Clinical and Research News
Anticipatory Treatment May Curb SAD Recurrences
Psychiatric News
Volume 41 Number 11 page 25-25

People with a history of winter seasonal affective disorder (SAD) may lower their risk of having a recurrence by taking the antidepressant bupropion XL early in the autumn before symptoms emerge.

This finding comes from three similarly designed prospective double-blind, placebo-controlled studies involving 1,042 patients at 151 sites in the U.S. and Canada.

A team of eight researchers headed by Jack Modell, M.D., vice president for clinical psychiatry-North America at GlaxoSmithKline, the medication's manufacturer, conducted the three trials (referred to as A, B, and C).

According to their report in the October 15, 2005, Biological Psychiatry, the researchers enrolled adult volunteers with a history of SAD between September and November 2002 for studies A and B, and between September and November 2003 for study C. All subjects were diagnosed with SAD by psychiatrists after a clinical interview.

Enrollees started by taking bupropion XL 150 mg or placebo orally every morning for a week. They then took 300 mg of the drug or a matching placebo orally every morning unless the investigator thought they could not tolerate the higher dose. If they later were unable to tolerate 300 mg a day, their dose was reduced to 150 mg a day (or matching placebo) for the rest of the study. Some 80 percent of all subjects used the dose of 300 mg a day or the matching placebo for most of the study.

Beginning in the first week of spring, investigators lowered the subjects' dose of bupropion XL (or matching placebo) from 300 mg a day to 150 mg a day for two weeks, and then discontinued it. Investigators evaluated participants in person throughout the study and via telephone for eight weeks afterward.

Among all participants, 84 (16 percent) developed a recurrence of major depression on bupropion XL, compared with 142 (28 percent) of those on placebo.

Given the high recurrence rates subjects had reported on enrollment—13 previous episodes on average—the relatively small proportion of subjects in the placebo group who experienced a SAD episode was somewhat surprising, the researchers noted. Involvement in a clinical trial with close personal attention, they theorized, may offer protection against depression.

While light therapy has been a mainstay of SAD treatment for the past two decades, some patients may find it cumbersome and inconvenient. The three studies described in this paper, the authors said, "are the first to show that an antidepressant administered before the onset of a recurrent major depressive episode can have a preventative effect."

"A larger issue," Modell told Psychiatric News," is that even among psychiatrists, seasonal patterns of depression often go unrecognized and untreated."

"Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment With Bupropion XL" can be accessed at<www.sciencedirect.com> by clicking on "Journals," "B," "Biological Psychiatry," and "Volume 58, Issue 8."

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