Advertisement

Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL

      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 prospective, randomized, 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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Agresti A.
        Categorical Data Analysis. 2nd ed. Wiley, New York2002
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association, Washington, DC1994
        • Ashton A.K.
        • Jamerson B.D.
        • Weinstein W.L.
        • Wagoner C.
        Antidepressant-related adverse events impacting treatment compliance.
        Current Therapeutic Res. 2005; 66: 96-106
        • Avery D.H.
        • Khan A.
        • Dager S.R.
        • Cohen S.
        • Cox G.B.
        • Dunner D.L.
        Morning or evening bright light treatment of winter depression?The significance of hypersomnia.
        Biol Psychiatry. 1991; 29: 117-126
        • Avery D.H.
        • Khan A.
        • Dager S.R.
        • Cox G.B.
        • Dunner D.L.
        Bright light treatment of winter depression.
        Acta Psychiatr Scand. 1990; 82: 335-338
        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research. Volume I—The analysis of case–control studies.
        IARC Sci Pub. 1980; 32: 5-338
        • Booker J.M.
        • Hellekson C.J.
        Prevalence of seasonal affective disorder in Alaska.
        Am J Psychiatry. 1992; 149: 1176-1182
        • Cox D.R.
        Regression models and life tables.
        J Royal Statistical Soc. 1972; B34: 187-220
        • Dilsaver S.C.
        • Jaeckle R.S.
        Winter depression responds to an open trial of tranylcypromine.
        J Clin Psychiatry. 1990; 51: 326-329
        • Dilsaver S.C.
        • Qamar A.B.
        • Del Medico V.J.
        The efficacy of bupropion in winter depression.
        J Clin Psychiatry. 1992; 53: 252-255
        • Eastman C.I.
        • Young M.A.
        • Fogg L.F.
        • Liu L.
        • Meaden P.M.
        Bright light treatment of winter depression.
        Arch Gen Psychiatry. 1998; 55: 883-889
        • Fava M.
        • Evins A.E.
        • Dorer D.J.
        • Schoenfeld D.A.
        The problem of the placebo response in clinical trials for psychiatric disorders.
        Psychother Psychosom. 2003; 72: 115-127
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV Axis I Disorders—Clinician Version (SCID-CV). American Psychiatric Press, Washington, DC1997
        • Garvey M.J.
        • Wesner R.
        • Godes M.
        Comparison of seasonal and nonseasonal affective disorders.
        Am J Psychiatry. 1988; 145: 100-102
        • Haggarty J.M.
        • Cernovsky Z.
        • Husni M.
        • Minor K.
        • Kermeen P.
        • Merskey H.
        Seasonal affective disorder in an Arctic community.
        Acta Psychiatr Scand. 2002; 105: 378-384
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Hardin T.A.
        • Wehr T.A.
        • Brewerton T.
        • Kasper S.
        • Berrettini W.
        • Rabkin J.
        • Rosenthal N.E.
        Evaluation of seasonality in six clinical populations and two normal populations.
        J Psychiatr Res. 1991; 25: 75-87
        • Hilger E.
        • Willeit M.
        • Praschak-Rieder N.
        • Stastny J.
        • Neumeister A.
        • Kasper S.
        Reboxetine in seasonal affective disorder.
        Eur Neuropsychopharmacol. 2001; 11: 1-5
        • Imai M.
        • Kayukawa Y.
        • Ohta T.
        • Li L.
        • Nakagawa T.
        Cross-regional survey of seasonal affective disorders in adults and high-school students in Japan.
        J Affect Disord. 2003; 77: 127-133
        • Jacobsen F.M.
        • Wehr T.A.
        • Sack D.A.
        • James S.P.
        • Rosenthal N.E.
        Seasonal affective disorder.
        Am J Public Health. 1987; 77: 57-60
        • Kaplan E.L.
        • Meier P.
        Non-parametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Kennedy S.H.
        • Lam R.W.
        • Cohen N.L.
        • Ravindran A.V.
        Clinical guidelines for the treatment of depressive disorders. IV. Medications and other biological treatments.
        Can J Psychiatry. 2001; 46: 38S-58S
        • Lam R.W.
        • Gorman C.P.
        • Michalon M.
        • Steiner M.
        • Levitt A.J.
        • Corral M.R.
        • Watson G.D.
        Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder.
        Am J Psychiatry. 1995; 152: 1765-1770
        • Levitt A.J.
        • Boyle M.H.
        • Joffe R.T.
        • Baumal Z.
        Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample.
        Can J Psychiatry. 2000; 45: 650-654
        • Levitt A.J.
        • Joffe R.T.
        • Moul D.E.
        • Lam R.W.
        • Teicher M.H.
        • Lebegue B.
        • et al.
        Side effects of light therapy in seasonal affective disorder.
        Am J Psychiatry. 1993; 150: 650-652
        • Lewy A.J.
        • Bauer V.K.
        • Cutler N.L.
        • Sack R.L.
        • Ahmed S.
        • Thomas K.H.
        • et al.
        Morning vs evening light treatment of patients with winter depression.
        Arch Gen Psychiatry. 1998; 55: 890-896
        • Lewy A.J.
        • Kern H.A.
        • Rosenthal N.E.
        • Wehr T.A.
        Bright artificial light treatment of a manic–depressive patient with a seasonal mood cycle.
        Am J Psychiatry. 1982; 9: 1496-1498
        • Lewy A.J.
        • Sack R.L.
        • Miller L.S.
        • Hoban T.M.
        Antidepressant and circadian phase-shifting effects of light.
        Science. 1987; 235: 352-354
        • Lingjaerde O.
        • Reichborn-Kjennerud T.
        • Haggag A.
        • Gartner I.
        • Narud K.
        • Berg E.M.
        Treatment of winter depression in Norway. II. A comparison of the selective monoamine oxidase A inhibitor moclobemide and placebo.
        Acta Psychiatr Scand. 1993; 88: 372-380
        • Low K.G.
        • Feissner J.M.
        Seasonal affective disorder in college students.
        J Am Coll Health. 1998; 47: 135-137
        • Mantel N.
        • Haenszel W.
        Chi-Square tests with one degree of freedom.
        J Am Stat Assoc. 1963; 58: 690-700
        • Martinez B.
        • Kasper S.
        • Ruhrmann S.
        • Moller H.J.
        Hypericum in the treatment of seasonal affective disorders.
        J Geriatr Psychiatry Neurol. 1994; 7: S29-S33
        • Mersch P.P.
        • Middendorp H.M.
        • Bouhuys A.L.
        • Beersma D.G.
        • van den Hoofdakker R.H.
        Seasonal affective disorder and latitude.
        J Affect Disord. 1999; 53: 35-48
        • Merch P.P.
        • Vastenburg N.C.
        • Meesters Y.
        • Bouhuys A.L.
        • Beersma D.
        • van den Hoofdakker R.H.
        • Den Boer J.A.
        The reliability and validity of the seasonal pattern assessment questionnaire.
        J Affect Disord. 2004; 80: 209-219
        • Michalak E.E.
        • Hayes S.
        • Wilkinson C.
        • Hood K.
        • Dowrick C.
        Treatment compliance in light therapy.
        J Affect Disord. 2002; 68: 341-342
        • Michalon M.
        • Eskes G.A.
        • Mate-Kole C.C.
        Effects of light therapy on neuropsychological function and mood in seasonal affective disorder.
        J Psychiatry Neurosci. 1997; 22: 19-28
        • Molin J.
        • Mellerup E.
        • Bolwig T.
        • Scheike T.
        • Dam H.
        The influence of climate on development of winter depression.
        J Affect Disord. 1996; 37: 151-155
        • Neumeister A.
        • Konstantinidis A.
        • Praschak-Rieder N.
        • Willeit M.
        • Hilger E.
        • Stastny J.
        • Kasper S.
        Monoaminergic function in the pathogenesis of seasonal affective disorder.
        Int J Neuropsychopharmacol. 2001; 4: 409-420
        • Oren D.A.
        • Rosenthal N.E.
        Seasonal affective disorders.
        in: Paykel E.S. Handbook of Affective Disorders. 2nd ed. Guilford Press, New York1992: 551-567
        • O’Rourke D.
        • Wurtman J.J.
        • Wurtman R.J.
        • Chebli R.
        • Gleason R.
        Treatment of seasonal depression with d-fenfluramine.
        J Clin Psychiatry. 1989; 50: 343-347
        • Palinkas L.A.
        • Cravalho M.
        • Browner D.
        Seasonal variation of depressive symptoms in Antarctica.
        Acta Psychiatr Scand. 1995; 91: 423-429
        • Partonen T.
        • Lonnqvist J.
        Moclobemide and fluoxetine in treatment of seasonal affective disorder.
        J Affect Disord. 1996; 41: 93-99
      1. Partonen T. Magnusson A. Seasonal Affective Disorder Practice and Research.. Oxford University Press, New York2001
        • Pendse B.P.
        • Ojehagen A.
        • Engstrom G.
        • Traskman-Bendz L.
        Social characteristics of seasonal affective disorder patients.
        Eur Psychiatry. 2003; 18: 36-39
        • Pjrek E.
        • Winkler D.
        • Stastny J.
        • Konstantinidis A.
        • Heiden A.
        • Kasper S.
        Bright light therapy in seasonal affective disorder—does it suffice?.
        Eur Neuropsychopharmacol. 2004; 14: 347-351
        • Rosen L.N.
        • Targum S.D.
        • Terman M.
        • Bryant M.J.
        • Hoffman H.
        • Kasper S.F.
        • et al.
        Prevalence of seasonal affective disorder at four latitudes.
        Psychiatry Res. 1990; 31: 131-144
        • Rosenthal N.E.
        Winter Blues. Guilford Press, New York2005
      2. Rosenthal N.E. Blehar M.C. Seasonal Affective Disorders and Phototherapy. Guilford Press, New York1989
        • Rosenthal N.E.
        • Sack D.A.
        • Carpenter C.J.
        • Parry B.L.
        • Mendelson W.B.
        • Wehr T.A.
        Antidepressant effects of light in seasonal affective disorder.
        Am J Psychiatry. 1985; 142: 163-170
        • Rosenthal N.E.
        • Sack D.A.
        • Gillin J.C.
        • Lewy A.J.
        • Goodwin F.K.
        • Davenport Y.
        • et al.
        Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy.
        Arch Gen Psychiatry. 1984; 41: 72-80
        • Rosenthal N.E.
        • Skwerer R.G.
        • Sack D.A.
        • Dunkan C.C.
        • Jacobsen F.M.
        • Tamarkin L.
        • Wehr T.A.
        Biological effects of morning-plus-evening bright light treatment of seasonal affective disorder.
        Psychopharmacol Bull. 1987; 23: 364-369
        • Ruhrmann S.
        • Kasper S.
        • Hawellek B.
        • Martinez B.
        • Hoflich G.
        • Nickelsen T.
        • Moller H.J.
        Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder.
        Psychol Med. 1998; 28: 923-933
        • Sack R.L.
        • Lewy A.J.
        • White D.M.
        • Singer C.M.
        • Fireman M.J.
        • Vandiver R.
        Morning vs evening light treatment for winter depression. Evidence that the therapeutic effects of light are mediated by circadian phase shifts.
        Arch Gen Psychiatry. 1990; 47: 343-351
        • Schlager D.S.
        Early-morning administration of short-acting beta-blockers for treatment of winter depression.
        Am J Psychiatry. 1994; 151: 1383-1385
        • Schwartz P.J.
        • Murphy D.L.
        • Wehr T.A.
        • Garcia-Borreguero D.
        • Oren D.A.
        • Moul D.E.
        • et al.
        Effects of meta-chlorophenylpiperazine infusions in patients with seasonal affective disorder and healthy control subjects.
        Arch Gen Psychiatry. 1997; 54: 375-384
        • Stahl S.
        • Pradko J.
        • Haight B.
        • Modell J.G.
        • Rockett C.
        • Learned-Coughlin S.
        A review of the neuropharmacology of bupropion SR.
        Prim Care Companion J Clin Psychiatry. 2004; 6: 159-166
        • Terman M.
        • Terman J.S.
        • Quitkin F.M.
        • McGrath P.J.
        • Stewart J.W.
        • Rafferty B.
        Light therapy for seasonal affective disorder. A review of efficacy.
        Neuropsychopharmacology. 1989; 2: 1-22
        • Terman M.
        • Terman J.S.
        • Ross D.C.
        A controlled trial of timed bright light and negative air ionization for treatment of winter depression.
        Arch Gen Psychiatry. 1998; 55: 875-882
        • Terman J.S.
        • Terman M.
        • Schlager D.
        • Rafferty B.
        • Rosofsky M.
        • Link M.J.
        • et al.
        Efficacy of brief, intense light exposure for treatment of winter depression.
        Psychopharmacol Bull. 1990; 26: 3-11
        • Thase M.
        Defining and Treating Seasonal Affective Disorder.
        Psychiatric Annals. 1986; 12: 733-737
        • Thompson C.
        • Rodin I.
        • Birtwhistle J.
        Light therapy for seasonal and non-seasonal affective disorder.
        Society for Light Treatment and Biological Rhythms Abstracts. 1999; : 11
        • Turner E.H.
        • Schwartz P.J.
        • Lowe C.H.
        • Nawab S.S.
        • Feldman-Naim S.
        • Drake C.L.
        • et al.
        Double-blind, placebo-controlled study of single-dose metergoline in depressed patients with seasonal affective disorder.
        J Clin Psychopharmacol. 2002; 22: 216-220
        • Walsh B.T.
        • Seidman S.N.
        • Sysko R.
        • Gould M.
        Placebo response in studies of major depression.
        JAMA. 2002; 287: 1840-1847
        • Wehr T.A.
        • Skwerer R.G.
        • Jacobsen F.M.
        • Sack D.A.
        • Rosenthal N.E.
        Eye versus skin phototherapy of seasonal affective disorder.
        Am J Psychiatry. 1987; 144: 753-757
        • Wheatley D.
        Hypericum in seasonal affective disorder (SAD).
        Curr Med Res Opin. 1999; 15: 33-37
        • Williams J.B.W.
        • Link M.J.
        • Rosenthal N.E.
        • Amira L.
        • Terman M.
        Structured Interview Guide for the Hamilton Depression Rating Scale—Seasonal Affective Disorder Version. New York State Psychiatric Institute, New York2002
        • Young M.A.
        • Meaden P.M.
        • Fogg L.F.
        • Cherin E.A.
        • Eastman C.I.
        Which environmental variables are related to the onset of seasonal affective disorder?.
        J Abnorm Psychol. 1997; 106: 554-562