Should we be treating seasonal affective disorder with antidepressants?


Seasonal affective disorder (winter depression) is a type of depression that recurs in the autumn and lasts until the spring. It is similar to regular depression except sufferers are usually very tired and have an increase in their appetite. It is more common in countries with few daylight hours in winter.

People with seasonal affective disorder may be offered a range of treatments included antidepressants, talking treatments or light therapy.

This new Cochrane review set out to assess the efficacy and safety of second generation antidepressants for the treatment of seasonal affective disorder in adults in comparison with placebo, light therapy, other second generation antidepressants or psychotherapy.

The authors conducted a systematic search of the usual databases and trials registers but found very little useful evidence to include in their review. For efficacy, they included three randomised trials of between five and eight weeks duration with a total of 204 participants. For adverse effects, they included two randomised trials and three observational (non-randomised) studies of five to eight weeks duration with a total of 225 participants.

Here’s what they found:

  • One small trial (with 68 participants) showed that fluoxetine was not significantly more effective than placebo in achieving clinical response (risk ratio (RR) 1.62, 95% confidence interval (CI) 0.92 to 2.83). The number of adverse effects were similar between the two groups
  • A meta-analysis of two small trials (with a total of 136 participants) showed fluoxetine and light therapy to be approximately equal in treating seasonal depression: RR of response 0.98 (95% CI 0.77 to 1.24), RR of remission 0.81 (95% CI 0.39 to 1.71). The number of adverse effects was similar in both groups

The reviewers concluded:

The lack of available evidence precludes the ability to draw any overall conclusions on the use of second generation antidepressants for seasonal affective disorder. Further larger RCTs are required to expand and strengthen the evidence base on this topic, and should also include comparisons with psychotherapy and other second generation antidepressants.

Thaler K, Delivuk M, Chapman A, Gaynes BN, Kaminski A, Gartlehner G. Second-generation antidepressants for seasonal affective disorder. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008591. DOI: 10.1002/14651858.CD008591.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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