title: Light visor treament for seasonal affective disorder: A multicenter study A Multicenter Study of the Light Visor for Seasonal Affective Disorder: No Difference in Efficacy Found Between Two Different Intensities Feasibility study to inform the design of a randomised controlled trial to eradicate Pseudomonas aeruginosa infection in individuals with Cystic Fibrosis Prevention of winter seasonal affective disorder by bright-light treatment. The influence of comorbid disorders and of continuation light treatment on remission and recurrence in winter depression. Follow-up study of seasonal affective disorder in Switzerland. Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial An attempt to prevent winter depression by light exposure at the end of September Effects of morning phototherapy on circadian markers in seasonal affective disorder. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Prevention of depression and sleep disturbances in elderly with memory-problems by activation of the biological clock with light - a randomized clinical trial Early light treatment can prevent an emerging winter depression from developing into a full-blown depression. Light therapy for seasonal affective disorder in primary care: randomised controlled trial. Light therapy for seasonal affective disorder. The effects of timing. Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up. Morning or night-time melatonin is ineffective in seasonal affective disorder. Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment. Prevalence of seasonal affective disorder at four latitudes The phototherapy light visor: more to it than meets the eye. A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study. The circadian basis of winter depression. Phototherapy for seasonal affective disorder: a blind comparison of three different schedules.
abstract: The effectiveness of light therapy in seasonal affective disorder ( SAD ) was evaluated in 105 subjects across five centers . Three intensities of light ( 60 lux , 600 lux , and 3500 lux ) were used in a 2-week r and omized , parallel design . There was no significant difference in antidepressant efficacy of the three intensities of light . All three intensities produced a similar frequency of antidepressant response to each other and to that reported in previous studies . There were site differences in the severity of depression during light treatment , but diagnosis and medication status did not affect antidepressant response . These findings suggest that light therapy has an antidepressant action by a nonspecific effect or that light is biologically active in the treatment of SAD across a wide range of intensities Fifty-five patients with winter seasonal affective disorder ( SAD ) were treated with a light visor , a newly developed portable light-delivery system , in a controlled parallel design . A dim ( 400 lux ) visor was compared with a bright ( 6000 lux ) visor for either 30 or 60 minutes in the morning for 1 week . Response rates for these two treatments were 36 % and 56 % , respectively ; the duration of treatment sessions did not affect outcome . There was no evidence that the brighter visor was superior in efficacy to the dimmer one . Significantly greater relapse occurred following withdrawal of the dimmer visor . Alterative explanations for these findings are that the light visor is acting as a placebo or that it is equally effective over a wide range of intensities Background There are controversies about the most effective treatment to eradicate first growth of Pseudomonas aeruginosa ( P aeruginosa ) from the lower airways of patients with cystic fibrosis ( CF ) . UK guidelines recommend oral treatment , but some advocate intravenous ( IV ) treatment . The objective of this study was to assess the feasibility of conducting a r and omised controlled trial comparing two treatment strategies to eradicate P aeruginosa in CF patients . Methods /Principal Findings Two surveys were conducted . Survey [ 1 ] included clinicians who were responsible for the treatment of individuals with CF , to assess their clinical practice , opinions  and  numbers of potentially eligible patients . Survey [ 2 ] included adults and young people aged 13 years or more with CF and parents of children with CF aged less than 13 years , identified at six UK CF centres , who fulfilled eligibility criteria for the proposed clinical trial , to assess their views about the interventions and their willingness to participate in the trial . Generally clinicians treat first or new growth of P aeruginosa with oral antibiotics , but 90 % reported that they would consider IV treatment of first isolation of P aeruginosa . 74 % of clinicians would consider recruiting their patients and 45 % of consumers would consider entry for themselves or their children into a trial comparing oral with intravenous antibiotics . The median rate per annum for first or new growths of P aeruginosa in adults was 3 % ( range 1 % to 9 % ) and in children was 10 % ( range 3 % to 23 % ) . If the trial was conducted across the UK , with a consent rate of 45 % , then the number of eligible patients per annum who would be willing to take part in a study would be approximately 41 adults and 203 children . Conclusions This work demonstrates the importance of feasibility studies in preparation for multicentre clinical trials . It confirmed the uncertainty amongst clinicians and patients about the clinical question , enabled assessment of the number of potentially eligible patients , the proportion of patients and clinicians prepared to participate and aspects of trial design which might encourage this . It showed that a clinical trial was feasible , but only if patients were recruited from across United Kingdom In patients with winter seasonal affective disorder ( SAD ) the onset of a depressive episode is probably associated with the decreasing amount of light during the autumn . A highly predictable onset of a recurrent depressive episode with seasonal pattern provides a rationale for testing the efficacy of bright-light treatment as a preventive measure . Twelve out- patients with winter SAD were assigned to start bright light treatment either when they were well , or not to start it until the first symptoms of depression had already emerged . The severity of depressive symptoms was prospect ively rated for a parallel r and omized comparison . Bright light given well in advance of the emerging symptoms prevented a depressive episode . Clinical remission was significantly more frequent in the former subgroup of the patients in January and in March . To sum up , bright light can be successfully administered as prophylactic treatment for the prevention of winter SAD The objectives of this prospect i ve study were to investigate the influence of comorbid disorders and that of continuation light treatment on remission rates and on a subsequent onset of a depressive episode in out patients ( n = 20 ) with winter depression . The effects of light treatment were evaluated by the structured clinical interviews and by the self-ratings of mood scored monthly for a follow-up period of 1 year . The remission rates of the patients ( n = 8) who proceeded light treatment until the late winter were not significantly different from those of the patients ( n = 6 ) who stopped treatment early during the winter . A more extensive variation in the rates during the year was observed in the former group of patients among whom the comorbid avoidant personality was more frequent , indicating an increased risk of an earlier onset of a depressive episode Of 39 diagnosed Seasonal Affective Disorder ( SAD ) patients who were interviewed 2 - 5 years after participation in a light therapy trial , 10 continued to have recurrent  major depressive episodes  in winter , and 17 manifested sub-syndromal SAD ( 2 patients also had recurrent brief depression , seasonal type ) . 8 patients had recovered , and 4 had shifted in symptomatology . Thus , over a number of years , the clinical diagnosis changed for the better in 64 % of the patients , suggesting that SAD is not a prodromal form of a more chronic major affective disorder , and that light therapy ( and perhaps also light-oriented behaviour ) reduced the incidence and depth of subsequent depressive episodes . Further evidence for this was the large reduction in use of conventional antidepressant drugs ( from 17 to 1 ) during the follow-up period . Diagnosis of SAD was stable and reliable Seasonal affective disorder ( SAD ) is a syndrome characterized by recurrent depressions that occur annually at the same time each year . We describe 29 patients with SAD ; most of them had a bipolar affective disorder , especially bipolar II , and their depressions were generally characterized by hypersomnia , overeating , and carbohydrate craving and seemed to respond to changes in climate and latitude . Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave ( delta ) sleep . Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect Background Seasonal affective disorder ( SAD ) is a subtype of recurrent depression involving major depressive episodes during the fall and /or winter months that remit in the spring . The central public health challenge in the management of SAD is prevention of winter depression recurrence .  Light therapy ( LT ) is the established and best available acute SAD treatment . However , long-term compliance with daily LT from first symptom through spontaneous springtime remission every fall/winter season is poor . Time-limited alternative treatments with effects that endure beyond the cessation of acute treatment are needed to prevent the annual recurrence of SAD . Methods / design This is an NIMH-funded R01-level r and omized clinical trial to test the efficacy of a novel , SAD-tailored cognitive-behavioral group therapy ( CBT ) against LT in a head-to-head comparison on next winter outcomes . This project is design ed to test for a clinical ly meaningful difference between  CBT and LT on depression recurrence in the next winter ( the primary outcome ) . This is a concurrent two-arm study that will r and omize 160 currently symptomatic community adults with major depression , recurrent with seasonal pattern , to CBT or LT .  After 6 weeks of treatment in the initial winter , participants are followed in the subsequent summer , the next winter , and two winters later . Key method ological issues surround timing study procedures for a predictably recurrent and time-limited disorder with a focus on long-term outcomes . Discussion The chosen design answers the primary question of whether prior exposure to CBT is associated with a substantially lower likelihood of depression recurrence the next winter than LT . This design does not test the relative contributions of the cognitive-behavioral treatment components vs. nonspecific factors to CBT ’s outcomes and is not adequately powered to test for differences or equivalence between cells at treatment endpoint . Alternative design s addressing these limitations would have required more patients , increased costs , and reduced power to detect a difference in the primary outcome .Trial registration Clinical trials.gov identifier Seasonal affective disorder ( SAD ) , winter type , is characterized by the occurrence of depression in autumn/winter , followed by a complete recovery in spring/summer . In SAD patients , some atyp- ical symptoms are highly characteristic , such as hypersomnia , carbohydrate craving , weight gain , fatigue , and loss of social inter- actions ( Rosenthal et ai 1984 ) . The repeated occurrence of symp- toms during successive winters is one of the diagnostic criteria , l ~ lot every SAD patient becomes depressed every year , however . In prospect i ve studies it was found that 70,4 % of the SAD diagnosed subjects who were followed from a symptom-free moment at the end of September , became depressed during the following winter ( Meesters et al 1991 ; 1993a ) , In a previous study it was found that severe winter depression can be prevented by light treatment administered at the first signs of an emerging winter depression , that is , the moment subjects reported complaints of slight depression ( Meesters et al 1991 ; 1993a ) . In the present study , the question was raised whether light exposure given at the beginning of the winter season , when sub- jeers are still free of symptoms , could be successful in preventing the development of a winter depressmn during the rest of the season . Such a ueatment , which might prevent depression alto- gether , would be highly advantageous BACKGROUND The suppression of melatonin by light at 00.30 hours has been shown to be greater in winter than in summer on patients with seasonal affective disorder ( SAD ) but not in matched normal controls . METHOD In this study 12 patients with SAD and 12 matched normal controls were exposed to morning light therapy in the winter .  Melatonin profiles and sensitivity to light were measured before and after treatment . RESULTS The SAD but not the normal group showed a phase advance of melatonin rhythms in response to phototherapy . There was an association between phase position and phase shift in the SAD but not in the normal group . CONCLUSIONS There may be instability of circadian rhythms in SAD mediated by a high-amplitude phase response curve , rather than a fixed phase abnormality as had been previously suggested . This instability may be secondary to impaired serotoninergic function in the afferent pathways to the suprachiasmatic nuclei OBJECTIVE Light therapy and antidepressants have shown comparable efficacy in separate studies of seasonal affective disorder treatment , but few studies have directly compared the two treatments . This study compared the effectiveness of light therapy and an antidepressant within a single trial . METHOD This double-blind , r and omized , controlled trial was conducted in four Canadian centers over three winter seasons . Patients met DSM-IV criteria for major depressive disorder with a seasonal ( winter ) pattern and had scores > or = 23 on the 24-item Hamilton Depression Rating Scale . After a baseline observation week , eligible patients were r and omly assigned to 8 weeks of double-blind treatment with either 1 ) 10,000-lux light treatment and a placebo capsule , or 2 ) 100-lux light treatment ( placebo light ) and fluoxetine , 20 mg/day . Light treatment was applied for 30 minutes/day in the morning with a fluorescent white-light box ; placebo light boxes used neutral density filters . RESULTS A total of 96 patients were r and omly assigned to a treatment condition . Intent-to-treat analysis showed overall improvement with time , with no differences between treatments . There were also no differences between the light and fluoxetine treatment groups in clinical response rates ( 67 % for each group ) or remission rates ( 50 % and 54 % , respectively ) . Post hoc testing found that light-treated patients had greater improvement at 1 week but not at other time points . Fluoxetine was associated with greater treatment-emergent adverse events ( agitation , sleep disturbance , palpitations ) , but both treatments were generally well-tolerated with no differences in overall number of adverse effects . CONCLUSIONS Light treatment showed earlier response onset and lower rate of some adverse events relative to fluoxetine , but there were no other significant differences in outcome between light therapy and antidepressant medication . Although limited by lack of a double-placebo condition , this study supports the effectiveness and tolerability of both treatments for seasonal affective disorder and suggests that other clinical factors , including patient preference , should guide selection of first-line treatment Background  Depression  frequently occurs in the elderly and in patients suffering from dementia . Its cause is largely unknown , but several studies point to a possible contribution of circadian rhythm disturbances . Post-mortem studies on aging , dementia and depression show impaired functioning of the suprachiasmatic nucleus ( SCN ) which is thought to be involved in the increased prevalence of day-night rhythm perturbations in these conditions . Bright light enhances neuronal activity in the SCN . Bright light therapy has beneficial effects on rhythms and mood in institutionalized moderate to advanced demented elderly . In spite of the fact that this is a potentially safe and inexpensive treatment option , no previous clinical trial evaluated the use of long-term daily light therapy to prevent worsening of sleep-wake rhythms and depressive symptoms in early to moderately demented home-dwelling elderly . Methods / Design This study investigates whether long-term daily bright light prevents worsening of sleep-wake rhythms and depressive symptoms in elderly people with memory complaints . Patients with early Alzheimer 's Disease ( AD ) , Mild Cognitive Impairment ( MCI ) and Subjective Memory Complaints ( SMC ) , between the ages of 50 and 75 , are included in a r and omized double-blind placebo-controlled trial . For the duration of two years , patients are exposed to ~10,000 lux in the active condition or ~300 lux in the placebo condition , daily , for two half-hour sessions at fixed times in the morning and evening . Neuropsychological , behavioral , physiological and endocrine measures are assessed at baseline and follow-up every five to six months . Discussion If bright light therapy attenuates the worsening of sleep-wake rhythms and depressive symptoms , it will provide a measure that is easy to implement in the homes of elderly people with memory complaints , to complement treatments with cholinesterase inhibitors , sleep medication or anti-depressants or as a st and -alone treatment . Trial registration IS RCT The administration of light at the development of the first signs of a winter depression appears to prevent it from developing into a full-blown depression . Not a single patient from a group of 16 treated this way became severely depressed during the remaining part of the winter season , whereas 5 out of 11 from the non-treated control group did BACKGROUND Studies of light therapy have not been conducted previously in primary care . AIMS To evaluate light therapy in primary care . METHOD Fifty-seven participants with seasonal affective disorder were r and omly allocated to 4 weeks of bright white or dim red light . Baseline expectations for treatment were assessed . Outcome was assessed with the Structured Interview Guide for the Hamilton Depression Scale , Seasonal Affective Disorder Version . RESULTS Both groups showed decreases in symptom scores of more than 40 % . There were no differences in proportions of responders in either group , regardless of the remission criteria applied , with around 60 % ( 74 % white light , 57 % red light ) meeting broad criteria for response and 31 % ( 30 % white light , 33 % red light ) meeting strict criteria . There were no differences in treatment expectations . CONCLUSIONS Primary care patients with seasonal affective disorder improve after light therapy , but bright white light is not associated with greater improvements BACKGROUND Sixty-eight patients with seasonal affective disorder participated in a 10,000-lux light treatment study in which two questions were addressed : do response rates differ when the light is applied at different times of the day and does short-term rank ordering of morning and evening light influence response rates ? METHOD Three groups of patients received a 4-day light treatment : ( I ) in the morning ( 8.00 - 8.30 a.m. , n = 14 ) , ( II ) in the afternoon ( 1.00 - 1.30 p.m. , n = 15 ) or ( III ) in the evening ( 8.00 - 8.30 p.m. , n = 12 ) . Two additional groups of patients received two days of morning light treatment followed by two days of evening light ( IV , n = 13 ) or vice versa ( V , n = 14 ) . RESULTS Response rates for groups I , II and III were 69 , 57 and 80 % respectively , with no significant differences between them . Response rates for groups IV and V were 67 and 50 % respectively ; this difference was not significant and these percentages did not differ significantly from those of groups I and III . CONCLUSIONS The results indicate that the timing of light treatment is not critical and that short-term rank ordering of morning and evening light does not influence therapeutic outcome This placebo-controlled , double-blind , 1-year pilot study aim ed at investigating possible clinical advantages of combining initial light therapy with the selective serotonin reuptake inhibitor ( SSRI ) citalopram as well as the effects of continuous long-term administration of this drug in patients with seasonal affective disorder ( SAD ) . Eight physically healthy women who met the DSM-III-R criteria for SAD were included in the study . Four women were r and omized to the citalopram group receiving 40 mg citalopram daily from the first of 10 light treatment days and throughout the 1-year study . The remaining four women were allocated to the placebo group using the same double-blind repeated measures design . The clinical outcome was measured by using three versions of the Comprehensive Psychopathological Rating Scale ( CPRS ) and Visual Analog Scales ( VAS ) , respectively . Taking the initial rating scores into account in covariance analyses , no statistically significant group difference was found during the light treatment period . However , during the follow-up period the full version of the CPRS and the self-rating version of CPRS and the VAS-scales for global condition and depressed mood were statistically significantly lower in the citalopram group compared with the placebo group . Thus , in this small but carefully observed sample of SAD- patients combining initial light therapy and long-term citalopram treatment was clinical ly more effective over time than the placebo combination . Our findings support the notion that light therapy with concomitant and continued SSRI ( citalopram ) treatment is a useful strategy to achieve beneficial long-term effects in patients with the SAD syndrome Melatonin , at the same doses used to treat circadian-rhythm related sleep disturbances , had no effect on the depressive symptoms in seasonal affective disorder ( SAD ) patients , whether given early ( 7 a.m. ) or late ( 11 p.m. ) for a week . Slight improvements in sleep were seen with nighttime administration . The circadian rhythmicity of urinary 6-sulphatoxymelatonin was not modified in any way . Melatonin at this dosage ( 5 mg/day ) or at these two times is therefore not a potential alternative treatment for SAD ; light remains the therapy of choice BACKGROUND Seasonal affective disorder ( SAD ) can cause significant distress and impairment . No antidepressant studies have previously attempted to prevent the onset of autumn-winter depression . METHODS Three prospect i ve , r and omized , placebo-controlled prevention trials were conducted on 1042 SAD patients , enrolled in autumn and treated while still well , across the northern US and Canada . Patients received either bupropion XL 150 - 300 mg or placebo daily by mouth from enrollment until spring and were then followed off medications for 8 additional weeks . Primary efficacy variables were end-of-treatment depression-free rates and survival distributions of depressive recurrence . RESULTS Despite a reported average of 13 previous seasonal depressive episodes , almost 60 % of patients had never previously been treated for depression . Major depression recurrence rates during the three studies for bupropion XL and placebo groups were 19 % versus 30 % ( p = 0.026 ) , 13 % versus 21 % ( p = 0.049 ) , and 16 % versus 31 % ; yielding a relative risk reduction across the three studies of 44 % for patients taking bupropion XL .  Survival analyses for depression onset also favored bupropion XL over placebo ( p = .081 , .057 , and < .001 ) . CONCLUSIONS It is possible to prevent recurrence of seasonal major depressive episodes by beginning bupropion treatment early in the season while patients are still well BACKGROUND Thirty-eight patients with SAD participated in a light visor study addressing two questions . 1 . Can the development of a depressive episode be prevented by daily exposure to bright light started before symptom onset in early fall and continued throughout the winter ? 2 . Does the light have to be visible in order to have beneficial effects ? METHODS Three groups participated in the study : I ( n = 14 ) received bright white light ( 2500 lux ) ; II , ( n = 15 )  received infrared light ( 0.18 lux ) ; III ( n = 9 ,  control group ) did not receive any light treatment at all . RESULTS Infrared light is just as effective as bright white light . Both are more effective than the control condition . CONCLUSIONS Light visors can be effectively used to prevent the development of SAD . The fact that exposure to infrared light was as effective as exposure to bright white light questions the specific role of visible light in the treatment of SAD The central public health challenge in the management of  seasonal affective disorder ( SAD ) is prevention of depression recurrence each fall/winter season . The need for time-limited treatments with enduring effects is underscored by question able long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year . We previously developed a SAD-tailored group cognitive-behavioral therapy ( CBT ) and tested its acute efficacy in 2 pilot studies . Here , we report an intent-to-treat ( ITT ) analysis of outcomes during the subsequent winter season ( i.e. , approximately 1 year after acute treatment ) using participants r and omized to CBT , light therapy , and combination treatment across our pilot studies ( N=69 ) . We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment , were withdrawn from protocol , or were lost to follow-up . The CBT ( 7.0 % ) and combination treatment ( 5.5 % ) groups had significantly smaller proportions of winter depression recurrences than the light therapy group ( 36.7 % ) . CBT alone , but not combination treatment , was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone . Among completers who provided 1-year data , all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy , antidepressants , and psychotherapy . If these findings are replicated , CBT could represent a more effective , practical , and palatable approach to long-term SAD management than light therapy The Seasonal Pattern Assessment Question naire ( SPAQ ) was mailed to a sample population balanced for sex and r and omly selected from local telephone directories in four areas : Nashua , NH , New York , NY , Montgomery County , MD , and Sarasota , FL . On the basis of responses to this question naire , prevalence rates of winter seasonal affective disorder ( winter SAD ) , summer seasonal affective disorder ( summer SAD ) , and subsyndromal winter SAD were estimated for the four areas . Rates of winter SAD and subsyndromal SAD were found to be significantly higher at the more northern latitudes , while no correlation was found between latitude and summer SAD . The positive correlation between latitude and prevalence of winter SAD applied predominantly to the age groups over 35 OBJECTIVE The purpose of the study was to ascertain whether phototherapy light visors provide an effective treatment for  seasonal affective disorder .  Previous studies have demonstrated a moderate response rate but have failed to find any difference in efficacy between light intensities . METHOD Subjects were r and omly assigned to receive , over a 2-week treatment period , 30 minutes of morning phototherapy with a light visor that emitted either a dim ( 30-lux ) red light or a bright ( 600-lux ) white light . Raters were blind to treatment , and patients were unaware of the alternatives . Response was assessed by using the structured 21-item Hamilton Depression Rating Scale , with an eight-item addendum for atypical depressive symptoms . Fifty-seven patients were enrolled across two sites . RESULTS Patients assigned to the different visors had similar baseline depression scores and similar expectations of outcome . Hamilton depression scale scores declined by 34.6 % for subjects given bright white light and by 40.9 % for subjects given dim red light .  Scores for atypical depressive symptoms fell by 44.1 % for patients assigned the bright white light visors and by 49.0 % for patients assigned the dim red light visors . Altogether , 39.3 % of the patients who received red light  and 41.4 % of the patients who received bright white light showed a full clinical response . CONCLUSIONS There were no significant differences in therapeutic response between patients who were treated with red or white light .  The results of this study suggest that the phototherapy light visor may function as an elaborate placebo . Alternative explanations , however , are considered This first controlled psychotherapy trial for seasonal affective disorder ( SAD ) compared SAD-tailored cognitive-behavioral therapy ( CBT ) , light therapy ( LT ) , and their combination to a concurrent wait-list control . Adults ( N = 61 ) with major depression , recurrent with seasonal pattern , were r and omized to one of four 6-week conditions : CBT ( 1.5-hr twice-weekly group therapy ) , LT ( 10,000-lux for 90-min/day with administration time individually adjusted ) , combined CBT + LT , or a minimal contact/delayed LT control ( MCDT ; LT following 6 weeks of monitoring ) . CBT , LT , and CBT + LT significantly and comparably improved depression severity relative to MCDT in intent-to-treat and completer sample s. CBT + LT ( 73 % ) had a significantly higher remission rate than MCDT ( 20 % ) . Using prospect ively measured summer mood status to estimate the " functional " population , CBT + LT also had a significantly larger proportion of participants with clinical ly significant change over treatment compared with MCDT . The LT condition outcomes virtually replicated results from prior trials . CBT , alone or combined with LT , holds promise as an efficacious SAD treatment and warrants further study . If replicated , CBT + LT 's  remission rate would represent a clinical ly meaningful improvement over the 53 % observed across LT studies BACKGROUND The best available treatment for seasonal affective disorder ( SAD ) is light therapy . Yet , this treatment does not prevent recurrence of depression in subsequent seasons . The aim of the study is to gain preliminary insight in the efficacy of Mindfulness Based Cognitive Therapy ( MBCT ) in the prevention of SAD recurrence . METHODS This is a r and omized controlled pilot study , in which SAD patients in remission were r and omly allocated to an individual format of MBCT or a control condition ( i.e. treatment as usual ) . MBCT was given between May and June 2011 , when there was no presence of depressive symptoms . The Inventory for Depressive Symptomatology Self-Report ( IDS-SR ) , which patients received on a weekly basis from September 2011 to April 2012 , was used to assess moment of recurrence ( ≥20 ) and severity at moment of recurrence . RESULTS 23 SAD patients were r and omized to MBCT and 23 to the control condition . Kaplan-Meier survival curve showed that the groups did not differ in moment of recurrence ( χ²(1).41 , p=.52 ) . T-tests showed no group difference in mean IDS-SR scores at moment of recurrence ( t(31)=-.52 , p=.61 ) . LIMITATIONS The results are limited by small sample size ( n=46 ) and missing data of weekly IDS-SR assessment s. CONCLUSION The findings of this pilot RCT suggest that individual MBCT is not effective in preventing a SAD recurrence when offered in a symptom free period ( i.e. spring ) The following test of the circadian phase-shift hypothesis for patients with winter depression ( seasonal affective disorder , or SAD ) uses low-dose melatonin administration in the morning or afternoon/evening to induce phase delays or phase advances , respectively , without causing sleepiness . Correlations between depression ratings and circadian phase revealed a therapeutic window for optimal alignment of circadian rhythms that also appears to be useful for phase-typing SAD patients for the purpose of administering treatment at the correct time . These analyses also provide estimates of the circadian component of SAD that may apply to the antidepressant mechanism of action of appropriately timed bright light exposure , the treatment of choice . SAD may be the first psychiatric disorder in which a physiological marker correlates with symptom severity before , and in the course of , treatment in the same patients . The findings support the phase-shift hypothesis for SAD , as well as suggest a way to assess the circadian component of other psychiatric , sleep , and chronobiologic disorders The authors investigated the outcome of an alternating time schedule versus two fixed schedules ( either morning or evening ) of bright light treatment for seasonal affective disorder . The subjects were 31 patients who met DSM-III-R criteria for major depression with a seasonal pattern . No statistically significant difference was observed among patients in the three groups for response criteria after 1 week of treatment . These results support the use of more flexible phototherapy schedules
target: Overall , both forms of preventive light therapy reduced the incidence of SAD numerically compared with no light therapy .
background: BACKGROUND Seasonal affective disorder ( SAD ) is a seasonal pattern of recurrent major depressive episodes that most commonly occurs during autumn or winter and remits in spring .
  The prevalence of SAD ranges from 1.5 % to 9 % , depending on latitude .
  The predictable seasonal aspect of SAD provides a promising opportunity for prevention .
  This review - one of four review s on efficacy and safety of interventions to prevent SAD - focuses on light therapy as a preventive intervention .
  Light therapy is a non-pharmacological treatment that exposes people to artificial light .
  Mode of delivery ( e.g. visors , light boxes ) and form of light ( e.g. bright white light ) vary .
  OBJECTIVES To assess the efficacy and safety of light therapy ( in comparison with no treatment , other types of light therapy , second-generation antidepressants , melatonin , agomelatine , psychological therapies , lifestyle interventions and negative ion generators ) in preventing SAD and improving patient-centred outcomes  among adults with a history of SAD .