Follow-up study of seasonal affective disorder in Switzerland. Agomelatine in the treatment of seasonal affective disorder Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. An attempt to prevent winter depression by light exposure at the end of September Prevention of winter seasonal affective disorder by bright-light treatment. Seasonal depression: the dual vulnerability hypothesis revisited. Reboxetine in seasonal affective disorder: an open trial Light visor treament for seasonal affective disorder: A multicenter study A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study. Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial Estimated Prevalence of the Seasonal Subtype of Major Depression in a Canadian Community Sample Hypericum in the treatment of seasonal affective disorders. Controlled trial of bright light and negative air ions for chronic depression. A controlled trial of light therapy for the treatment of pediatric seasonal affective disorder. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light?
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 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 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 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 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 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 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 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 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 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 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 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 Objective : To examine estimates of lifetime prevalence of  seasonal affective disorder ( SAD ) in Toronto , Ontario . Method R and om telephone numbers were generated for the city of Toronto , and 781 respondents completed a telephone interview .  Trained nonphysician interviewers conducted all interviews , which involved structured questions for diagnosing major depression . Patterns of symptom change across seasons were evaluated to establish a diagnosis of SAD according to DSM-III-R criteria . Results Correcting for sex and age , the prevalence of SAD defined by DSM-III-R criteria was 2.9 % ( 95%CI , 1.7 % to 4.0 % ) , and the overall lifetime prevalence of major depression in the sample was 26.4 % ( 95%CI , 23.3 % to 29.4 % ) . Some subjects were contacted for a follow-up interview conducted in person ; the positive predictive value for the diagnosis of major depression for the telephone interview was 100 % , and the negative predictive value was 93 % . Conclusions The seasonal subtype of depression represents 11 % of all subjects with major depression , suggesting that SAD is a significant public health concern . The telephone interview demonstrated adequate reliability , indicating that it is appropriate for epidemiological surveys of this nature 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 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 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 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
AUTHORS ' CONCLUSIONS No available method ologically sound evidence indicates that melatonin or agomelatine is or is not an effective intervention for prevention of SAD and improvement of patient-centred outcomes among adults with a history of SAD .
A well-conducted RCT of melatonin or agomelatine for prevention of SAD would assess the comparative benefits and risks of these interventions against others currently used to treat the disorder
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 in the United States ranges from 1.5 % to 9 % , depending on latitude .
The predictable seasonal aspect of SAD provides a promising opportunity for prevention .
This is one of four review s on the efficacy and safety of interventions to prevent SAD ; we focus on agomelatine and melatonin as preventive interventions .
OBJECTIVES To assess the efficacy and safety of agomelatine and melatonin ( in comparison with each other , placebo , second-generation antidepressants , light therapy , psychological therapy or lifestyle interventions ) in preventing SAD and improving patient-centred outcomes among adults with a history of SAD .