Summary
The current first-line treatment for patients with winter seasonal affective disorder (SAD) is bright-light therapy, that is exposure to strong artificial light visible to the eye. Patients at risk of light-induced eye damage, such as those using photosensitizing medication, need to consult an ophthalmologist before the bright-light therapy is started, and eventually at regular intervals thereafter. Antidepressant drugs have not gained much attention in the treatment of winter SAD. They are still a relatively unexplored mode of and best regarded as the second-line treatment. Preliminary data from randomized controlled trials suggest that several antidepressants may be effective. Continuing treatment throughout the winter season, or in some cases all the year round, is advisable to prevent relapses.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Partonen T, Lönnqvist J. Seasonal affective disorder. Lancet 1998; 352:1369–1374.
Partonen T, Lönnqvist J. Seasonal affective disorder: A guide to diagnosis and management. CNS Drugs 1998; 9:203–212.
Lam RW. Seasonal affective disorder: Diagnosis and management. Primary Care Psychiatry 1998; 4:63–74.
In: Lam RW, Levitt AJ, eds. Canadian consensus guidelines for the treatment of seasonal affective disorder: A summary of the report of the Canadian Consensus Group on SAD. The Canadian Journal of Diagnosis Oct 1998; (Suppl):1–16.
Zulman DM, Oren DA. Seasonal affective disorder. Curr Opinion Psychiatry 1999; 12:81–86.
Rosenthal NE, Sack DA, Gillin JC et al. Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41:72–80.
Kasper S, Rogers SLB, Yancey A et al. Phototherapy in individuals with and without subsyndromal seasonal affective disorder. Arch Gen Psychiatry 1989; 46:837–844.
Kräuchi K, Wirz-Justice A, Graw P. High intake of sweets late in the day predicts a rapid and persistent response to light therapy in winter depression. Psychiatry Res 1993; 46:107–117.
Wehr TA, Duncan Jr WC, Sher L et al. A circadian signal of change of season in patients with seasonal affective disorder. Arch Gen Psychiatry 2001; 58:1108–1114.
Wirz-Justice A, Graw P, Krauchi K et al. Morning or night-time melatonin is ineffective in seasonal affective disorder. J Psychiatr Res 1990; 24:129–137.
Lewy AJ, Bauer VK, Cutler NL et al. Melatonin treatment of winter depression: A pilot study. Psychiatry Res 1998; 77:57–61.
Leppämäki S, Partonen T, Vakkuri O et al. Effect of controlled-release melatonin on sleep quality, mood, and quality of life in subjects with seasonal or weather-associated changes in mood and behaviour. Eur Neuropsychopharmacol 2003; 13:137–145.
Teicher MH, Glod CA, Magnus E et al. Circadian rest-activity disturbances in seasonal affective disorder. Arch Gen Psychiatry 1997; 54:124–130.
Boivin DB, Czeisler CA, Dijk DJ et al. Complex interaction of the sleep-wake cycle and circadian phase modulates mood in healthy subjects. Arch Gen Psychiatry 1997; 54:145–152.
Schwartz PJ, Rosenthal NE, Kajimura N et al. Ultradian oscillations in cranial thermoregulation and electroencephalographic slow-wave activity during sleep are abnormal in humans with annual winter depression. Brain Res 2000; 866:152–167.
Moscovitch A, Blashko C, Wiseman R et al. A double-blind, placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder [abstract]. 148th Annual Meeting of the American Psychiatric Association. Miami May 1995; 20–25.
Lam RW, Gorman CP, Michalon M et al. Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder. Am J Psychiatry 1995; 152:1765–1770.
Lingærde O, Reichborn-Kjennerud T, Haggag A et al. Treatment of winter depression in Norway: II. A comparison of the selective monoamine oxidase A inhibitor moclobemide and placebo. Acta Psychiatr Scand 1993; 88:372–380.
Partonen T, Lönnqvist J. Moclobemide and fluoxetine in treatment of seasonal affective disorder. J Affect Disord 1996; 41:93–99.
Johansson C, Willeit M, Smedh C et al. Circadian clock-related polymorphisms in seasonal affective disorder and their relevance to diurnal preference. Neuropsychopharmacology 2003; 28:34–739.
Further Reading
Childs PA, Rodin I, Martin NJ et al. Effect of fluoxetine on melatonin in patients with seasonal affective disorder and matched controls. Br J Psychiatry 1995; 166:196–198.
Dilsaver SC, Jaeckle RS. Winter depression responds to an open trial of tranylcypromine. J Clin Psychiatry 1990; 51:326–329.
Dilsaver SC, Del Medico VJ, Quadri A et al. Pharmacological responsiveness of winter depression. Psychopharmacol Bull 1990; 26:303–309.
Dilsaver SC, Qamar AB, Del Medico VJ. The efficacy of bupropion in winter depression: Results of an open trial. J Clin Psychiatry 1992; 53:252–255.
Garcia-Borreguero D, Jacobsen FM, Murphy DL et al. Hormonal responses to the administration of m-chlorophenylpiperazine in patients with seasonal affective disorder and controls. Biol Psychiatry 1995; 37:740–749.
Ghadirian A-M, Murphy BEP, Gendron M-J. Efficacy of light versus tryptophan therapy in seasonal affective disorder. J Affect Disord 1998; 50:23–27.
Gloth 3rd FM, Alam W, Hollis B. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging 1999; 3:5–7.
Hesselmann B, Habeler A, Praschak-Rieder N et al. Mirtazapine in seasonal affective disorder (SAD): A preliminary report. Hum Psychopharmacol Clin Exp 1999; 14:59–62.
Hilger E, Willeit M, Praschak-Rieder N et al. Reboxetine in seasonal affective disorder: An open trial. Eur Neuropsychopharmacol 2001; 11:1–5.
Jacobsen FM, Mueller EA, Rosenthal NE et al. Behavioral responses to intravenous meta-chlorophenylpiperazine in patients with seasonal affective disorder and control subjects before and after phototherapy. Psychiatry Res 1994; 52:181–197.
Joseph-Vanderpool JR, Jacobsen FM, Murphy DL et al. Seasonal variation in behavioral responses to m-CPP in patients with seasonal affective disorder and controls. Biol Psychiatry 1993; 33:496–504.
Lam RW, Levitan RD, Tam EM et al. L-tryptophan augmentation of light therapy in patients with seasonal affective disorder. Can J Psychiatry 1997; 42:303–306.
Levitan RD, Kaplan AS, Brown GM et al. Hormonal and subjective responses to intravenous m-chlorophenylpiperazine in women with seasonal affective disorder. Arch Gen Psychiatry 1998; 55:244–249.
Levitt AJ, Brown GM, Kennedy SH et al. Tryptophan treatment and melatonin response in a patient with seasonal affective disorder. J Clin Psychopharmacol 1991; 11:74–75.
Lingærde O, Haggag A. Moclobemide in winter depression: Some preliminary results from an open trial. Nord J Psychiatry 1992; 46:201–203.
Lingærde O, Føreland AR, Magnusson A. Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial. Acta Psychiatr Scand 1999; 100:62–66.
Martinez B, Kasper S, Ruhrmann S et al. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatry Neurol 1994; 7(Suppl 1):S29–S33.
McGrath RE, Buckwald B, Resnick EV. The effect of L-tryptophan on seasonal affective disorder. J Clin Psychiatry 1990; 51:162–163.
Oren DA, Moul DE, Schwartz PJ et al. A controlled trial of levodopa plus carbidopa in the treatment of winter seasonal affective disorder: A test of the dopamine hypothesis. J Clin Psychopharmacol 1994; 14:196–200.
Oren DA, Teicher MH, Schwartz PJ et al. A controlled trial of cyanocobalamin (Vitamin B12) in the treatment of winter seasonal affective disorder. J Affect Disord 1994; 32:197–200.
O’Rourke DA, Wurtman JJ, Brzezinski A et al. Serotonin implicated in etiology of seasonal affective disorder. Psychopharmacol Bull 1987; 23:358–359.
O’Rourke D, Wurtman JJ, Wurtman RJ et al. Treatment of seasonal depression with d-fenfluramine. J Clin Psychiatry 1989; 50:343–347.
Pande AC. Pharmacological treatments of SAD. Can J Psychiatry 1990; 35:721–722.
Rosenthal NE, Jacobsen FM, Sack DA et al. Atenolol in seasonal affective disorder: A test of the melatonin hypothesis. Am J Psychiatry 1988; 145:52–56.
Ruhrmann S, Kasper S, Hawellek B et al. Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder. Psychol Med 1998; 28:923–933.
Schlager DS. Early-morning administration of short-acting β blockers for treatment of winter depression. Am J Psychiatry 1994; 151:1383–1385.
Schwartz PJ, Turner EH, Garcia-Borreguero D et al. Serotonin hypothesis of winter depression: Behavioral and neuroendocrine effects of the 5-HT(1A) receptor partial agonist ipsapirone in patients with seasonal affective disorder and healthy control subjects. Psychiatry Res 1999; 86:9–28.
Sherer MA, Weingartner H, James SP et al. Effects of melatonin on performance testing in patients with seasonal affective disorder. Neurosci Lett 1985; 58:277–282.
Teicher MH, Glod CA. Seasonal affective disorder: Rapid resolution by low-dose alprazolam. Psychopharmacol Bull 1990; 26:197–202.
Thorell LH, Kjellman B, Arned M et al. Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up. Int Clin Psychopharmacol 1999; 14(Suppl 2):S7–S11.
Turner EH, Schwartz PJ, Lowe CH et al. Double-blind, placebocontrolled study of single-dose metergoline in depressed patients with seasonal affective disorder. J Clin Psychopharmacol 2002; 22:216–220.
Wheatley D. Hypericum in seasonal affective disorder (SAD). Curr Med Res Opin 1999; 15:33–37.
Wirz-Justice A, van der Velde P, Bucher A et al. Comparison of light treatment with citalopram in winter depression: A longitudinal single case study. Int Clin Psychopharmacol 1992; 7:109–116.
Yamadera H, Okawa M, Takahashi K. Open study of effects of alprazolam on seasonal affective disorder. Psychiatry Clin Neurosci 2001; 55:27–30.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2006 Landes Bioscience/Eurekah.com and Springer Science+Business Media
About this chapter
Cite this chapter
Partonen, T. (2006). Pharmacotherapy for Seasonal Affective Disorder. In: Sleep and Sleep Disorders. Springer, Boston, MA. https://doi.org/10.1007/0-387-27682-3_12
Download citation
DOI: https://doi.org/10.1007/0-387-27682-3_12
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-27681-6
Online ISBN: 978-0-387-27682-3
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)