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Seasonal Affective Disorder is a condition in which the patient feels depressed in a certain period of the year. As symptoms are experienced with the change in season, this condition is called seasonal affective disorder (SAD). The symptoms are often experienced in winter when the intensity of sunlight is low. In rare cases, some people also experience this condition in summer. Most of the symptoms of SAD overlaps with other neurological conditions such as chronic fatigue syndrome or bipolar disorder, it is sometimes difficult to accurately diagnose SAD. Various treatment options are available for managing SAD.
5 Best Medications For Treating SAD
Various treatment strategies are available for patients suffering from Seasonal Affective Disorder. These include treatment through medications, phototherapy, and psychotherapy. American Psychiatric Association has recommended that in treating Seasonal Affective Disorder, drugs that are available for treating depression or Major Depressive Disorder can be used. Antidepressants are used for managing the symptoms of Seasonal Affective Disorder. Various categories of antidepressants used for this condition are
1. SSRI Antidepressants
SSRIs (Selective Serotonin Reuptake Inhibitors) are the drug of choice for Seasonal Affective Disorder. These drugs enhance the effect of serotonin, a type of neurotransmitter, and helps reduce the symptoms of depression. The drugs in this category include escitalopram, sertraline, fluoxetine, paroxetine, and citalopram. Most of the SSRIs have little or no effect on other neurotransmitters such as dopamine or norepinephrine.
2. SNRI Antidepressants
When Selective Serotonin Reuptake Inhibitors fails to provide optimum benefit to the patient, the next class of antidepressant usually administered to the patients is Serotonin and norepinephrine reuptake inhibitors (SNRIs). These drugs may also have an effect on dopamine and other neurotransmitters. Drugs of this category are levomilnacipran, duloxetine, venlafaxine, and desvenlafaxine.
3. Tricyclic Antidepressants
Tricyclic antidepressants are another class of drugs used in the patient with Seasonal Affective Disorder when SSRI is not effective. They work through a different mechanism of actions and inhibits norepinephrine and serotonin uptake. They also inhibit the amine pump and have anticholinergic action. Examples of Tricyclic Antidepressants are amitriptyline, nortriptyline, imipramine, and doxepin.
4. Dopamine/Norepinephrine Reuptake Inhibitors
This class of antidepressants is also used in the management of Seasonal Affective Disorder. Bupropion, a drug of this class has been approved by USFDA for the management of this condition. Although the main action of bupropion is to inhibit the reuptake of dopamine, it also has weak action of inhibiting the uptake of serotonin and norepinephrine.
5) Mono-Amine Oxidase Inhibitors
Monoamine oxidase is an enzyme that is responsible for the degradation of neurotransmitters. Monoamine oxidase inhibitors inhibit this enzyme leading to increased concentration of neurotransmitters. This result in alleviating the symptom of depression. As compared to tricyclic antidepressants, monoamine oxidase inhibitors do not show dependence.
Other Treatment Options
Apart from medications, other treatment options include light therapy or phototherapy and psychotherapy. The Medications and light treatment for seasonal affective disorder should be carefully used in the patient suffering from bipolar disorder as both may cause manic episodes.
Bright Light Therapy or Phototherapy
Bright light therapy is considered as the treatment of choice in patients with Seasonal Affective Disorder. Phototherapy is generally recommended in the milder form of SAD, while in a severe form of SAD, phototherapy can be combined with other forms of treatment. In this therapy, the patient is advised to sit at a particular distance, maybe a few feet, from a lightbox. The patient is exposed to a light of intensity 10000 lux for approximately 1 hour preferably after waking up in the morning. Therapy with lights for the seasonal affective disorder may have an effect similar to natural light and changes the level of chemicals in the brain that is linked to mood. Exposure to bright light for a prolonged period may damage the retina, patients who have a retinal disease or are on photosensitive medications should have ophthalmic examination prior to bright light therapy.
The patient should consult with the doctor about the type of light box that would be best suitable. The effects of light therapy are seen within a few days to a few weeks.
Psychotherapy is also known as talk therapy. The most common type of psychotherapy used in managing SAD is Cognitive-Behavioral Therapy. Study indicates that in treating an acute form of SAD, cognitive behavioral therapy is as effective as light therapy. Psychotherapy helps in noticing the negative thoughts and changing those thoughts, managing stress, and scheduling the activities by reducing avoidance behavior. Psychotherapy is used either alone or with other treatment options.
Various other techniques related to mind-body balance are also used to manage SAD. These include relaxation techniques such as yoga, and meditation, music therapy, and guided imagery. Various Supplements for managing seasonal affective disorder such as melatonin and St. Johnâ€™s wart were studied, but they failed to provide consistent benefits. Low level of vitamin D is found in people with SAD which implies that supplementation with Vitamin D may provide some benefit in SAD.
The treatment options for SAD include medications, phototherapy, and psychotherapy. Antidepressant drugs are generally used for alleviating symptoms. Various classes of antidepressants drugs such as SSRIs, SNRIs, MAOIs, Dopamine/Norepinephrine Reuptake Inhibitors and TCAs are found to be effective in SAD.