Seasonal Affective Disorder (SAD)

Home Treatment

Home treatment is very important in the treatment of seasonal affective disorder (SAD). Home treatment for an episode of depression may include a combination of the following:

Light therapy

There are two types of light therapy: bright light treatment, in which you sit in front of a "light box" for a certain amount of time (usually in the morning); and dawn simulation, which is done while you sleep. For dawn simulation, a low-intensity light is timed to go on at a certain time in the morning before you wake up and gradually gets brighter.

Light boxes are available commercially and use fluorescent lights that are brighter than indoor lights but not as bright as sunlight. Ultraviolet light, full-spectrum light, tanning lamps, or heat lamps should not be used. You place the light box at a specified distance (usually 30 to 45 centimetres [12 to 18 inches]) from you on a desk or in front of a chair and use it while you read, eat breakfast, or work at a computer. Light therapy is usually prescribed for 30 minutes to 2 hours, depending on the intensity of the light used.³

Some people find dawn simulation light therapy more convenient because it works as they sleep. Light box therapy, which some studies have shown to be most effective if done in the morning, may be less convenient for people who have busy schedules.⁴ Studies, however, have found that dawn simulation therapy is not as effective as bright light therapy.³

It may take as little as 3 to 5 days or up to 2 weeks before you respond to light therapy. Stopping light therapy can cause you to relapse back into depression.³

Light therapy may work by resetting your "biological clock" (circadian rhythms), which controls sleeping and waking.

If you have eye problems or you take medications that make you light-sensitive, ask your health professional about whether light therapy is safe for you. Tell your health professional about any conditions you have and medications you are taking before you start treatment.

Using light therapy at home for SAD

Physical activity

Being physically active during the daytime, especially first thing in the morning during winter, may help improve your energy level and relieve depression. Gentle exercises like walking, stationary cycling, and swimming are a good way to start an exercise routine.

• Start slowly. If you have not been active for a while, start with just 10 to 15 minutes of exercise each day and increase by 1 minute per session every 3 to 4 days until you can exercise for 20 to 30 minutes at a time.
• Try to exercise most days of the week.
• Go slow. If you have not exercised for some time, you can easily become fatigued, which will defeat the purpose of exercise.

Be sure to check with your health professional before starting an exercise program.

Healthy diet

Eating a healthy, balanced diet is helpful for any type of depression and may help relieve some of the symptoms of SAD.

Complementary treatment Initial research suggests the following complementary treatments may be helpful in treating symptoms of SAD, although there currently is not enough scientific evidence to prove their usefulness.⁶

• There is some evidence that an herb called St. John's wort may help ease depression symptoms.
• Melatonin is a hormone that may help regulate your biological clock (circadian rhythms). However, you need to take a very low dose at a specific time of the day.

Be sure to check with your health professional before you try these complementary therapies, because they may interact with other medications you are currently taking.

You should not take St. John's wort if you are taking other antidepressants. Also, St. John's wort may cause light sensitivity. If you are using light therapy, you may want to discuss with your health professional whether St. John's wort is right for you in the treatment of SAD.

Research on the effectiveness of other SAD treatments is ongoing.

Advice for caregivers

Sometimes family members and friends are not sure how to help someone who has seasonal affective disorder. It may help to:

• Spend time with your loved one even though he or she may be withdrawn or quiet.
• Offer to help with daily tasks that temporarily may be too difficult to do alone. It is important, however, that you do not enable the person to remain depressed by taking over all of the daily responsibilities.
• Take a walk or do some other type of exercise activity together. Getting out first thing in the morning for a walk may be helpful.
• Help the person to stick with the prescribed treatment plan.

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Author:	Douglas Dana Sabra L. Katz-Wise	Last Updated: November 1, 2006
Medical Review:	Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Alfred Lewy, MD, PhD - Neurology, Psychiatry
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