How Should I Get Treatment for SAD?

The first step in getting treatment for SAD is to consult a mental health professional who can do a proper assessment. Depression is a serious condition, and only a professional can evaluate all of the factors in a particular patient. Light therapy, like antidepressant medications, may have risks as noted in this presentation/ Such treatment should be started only under the guidance of an experienced clinician. This website may provide guidance if you and your clinician decide to try bright light treatment. Antidepressant medications may work for some individuals with SAD, but many patients prefer to try a natural therapy like light first.

What is the Standard Treatment for SAD?

Substantial research suggests that bright light by “light box” is an effective treatment for SAD for most people. The most recent research suggests that bright light early in the morning is very helpful for most people. Most experts recommend use of a large 10,000 lux light box (lux is a measure of how bright light appears to the eye – 10,000 lux is like being outside on a sunny day in the summer). A typical approach is to use the light box for 30 minutes, completing treatment before 8 am. Some research suggests that light treatment is more effective the earlier in the morning it is done, so light treatment should be done upon awakening and as early as possible in the morning. Sometimes patients have difficulty doing treatment before 8 A.M. because they are waking up late, but as they continue treatment it becomes easier to wake up and begin treatment earlier. Treatment should be done 7 days a week at roughly the same time: the treatment may not work if the patient sleeps in on the weekend and does not do treatment in the early morning.

In general, research suggests that brighter light allows shorter duration of treatment, with 30 minutes at 10,000 lux being equivalent to 1 hour at 5,000 lux or 2 hours at 2,500 lux. Consequently, it is important to use a device that can produce 10,000 lux, and to use the device at the correct distance to obtain this level of exposure.

10,000 lux represents bright light. In order to receive this level of intensity, the patient must sit with the eye at a specific distance from the light box. The manufacturer of the light box should specify this distance (typically 11 to 30 inches). If the eyes are not within this distance, a lower level of light will be received. The patient does not need to look at the light box directly, but the box must be fully within the field of view of the eye: the peripheral retina seems to be just as sensitive as the central retina. Typically the light box is placed on a counter or table in front of, or partly off to the side, of the patient. The patient can read the paper, eat, apply make-up, or perform other activities. Indeed, the therapy is time consuming and will not work for patients on tight morning schedules that do not allow this interval of treatment. A larger and brighter light box makes it easier to receive an adequate light. Smaller and dimmer light boxes will require the patient to sit at a closer distance and permit less side to side movement.

Most manufacturers provide legs or stands so that the light box is lifted off the table and inclined over the patient. This gives more room on the table, makes it easier to get the eyes within the required distance, and reduces the sensation of glare, and some evidence suggests light from above may be particularly effective.

Patients often start to notice improvement within 1 week, but a full effect may require 3 to 6 weeks of treatment. Once symptoms have improved, some patients find they can use the light for 20 to 30 minutes, or do the treatment for only 5 or 6 days per week, or use a lower intensity of light. We strongly recommend that any individual beginning treatment do the treatment every day of the week, at the correct distance to obtain 10,000 lux, at the same time of the morning, for the full 30 minutes, for at least 3 weeks. Once a good response is achieved, patients can explore whether less intense treatment will work for them. Many patients start light treatment but do not do the full treatment at an early time each day and then become discouraged at a poor response. Some patients require 45 or more minutes of light per day for a full response.

Some patients report benefitting from starting treatment early in the fall, while others find starting treatment later in the fall is adequate for them. Similarly, some patients stop treatment early in the spring, while others find light treatment useful until the late spring. We do have a few patients who feel that light treatment helps them in the summer, and these patients do treatment year round. We believe about 80% of patients with SAD benefit substantially from light treatment.

Patients who do not benefit from light treatment may benefit from pharmacological antidepressants. In our clinical experience, bupropion (Wellbutrin XL) or SSRIs such as sertraline (Zoloft) or escitalopram (Lexapro) are often useful in SAD (we have less experience with other antidepressants). Some patients prefer antidepressant treatment to light treatment. Most patients seem to prefer to try light first.

It is probably a good idea for anyone with SAD or subsyndromal SAD to leave bedroom curtains open to admit morning light and to have a good level of illumination in the home and workplace during the day. These measures alone, however, may not be sufficient for treatment of SAD. Some manufacturers sell “full spectrum” light bulbs intended to reproduce sunlight to help with winter mood symptoms. In fact, research suggests that it is not the full spectrum but certain parts of the spectrum that are most important, and there is no research to support the therapeutic effect of full spectrum bulbs.