Part II of this exciting, edge-of-your-seat, nerdifiable series about Seasonal Affective Disorder (SAD)...the TREATMENTS. Bottom line: save yourself 10 minutes and buy a light box. The end.
Treatments for Seasonal Affective Disorder
Several modalities of treatment have been shown as efficacious in SAD patients. Light therapy, cognitive behavioral therapy and the usage of antidepressants have all been utilized with varying degrees of success. Additionally, preventative measures have been identified for usage in those who are especially susceptible to SAD.
Light Therapy Treatment
The most frequently researched and widely accepted form of treatment for SAD is light therapy. The preferred device for light therapy is a fluorescent light box that emits 2,500 lux (a unit of illumination intensity) of light. In comparison, office light has 500 lux or less, a cloudy day has 4,000 lux and a sunny day could provide as much as 100,000 lux (Westrin & Lam, 2007). The results of light therapy are obtained quickly; Westrin and Lam (2007) report that SAD patients experienced “significant clinical improvement” after only 1-2 weeks of light therapy treatment, though in extremely severe cases, additional time (and, perhaps, alternate methods of treatment) may be required. Patients are susceptible to relapse after only a few weeks of discontinuing light therapy, so it is advised that they commence treatment as soon as SAD symptoms begin to emerge and continue until spring/summer remission (Westrin & Lam, 2007). Patients should have their eyes open during light therapy, but they should refrain from looking directly at the light source. The standard recommended “dosage” of light is 10,000 lux for 30 minutes per diem (Westrin & Lam, 2007). Side effects to light therapy include headache, nausea and blurred vision. Interestingly, Westrin and Lam (2007) have noted a potential risk of inducing a hypomanic or manic episode in vulnerable individuals; therefore, patients with Bipolar disorder should either be taking mood-stabilizing medications before beginning light therapy, or should refrain from it entirely and seek alternative treatment (Westrin & Lam, 2007).
The consensus of light therapy literature suggests that it is most effective when administered during the early morning hours, possibly due to the synchronization of circadian rhythm and melatonin production. However, Putilov and Danilenko (2005) conducted a study in which they were unable to establish a “best time” of day for light therapy administration. Additionally, they compared light therapy to “natural” methods of SAD treatment. They found that one week of light therapy was as effective as a trip to a location with more sunlight, or natural seasonal remission (Putilov & Danilenko, 2005).
Antidepressants
Several antidepressants have been noted for their efficacy in the treatment of SAD. Both light therapy and antidepressants are considered to be “first-line treatments” for SAD patients (Lam et al., 2006). Light therapy, however, requires a substantial time commitment in order for it to be effective, rendering it difficult for some SAD patients to adhere to treatment (Rohan et al., 2007). Though they have not been studied as extensively as light therapy in relation to SAD, Selective Serotonin Reuptake Inhibitors (SSRIs) have been identified as effective and have been proven successful for SAD patients.
Many studies have focused on fluoxetine as a possible alternative to light therapy. Since fluoxetine alters serotonin reuptake, it has been theorized that the increased serotonin dissemination acts as a mood-improving agent, thereby alleviating some of the depressive symptoms of SAD. Similarly, sertraline and citalopram, also in the SSRI family, have been shown to be effective for SAD patients (Westrin & Lam, 2007). Overall, fluoxetine has been proved to be as effective as light therapy, though light therapy produces results at a slightly faster rate (Lam et al, 2006). Counselors should note, however, that antidepressants have been known to cause an increased risk of suicide in children, teenagers and young adults. Overwhelmingly, the literature cautions that all antidepressant usage should be closely monitored.
Cognitive Behavioral Therapy
A possible alternative to, or supplement for, light therapy is cognitive behavioral therapy (CBT). Rohan et al. (2007) recommended that SAD patients undergo an intensified version of CBT, which utilizes 1.5 hour sessions, twice a week, for a duration of six weeks. It has been found that CBT, when used in conjunction with light therapy, produces complete remission in SAD patients (Rohan et al., 2007). Light therapy, when used by itself, has also been shown to produce complete remission; however, combination therapy has been associated with “lower atypical depression severity” (Rohan et al., 2007).
Though there has been a relatively small amount of research conducted as to the effectiveness of CBT when compared with light therapy and antidepressants, the literature that exists is primarily optimistic about its successful treatment of SAD. CBT, therefore, should be considered as a possible means of treatment for SAD.
Discussion
Seasonal Affective Disorder is a condition that can easily be confused with other forms of depression, but contains its own unique symptoms, causes and treatment modalities. It is crucial that counselors who are treating individuals with other forms of depression (Unipolar, Major Depressive Disorder, etc.) are cognizant of the distinction. Because the treatments have been widely researched and successfully implemented, it is imperative for the counselor to identify SAD and to treat accordingly with light therapy, antidepressants or CBT (or combinations of the three). The three forms of treatment have been proven to be successful, but may not be effective for every patient with SAD. The counselor, therefore, should be well-versed as to the specifics of each of the previously named modalities and should evaluate each case of SAD as individual and unique.
There are still vast and plentiful opportunities for SAD research. For example, the efficacy of SSRIs and SNRIs has been proven, but little is known about the side effects that could potentially occur with specific regard to SAD patients. Additionally, there exists much opportunity for combination studies: antidepressants when used in conjunction with light therapy and/or CBT, etc. Because each individual presents a unique case, knowledge about the causes and treatments for SAD will help those who suffer from this disorder to obtain an accurate diagnosis and will aid in the development of an effective treatment plan.
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