Open studies of pharmacotherapy of

seasonal affective disorder (SAD).54-61 Open studies A survey of open studies in SAD is given in Table III. 54-61 There is some suggestion from pilot data with small sample sizes that serotonergic agents like fluoxetine, citalopram, and trazodone may be treatment options for SAD.54,57 Tranylcypromine, a nonselective Inhibitors,research,lifescience,medical monoamine oxidase inhibitor was effective in the treatment of 14 patients leading to an average 91 % reduction in depressive symptoms within 4 weeks of initiation of treatment.55 A study in 20 patients indicates that St John’s wort (Hypericum perforatum) may be helpful in treating SAD. An add-on therapy with bright light in 10 of these patients treated with hypericum did not lead to a significantly better treatment outcome.59 Two studies in 6 patients each report

beneficial effects of the benzodiazepine Inhibitors,research,lifescience,medical alprazolam.56,60 A 6week open trial investigating efficacy and tolcrability of reboxetine, a selective noradrenaline reuptake inhibitor, led to rapid full remission of depressive symptoms in 1 1 out of 16 patients.61 A rapid relief of préexistent severe atypical symptoms was observed in 9 patients within the first week of treatment. This finding is of pathophysiological interest since, so far, atypical depressive symptoms Inhibitors,research,lifescience,medical like increased appetite, carbohydrate craving, and hypersomnia have been strongly associated with a dysfunction in brain serotonin systems. Controlled studies Controlled studies of pharmacotherapy in SAD are presented in Table IV. 62-66 A study by Ruhrmann et al comparing the SSRI fluoxetine and light therapy in 40 patients with SAD found no check details significant difference in treatment outcome between the groups, but a faster onset of antidepressant action in the light therapy Inhibitors,research,lifescience,medical group.63 Table IV. Controlled studies of pharmacotherapy of seasonal affective disorder (SAD).62-66 LT, light therapy. Because Inhibitors,research,lifescience,medical SAD is prevalent in winter when vitamin D stores are typically low, and because light

therapy includes wavelengths that allow the skin to produce vitamin D, the potential role of vitamin D in SAD has been investigated in a small pilot study.65 Vitamin D was reported to lead to a greater improvement of depressive symptoms than light therapy. However, no difference in vitamin D levels has been observed between patients with SAD and healthy subjects,70,77 and the antidepressant effect of light therapy has been shown to be independent of changes Cytidine deaminase in vitamin D levels.77 So far, any benefits of vitamin D on SAD remain unproven. In two small, preliminary trials, 4 to 6 g daily doses of the amino acid ltryptophan,the precursor of serotonin, were as effective as light therapy.62,64 In a postal survey using an 11 -item rating scale, 301 patients with SAD treated with hypericum at 300 mg three times daily for 8 weeks were asked to report changes in their symptoms.66 Of these patients, 133 used additional light therapy. Significant overall improvement was reported in both treatment groups.