Treating seasonal affective disorder

A number of treatments are available for seasonal affective disorder (SAD),including cognitive behavioural therapy, antidepressants and light therapy.

Your GP will recommend the most suitable treatment option for you, based onthe nature and severity of your symptoms. Thismay involve using a combination of treatments to get the best results.

NICE recommendations

TheNational Institute for Health and Care Excellence (NICE) recommends that SAD should be treated in the same wayas other types of depression.

This includes using talking treatments such as cognitive behavioural therapy(CBT) or medication such as antidepressants.

Light therapy isalso a populartreatment for SAD, although NICE says it's not clear whether it's effective.

See NICE guidance about the treatment and management of depression in adults.

Things you can try yourself

There are a number of simple things you cantrythat mayhelpimprove your symptoms, including:

• try to get as much naturalsunlight as possibleeven a brief lunchtime walk can be beneficial
• make your work and home environments as light andairy as possible
• sit near windows when you're indoors
• take plenty ofregular exercise, particularly outdoors and in daylight read more about exercise fordepression
• eat a healthy, balanced diet
• if possible, avoid stressful situations and take steps tomanage stress

It can also be helpful to talk to your family and friends about SAD,so they understandhow your mood changes during the winter. Thiscan help them to support you more effectively.

Psychosocial treatments

Psychosocial treatments focus on both psychological aspects (how your brain functions) and social aspects (how you interact with others). Some possible psychosocial treatments are described below.

Cognitive behavioural therapy

Cognitive behavioural therapy(CBT) is based on the idea thatthe way we think and behave affects the way we feel.Changing the way you think about situations and what you do about them can help you feel better.

If you have CBT, you'll have a number of sessions with a specially trained therapist, usually over several weeks or months. Your programme could be:

• an individual programme of self-help
• a programme designed for you and your partner (ifyourdepression is affecting your relationship)
• a group programme that you complete with other people in a similar situation
• a computer-based CBT programme that's tailored to your needs and supported by a trained therapist

The aim of the sessions is to find out whether anything in your past is affecting how you feel today.

It's not clear exactly how effective these two therapies are in treating depression.

They increase the level of the hormone serotonin in your brain, which can help lift your mood.

If you're prescribed antidepressants, you should be aware that:

• it can takeup tofour to sixweeks for the medication to takefull effect
• you should take the medication as prescribed and continue takingit until advised to gradually stop by your doctor
• some antidepressants have side effects and may interact with other types of medication you're taking

Common side effects of SSRIs includefeeling agitated, shaky or anxious, an upset stomach anddiarrhoea or constipation. Check the information leaflet that comes with your medication for a full list of possible side effects.

This involves sitting by a special lamp called a light box, usuallyfor around 30 minutes to an hour each morning.

Light boxes come in a variety of designs, including desk lamps and wall-mounted fixtures. They produce a very bright light. The intensity of the lightis measured in lux the higher lux, the brighter the light.

Dawn-stimulating alarm clocks, which gradually light up your bedroom as you wake up,may also be useful for some people.

The light produced by the light box simulates the sunlight that's missing during the darker winter months.

It's thoughtthe lightmay improve SAD by encouraging your brain to reduce the production of melatonin (a hormone that makes you sleepy) and increase the production of serotonin (a hormone that affects your mood).

Who can use light therapy?

Most people can use light therapy safely. The recommended light boxes have filters that remove harmful ultraviolent (UV) rays, so there's no risk of skin or eye damage for most people.

However, exposure to very bright light may not be suitable if you:

• have an eye condition or eye damage that makes your eyes particularly sensitive to light
• are taking medication that increases your sensitivity to light, such as certain antibioticsand antipsychotics,or the herbal supplement St. John's Wort

Speak to your GP if you're unsure about the suitability of a particular product.

Trying light therapy

Light boxes aren't usually available on the NHS, so you'll need to buy one yourself if you want to try light therapy.

Before using a light box, you should checkthe manufacturer's information and instructions regarding:

• whether the product is suitable for treating SAD
• the light intensity you should be using
• the recommended length of timeyou need to use the light

Make sure that you choose a light boxthat ismedicallyapproved for the treatment of SAD and produced by a fully certified manufacturer. The Seasonal Affective Disorder Association can provide you with a list of recommended manufacturers.

Does light therapy work?

There's mixed evidence regardingthe overall effectiveness of light therapy, but some studies have concluded it is effective, particularly if used first thing in the morning.

It's thought that light therapyis best for producing short-term results. This means itmay help relieve your symptoms when they occur, butyou mightstill be affected by SAD nextwinter.

Whenlight therapy has been found tohelp,most peoplenoticed an improvement intheir symptoms within a week or so.

Side effects of light therapy

It's rare for people using light therapy to have side effects. However, some peoplemay experience:

• agitation or irritability
• headaches or eye strain
• sleeping problems (avoiding light therapy during the evening may help prevent this)
• tiredness
• blurred vision

These side effects are usually mild and short-lived, but you should visit your GP if youexperience any particularly troublesome side effects while using light therapy.