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Antidepressants as Treatments for Seasonal Affective Disorder (SAD)

Because studies are still investigating the exact causes of SAD, also referred to as winter depression, current treatment options, such as antidepressants and light therapy, focus on minimizing the symptoms of this condition. In general, doctors only prescribe antidepressants to their SAD patients after other, non-invasive treatment courses, such as light therapy and ionized air reception, have failed.

Types of Antidepressants for SAD

Light therapy is usually the first choice in treating fall-onset SAD, that is, seasonal affective disorder triggered by the coming of the fall season. However, although studies show that light therapy is effective in treating over 80 percent of SAD patients, some still experience seasonal affective disorder after trying light therapy.

Similarly, light therapy may not be an option for some SAD patients, namely those who suffer from any eye disease (i.e. macular degeneration) that prevents them from being close to extremely strong light sources.

Consequently, those who don’t respond to or can’t practice light therapy may be better candidates for antidepressants. Antidepressant medication can also be effective for those with Summer SAD, seasonal affective disorder that occurs from March through August.

Antidepressants are also a viable treatment for SAD patients who have:

a history of depressive disorders unrelated to SAD
experienced significant regression in work and social environments
experienced success with prior use of antidepressants
pre-existing suicidal tendencies.

How Antidepressants Work

Antidepressants affect and work in conjunction with neurotransmitters, such as epinephrine, dopamine and norepinephrine. These chemicals reside in parts of the brain, controlling many natural bodily functions, including sleep, appetite and emotions.

MAOIs (monoamine oxidase inhibitors) and tricyclics were the first two groups of antidepressants to hit the market. While these early types of antidepressants have been proven effective at elevating mood, they can also destroy the brain's receptors over time.

By the 1980s, researchers felt that the neurotransmitter serotonin was neurotransmitter that primarily affected mood. As a result, new antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), arrived on the scene.

This family of drugs appeared to be more effective and have less associated side effects than earlier tricyclics and MAOIs. The next wave of antidepressant medication included selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) that also affected both serotonin and norepinephrine neurotransmitters.

Types of Antidepressants Used for SAD

SSRIs are among the main classes of antidepressants used to treat SAD. These include:

citalopram (Celexa)
escitalopram oxalate (Lexapro)
fluoxetine (Prozac/Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft).

SSNRIs include:

duloxetine (Cymbalta)
nefazodone (Serzone)
venlafaxine (Effexor).

Buproprion (Wellbutrin XL/Zyban) is one of the newer antidepressants that falls outside the above categories. It is also the first to receive approval by the FDA for specifically treating symptoms of seasonal affective disorder.

While tricyclic antidepressants and MAOIs may also be effective as SAD treatments, their associated side effects make less appealing than SSRIs, SSNRIs and buproprion.

Because all antidepressants have an effect on one or more neurotransmitters, over time, they may cause reverse effects, including decreased serotonin levels. Consequently, many individuals must switch to a different class of drugs to maintain the same level of benefits.

In general, SAD patients need to take antidepressants for about four weeks before noticing an improvement. Doctors typically prescribe a lower dosage at the beginning of treatment, gradually increasing dosage until the medication is effective. As the season that triggers SAD passes, patients can usually start weaning themselves off of antidepressant medication, until they eventually stop taking it altogether.

Side Effects of Antidepressants

As with any medication, antidepressant have some associated side effects, including:

anxiety
daytime drowsiness
diarrhea
dry mouth
headaches
insomnia
nausea
panic attacks
restlessness
sexual dysfunction
suicidal tendencies.

Milder forms of the above side effects, if tolerable, often dissipate within a few days. If, however, you start to experience some of the above side effects, you doctor will likely take you off antidepressant medication and help you explore other treatment options.

Natural Antidepressants

To avoid some of the more serious side effects associated with antidepressants, some suggest using herbs and amino acids as natural antidepressants. Some of these so-called natural antidepressants can include:

5-HTP (5-hydroxytriptophan)
Ginkgo
Ginseng
Sam-E (S-adenosyl-L-methionine)
St. John's Wort extract.

Over-the-counter forms of these natural antidepressants aren’t necessarily regulated by the FDA. It's a good idea to talk to your doctor and study labels carefully before starting an herbal regimen.

Resources

Patient.co.uk (2006). Tricyclic Antidepressants. Retrieved December 9, 2007, from the Patient Information Publications Web site: http://www.patient.co.uk/showdoc/23068678/.

Pick, Marcelle, OB/GYN, NP (2007). Antidepressants and Alternative Treatments for Depression. Retrieved December 9, 2007, from the Women to Women Web site: http://www.womentowomen.com/

depressionanxietyandmood/antidepressants.aspx.

Rousseau, Heather (2006). New Treatments Offer Ray of Hope for SAD Sufferers. Retrieved December 9, 2007, from the Healthy Place Web site: http://www.patient.co.uk/showdoc/23068678/.

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