phase , with relative shifts towards Eveningness being interpreted as phase delay . RESULTS As expected , a significant association was found between winter pattern seasonality of mood and within-subject phase delay in winter ( r=0.17 , P<0.01 ) . LIMITATIONS Circadian phase was operationalised on the MEQ . While a number of studies have shown the MEQ to correlate with physiological measures of circadian phase , the findings await replication using a more direct measure of the circadian system . CONCLUSIONS A positive association was found between lowered mood in winter and winter phase delay amongst a r and om community sample . This provisional finding adds support to Lewy 's PSH by demonstrating that phase delay may be causally important not just in clinical cases of SAD , but across the continuum of mood seasonality Of a total of 581 consecutive depressed subjects attending psychiatric services of 6 centres in Finl and , 183 patients were eligible and completed a 6-week r and omised double-blind trial with either moclobemide or fluoxetine . Of these , 32 ( 17.5 % ) patients met the DSM-III-R criteria for mood disorder with a seasonal ( winter ) pattern and 19 patients ( 10.5 % ) met the original criteria for seasonal affective disorder ( SAD ) . There were no significant difference in the antidepressive response to the treatment between the patients with SAD and other depressive disorder . The treatment of 6 weeks with either moclobemide ( 300 - 450 mg daily ) or fluoxetine ( 20 - 40 mg daily ) result ed in a full remission in 15 ( 52 % ) patients with SAD and in 44 ( 37 % ) patients with other depressive disorder . Altogether , 23 ( 79 % ) and 83 ( 70 % ) patients , respectively , got significant benefit from the treatment . The improvement in the health-related quality of life in terms of ability to work was significantly more extensive in the patients with SAD assigned to receive moclobemide compared with the other depressive patients allocated to the same medication . Subjects who in addition met the operational criteria for atypical depression were equally distributed into the SAD and other depressive patient groups 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 Hypersomnia is a cardinal symptom of seasonal affective disorder/winter depression . This open-label pilot study assessed modafinil , a novel wake-promoting agent , as treatment for seasonal affective disorder/winter depression . METHODS Total daily modafinil dose was 100 mg ( all patients week 1 ) , and 100 mg or 200 mg split dose ( weeks 2 - 8 ) . Efficacy assessment s ( weeks 1 , 2 , 5 , and 8) included the Structured Interview Guide for the Hamilton Depression ( HAM-D ) Rating Scale , Seasonal Affective Disorder Version ( SIGH-SAD ) , Montgomery-Asberg Depression Rating Scale ( MADRS ) , Clinical Global Impression of Change ( CGI-C ) , Fatigue Severity Scale ( FSS ) , and Epworth Sleepiness Scale ( ESS ) . RESULTS Thirteen patients ( 11 women ; mean age , 41 years ) were enrolled , 12 were evaluable for efficacy ( 100 mg dose , five patients ; 200 mg dose , seven patients ) , and nine completed treatment . Modafinil significantly improved winter depression as shown by reductions from baseline in mean SIGH-SAD at week 1 ( P<0.01 ) through week 8 ( P<0.001 weeks 2 - 8 ) and MADRS total scores from week 2 through week 8 ( P<0.01 for all ) . At week 8 , mean SIGH-SAD total score was 17.1 ( versus 37.2 at baseline , P<0.001 ) , and mean MADRS total score was 13.3 ( versus 26.9 at baseline , P<0.01 ) . Modafinil significantly improved overall clinical condition at all time points ( P<0.001 ) . The response rate was 67 % on the SIGH-SAD ( 29 item ) , HAM-D ( 21 item ) , and MADRS , and 100 % on eight atypical SIGH-SAD items . Modafinil significantly reduced fatigue ( FSS ) and improved wakefulness ( ESS ) from weeks 2 through 8 ( P<0.01 ) . Modafinil was well tolerated . LIMITATIONS This was an open-label , single site study . CONCLUSIONS Modafinil may be an effective and well-tolerated treatment in patients with seasonal affective disorder/winter depression BACKGROUND Seasonal affective disorder ( SAD ) can cause significant distress and impairment . No antidepressant studies have previously attempted to prevent the onset of autumn-winter depression . METHODS Three prospect i ve , r and omized , placebo-controlled prevention trials were conducted on 1042 SAD patients , enrolled in autumn and treated while still well , across the northern US and Canada . Patients received either bupropion XL 150 - 300 mg or placebo daily by mouth from enrollment until spring and were then followed off medications for 8 additional weeks . Primary efficacy variables were end-of-treatment depression-free rates and survival distributions of depressive recurrence . RESULTS Despite a reported average of 13 previous seasonal depressive episodes , almost 60 % of patients had never previously been treated for depression . Major depression recurrence rates during the three studies for bupropion XL and placebo groups were 19 % versus 30 % ( p = 0.026 ) , 13 % versus 21 % ( p = 0.049 ) , and 16 % versus 31 % ; yielding a relative risk reduction across the three studies of 44 % for patients taking bupropion XL .  Survival analyses for depression onset also favored bupropion XL over placebo ( p = .081 , .057 , and < .001 ) . CONCLUSIONS It is possible to prevent recurrence of seasonal major depressive episodes by beginning bupropion treatment early in the season while patients are still well 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 Abstract Mood changes synchronised to the seasons exist on a continuum between individuals , with anxiety and depression increasing during the winter months . An extreme form of seasonality is manifested as the clinical syndrome of seasonal affective disorder ( SAD ) with carbohydrate craving , hypersomnia , lethargy , and changes in circadian rhythms also evident . It has been suggested that seasonality and the symptoms of SAD may be due to changing levels of vitamin D3 , the hormone of sunlight , leading to changes in brain serotonin . Forty-four healthy subjects were given 400 IU , 800 IU , or no vitamin D3 for 5 days during late winter in a r and om double-blind study . Results on a self-report measure showed that vitamin D3 significantly enhanced positive affect and there was some evidence of a reduction in negative affect . Results are discussed in terms of their implication s for seasonality , SAD , serotonin , food preference , sleep , and circadian rhythms Noradrenergic and dopaminergic mechanisms have been proposed for the pathophysiology of seasonal affective disorder ( SAD ) . We investigated the effects of catecholamine depletion using α-methyl-para-tyrosine ( AMPT ) , an inhibitor of tyrosine hydroxylase , in patients with SAD in natural summer remission . Nine drug-free patients with SAD by DSM-IV criteria , in summer remission for at least eight weeks , completed a double-blind , crossover study . Behavioral ratings and serum HVA and MHPG levels were obtained for 3-day sessions during which patients took AMPT or an active control drug , diphenhydramine . The active AMPT session significantly reduced serum levels of HVA and MHPG compared with the control diphenhydramine session . The AMPT session result ed in higher depression ratings with all nine patients having significant clinical relapse , compared with two patients during the diphenhydramine session . All patients returned to baseline scores after drug discontinuation . Catecholamine depletion results in significant clinical relapse in patients with SAD in the untreated , summer-remitted state . AMPT-induced  depressive relapse may be a trait marker for SAD , and /or brain catecholamines may play a direct role in the pathogenesis of SAD 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 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 ) 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 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 Rationale The novel antidepressant agomelatine acts as a melatonergic ( MT1 and MT2 ) receptor agonist and as a serotonin-2C receptor antagonist . Previous studies showed that agomelatine is able to restore disrupted circadian rhythms , which were implicated in the pathophysiology of seasonal affective disorder ( SAD ) . Objectives The aim of this study was to investigate the efficacy and tolerability of agomelatine in the treatment of SAD . Material s and methods Thirty-seven acutely depressed SAD patients were included in an open study with agomelatine ( 25 mg/day in the evening ) over 14 weeks . Efficacy assessment s included the Structured Interview Guide for the Hamilton Depression Rating Scale ( SAD version ; SIGH-SAD ) , the Clinical Global Impression of Severity ( CGI-S ) and Improvement ( CGI-I ) , the Circscreen , a self-rating scale for the assessment of sleep and circadian rhythm disorders , and the Hypomania Scale . Results Agomelatine led to a progressive and statistically significant decrease of SIGH-SAD , CGI-S , and CGI-I scores from week 2 onward ( p < 0.001 ) . Furthermore , scores on the Circscreen improved significantly during the study ( p < 0.001 ) . Treatment with agomelatine over 14 weeks yielded a response rate of 75.7 % ( SIGH-SAD < 50 % of baseline value ) and a remission rate ( SIGH-SAD < 8) of 70.3 % in the intention to treat sample . Scores on the Hypomania Scale were consistently low during the study . Agomelatine showed good overall tolerability : throughout the study only one adverse event ( mild fatigue ) was related to the study drug . Conclusions The results of this study suggest that seasonal depression may be effectively and safely treated with agomelatine Patients with winter depression ( seasonal affective disorder ( SAD ) ) commonly complain of sleepiness . Sleepiness can be objective ly measured by spectral analysis of the waking  electroencephalogram  ( EEG ) in the 1–10 Hz b and . The waking EEG was measured every 3 h in 16 female SAD patients and 13 age-matched control women throughout a  total sleep deprivation of 30 h.  Melatonin ( or placebo ) under double-blind conditions was administered subsequently ( 0.5 mg at 1700 h for 6 days ) , appropriately timed to phase advance circadian rhythms , followed by re assessment in the laboratory for 12 h. The increase in EEG power density in a narrow theta b and ( 5–5.99 Hz , derivation Fz – Cz ) during the 30 h protocol was significantly attenuated in patients compared with controls ( difference between linear trends p=0.037 ) . Sleepiness ( p=0.092 ) and energy ( p=0.045 ) self-ratings followed a similar pattern . Six patients improved after sleep deprivation ( ⩾50 % reduction on SIGH-SAD22 score ) . EEG power density dynamics was correlated with clinical response to sleep deprivation : the steeper the build-up ( as in controls ) , the better the improvement ( p<0.05 ) . There was no differential effect  of melatonin or placebo on any measure ; both treatments stabilized the improvement . Overall , patients with winter depression manifest similar wake EEG characteristics as long sleepers or late chronotype with respect to an insufficient build-up of homeostatic sleep pressure . Sleep deprivation was an effective antidepressant treatment for some patients , but evening melatonin was not more efficacious than placebo in sustaining this antidepressant effect This first controlled psychotherapy trial for seasonal affective disorder ( SAD ) compared SAD-tailored cognitive-behavioral therapy ( CBT ) , light therapy ( LT ) , and their combination to a concurrent wait-list control . Adults ( N = 61 ) with major depression , recurrent with seasonal pattern , were r and omized to one of four 6-week conditions : CBT ( 1.5-hr twice-weekly group therapy ) , LT ( 10,000-lux for 90-min/day with administration time individually adjusted ) , combined CBT + LT , or a minimal contact/delayed LT control ( MCDT ; LT following 6 weeks of monitoring ) . CBT , LT , and CBT + LT significantly and comparably improved depression severity relative to MCDT in intent-to-treat and completer sample s. CBT + LT ( 73 % ) had a significantly higher remission rate than MCDT ( 20 % ) . Using prospect ively measured summer mood status to estimate the " functional " population , CBT + LT also had a significantly larger proportion of participants with clinical ly significant change over treatment compared with MCDT . The LT condition outcomes virtually replicated results from prior trials . CBT , alone or combined with LT , holds promise as an efficacious SAD treatment and warrants further study . If replicated , CBT + LT 's  remission rate would represent a clinical ly meaningful improvement over the 53 % observed across LT studies BACKGROUND Disturbances of serotonergic neurotransmission appear to be particularly important for the pathophysiology of winter depression . This study investigated whether fluoxetine has antidepressant effects comparable to bright light in the treatment of seasonal affective disorder ( winter type ) . METHOD A r and omized , parallel design was used with rater and patients blind to treatment conditions . One week of placebo ( phase I ) was followed by 5 weeks of treatment ( phase II ) with fluoxetine ( 20 mg per day ) and a placebo light condition versus bright light ( 3000 lux , 2 h per day ) and a placebo drug . There were 40 patients ( 20 in each treatment condition ) suffering from seasonal affective disorder ( SAD ) according to DSM-III-R who had a total score on the Hamilton Depression Scale of at least 16 . RESULTS Forty patients entered phase II and 35 completed it ( one drop-out in the fluoxetine group and four in the bright light group ) . Fourteen ( 70 % ) of the patients treated with bright light and 13 ( 65 % ) of those treated with fluoxetine were responders ( NS ) . The remission rate in the bright light group tended to be superior ( bright light 50 % , fluoxetine 25 % ; P = 0.10 ) . Light therapy  improved HDRS scores significantly faster , while fluoxetine had a faster effect on atypical symptoms . Light treatment in the morning produced a significantly faster onset of improvement , but at the end of treatment the time of light application seemed not to be crucial . CONCLUSION Both treatments produced a good antidepressant effect and were well tolerated . An apparently better response to bright light requires confirmation in a larger sample 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 OBJECTIVE To ascertain the extent to which childhood separation anxiety disorder ( SAD ) confers risk for the development of psychopathology during young adulthood ( ages 19 - 30 ) . METHOD A subset of the participants of the Oregon Adolescent Depression Project ( n = 816 ) was used . Subjects provided retrospective reports of lifetime mental illness ( including SAD ) and concurrent reports of current mental illness at age 16 and were then followed prospect ively until age 30 . Diagnostic assessment s were conducted twice during adolescence and again at ages 24 and 30 . Based on diagnosis during childhood/adolescence , the subjects were partitioned into four orthogonal groups : SAD ( n = 42 ) , other anxiety disorders ( n = 88 ) , a  heterogeneous psychiatric disorders control group ( n = 389 ) , and a  not mentally ill control group ( n = 297 ) . Adjusting for demographic variables that were significantly associated with group status and for comorbid disorders prior to age 19 , the results were analyzed with hierarchical multiple logistic regression . RESULTS SAD was a strong ( 78.6 % ) risk factor for the development of mental disorders during young adulthood . The major vulnerabilities were for panic disorder and depression . CONCLUSIONS Because SAD creates a major vulnerability for mental disorders during young adulthood , clinicians should be sensitive to the presence of SAD , and children and adolescents with SAD should be treated . Future research should evaluate whether successful treatment of SAD and /or the provision of a preventive intervention during childhood/adolescence reduce the risk for future psychopathology
Recent systematic review s have shown that  light therapy  is an efficacious and well-tolerated treatment for SAD .
There is also evidence for efficacy of pharmacotherapy to treat and prevent SAD .
SAD is a common condition with significant psychosocial impairment .
BACKGROUND Seasonal affective disorder ( SAD ) consists of recurrent major depressive episodes in the fall/winter with remissions in spring/summer .
RESULTS A careful history is important to make the diagnosis and differentiate SAD from other similar conditions such as subsyndromal SAD and atypical depression .
Seasonal patterns with winter worsening are also recognized in " nonseasonal " depression as well as many other psychiatric conditions , and comorbidity with SAD is common .
The pathophysiology of SAD seems to be heterogeneous as research on circadian , neurotransmitter function and genetic hypotheses have shown discrepant results .
A dual vulnerability model with differential loading on separate seasonal and depression factors has been proposed to explain these findings .