The November 2009 issue of the Drug and Therapeutics Bulletin (DTB) features an article discussing the management of seasonal affective disorder (SAD) – ‘recurrent major depressive episodes with seasonal pattern’ thought to affect up to 6% of the UK population.

The article looks at the symptoms and causes of SAD, its clinical course, diagnosis, and treatments.  The authors discuss the available evidence for the following treatments:

• Conventional antidepressants (acute treatment and prevention)
• Light therapy
• Cognitive behavioural therapy (CBT)
• Self-help and complementary treatments
• Negative ion generators

The article concludes with a look at the available guidance in this area from the American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, and NICE (draft guideline on depression in adults). 

The authors conclude that a common approach is to treat individuals with SAD as for non-seasonal depression, e.g. with SSRI antidepressants and/or CBT.  Light therapy has been suggested but trials are complex and methodological differences exist between available studies; in addition reviews and guidelines have included different studies and therefore come to different conclusions regarding use of this therapy.  Despite this they suggest that bright light therapy in the early morning is a reasonable first-line approach, instead of or as well as drug therapy +/- CBT in those with mild to moderate symptoms.  In those with severe symptoms they recommend antidepressants with or without light therapy and/or CBT.