Seasonal affective disorder - Emerging treatments

Alternative antidepressants

Limited data support the possible efficacy of several alternative antidepressants.[25] These include a reversible inhibitor of monoamine oxidase A, moclobemide.[88][89] Others include hypericum, agomelatine (a mixed melatonin agonist and serotonin antagonist) and D-fenfluramine (a serotonin-releasing drug).[90][91][92][93] A norepinephrine-reuptake inhibitor, reboxetine, may also be efficacious in managing seasonal affective disorder (SAD) symptoms.[94] A comparative analysis of reboxetine and escitalopram outcome studies noted that reboxetine yielded a shorter response time to treatment than escitalopram.[95] However, overall treatment outcome was similar between the two drugs, with reboxetine showing a more pronounced adverse-effect profile than escitalopram.[95] Although additional studies are warranted, the earlier onset of action through the noradrenergic system may have implications for the pathophysiology and clinical management of SAD. Research on the use of melatonin and agomelatine as prophylactic treatments in preventing the onset of seasonal depression have been inconclusive.[96]

Stimulants

Modafinil may significantly reduce fatigue symptoms.[97]

Mindfulness-based cognitive therapy (MBCT) to prevent seasonal affective disorder (SAD)

MBCT is an effective treatment for major depressive disorder.[98] One randomized trial compared eight weekly sessions of MBCT used in the springtime to a treatment as usual condition, which involved the use of light therapy when seasonal depression symptoms first appeared. No between-group differences were found between these conditions in regards to the incidence of new depressive episodes in the winter months.[99]

Group cognitive behavioral therapy (CBT) combined with other therapies

CBT is a well-established treatment for major depressive disorder.[100] Analyses suggest that CBT, either alone or in combination with light therapy, may be helpful in preventing relapse of seasonal depression above light therapy alone.[82][101] Dropout rates for light therapy are generally lower than for group therapy. Additional, larger randomized trials comparing individual and group CBT modalities with light therapy and pharmacotherapy are needed.

Alternate light exposure

Dawn simulators and bright white light therapy generally produce similar results on SAD symptoms.[65] Blue-enriched light, hypothesized to be particularly relevant in circadian functioning, has been found to be as effective as standard light therapy in reducing self-reported depression among patients with SAD.[102] Transcranial administration of bright light therapy in the ear canals has been found to reduce self-reported depressive symptoms, regardless of light intensity.[103]