Seasonal Affective Disorder (SAD): Home Treatment

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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 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 But studies 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 medicines that make you light-sensitive, ask your doctor about whether light therapy is safe for you. Before you start treatment, tell your doctor about any other conditions you have and about the medicines you are taking.

Seasonal affective disorder: Using light therapy

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. Moderate-intensity exercises like walking, stationary cycling, and swimming are a good way to start an exercise routine.

Experts advise doing either of these things to get and stay healthy:⁶

• Do moderate activity for at least 30 minutes a day, 5 days a week or more. Moderate activity is equal to a brisk walk, cycling about 10 to 12 miles per hour (mph), sailing, or shooting basketballs. You notice your heart beating faster with this kind of activity.
• Do vigorous activity for at least 20 minutes a day, 3 days a week or more. Vigorous activity is equal to jogging, cycling at least 12 mph, cross-country skiing, or playing a basketball game. You breathe rapidly and your heart beats much faster with this kind of activity.

Being active in several chunks of 10 minutes or more throughout the day can count towards the above activity. You can choose to do one or both types of activity. Always ask your doctor whether it is safe for you to start a fitness program.

Experts also advise people to do exercises to strengthen muscles at least two times each week.⁶ Examples include weight training or stair climbing on two or more days that are not in a row. For best results, use a resistance (weight) that gives you muscle fatigue after 8 to 12 repetitions of each exercise.

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.⁷

• 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). But you need to take a very low dose at a specific time of the day.

Be sure to check with your doctor before you try these complementary therapies, because they may interact with other medicines you are 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 doctor 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. But it is important that you do not enable the person to remain depressed by taking over all of his or her 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 stay with the prescribed treatment plan.

For more information on helping someone with SAD or depression, see:

Depression: Helping someone get treatment.

Depression: Supporting someone who is depressed.

Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasonswhy people don't get help and how to overcome them.

Last updated:	August 08, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Kathleen Romito, MD - Family Medicine, Alfred Lewy, MD, PhD - Psychiatry
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC