What treatments are available?
If you find that you cannot manage your symptoms yourself, or that they are starting to have a significant impact on your day-to-day life, you might find it helpful to talk to your family doctor. They will be able to give you further information and discuss treatment options with you. You may want to discuss your treatment with your family doctor regularly, particularly if symptoms worsen, or do not get better after trying different treatment options.
Your family doctor should discuss all your treatment options with you, and your views and preferences should be taken into account when making decisions about your treatment.
Talking treatments, such as counselling or cognitive behavioural therapy (CBT), can be extremely useful in helping people to cope with SAD symptoms. They can also help you recognise and deal with other factors that may be contributing to your symptoms.
CBT is often offered for SAD. It aims to identify connections between your thoughts, feelings and behaviour, and helps you develop practical skills to manage them. Although it is often short-term, it may last up to 12 months. You may also be offered computerised CBT for mild SAD, which uses a computer programme you can follow either by yourself or in addition to sessions with a therapist.
Your family doctor should be able to give you information about talking treatments and refer you to a local specialist.
Antidepressant drugs work on brain chemicals (such as serotonin) to lift your mood. They do not cure SAD, but can help you cope better with some of the symptoms. If you are offered antidepressants, you will usually be offered a SSRI (selective serotonin reuptake inhibitor) antidepressant, such as paroxetine (Seroxat), sertraline (Lustral) and fluoxetine (Prozac).
SSRIs have been shown to be effective in treating severe cases of SAD, but are not recommended as a treatment for mild or moderate SAD. They can be combined with light treatment and taken seasonally so they have more effect during the winter. SSRI antidepressants have to be taken for around two to six weeks before becoming effective, so you may want to begin taking them a few weeks before your symptoms usually begin to get the maximum benefit.
Occasionally, you may also be offered other antidepressants such as amitriptyline, imipramine and dosulepin, but these are not usually used as they are more likely to cause side effects such as sleepiness. All antidepressants can cause side effects, so it is important to discuss them and the possible benefits of taking them with your family doctor before starting medication.
St John’s wort
St John’s wort is a popular herbal remedy that some people find helpful to deal with mild or moderate symptoms of SAD. However, it is not suitable for severe SAD or if you use a light box as it can make your skin very sensitive to light. You should not take St John’s wort if you are taking prescription antidepressants. You should also seek advice from your family doctor or a pharmacist before using it with any other medication, as it can interfere with their effects.
Bright light therapy
Although you can use a light box to increase your light exposure yourself, in some cases a more structured course of light therapy supervised by a medical professional may be useful.
Specialist SAD services
If you require more intensive support, your family doctor may refer you to a psychiatrist or service that specialises in treating SAD.