Pharmacological responsiveness of winter depression

Seasonal affective disorders (SADs) are disturbances of mood bearing a fixed relationship to season. Wintertime depression is the most widely accepted form of SAD. Full-spectrum, bright artificial light is the standard treatment for this syndrome. Tranylcypromine was effective in the treatment of 14 patients meeting both the National Institute of Mental Health and DSM-III-R criteria for winter depression. The average patient experienced a 91 percent reduction in depressive symptoms within 3 to 4 weeks of the initiation of this treatment. Desipramine initially appeared to be an effective treatment for winter depression. Eight patients started treatment with desipramine in October or November. One patient was unresponsive, and 8 patients appeared to be responsive but relapsed in the following 2 to 4 months. Twenty-five patients were subsequently treated with bupropion. One patient was unresponsive to bupropion, but the others experienced a substantial reduction in symptoms. Chronobiologic properties that might explain or predict the effectiveness of drugs used to treat winter depression are discussed.