Seasonal affective disorder: rapid resolution by low-dose alprazolam

Seasonal affective disorder (SAD) has recently been recognized as a common psychiatric disorder, and treatment with bright artificial light has been shown to be effective in treating fall-winter SAD. However, many patients with SAD fail to respond or find phototherapy too inconvenient. We thus assessed the efficacy of alprazolam in 6 patients diagnosed with SAD during the course of ongoing clinical treatment. Alprazolam was administered in doses ranging from 0.5 mg to 1.5 mg daily. This agent produced rapid and dramatic results in 4 patients, with remission of symptoms occurring in about 3 days. These patients initially became hypomanic or hyperthymic, and then settled into a state of euthymia about 2 weeks later. Two patients had a moderate response but were still symptomatic. Five subjects received continuous treatment for at least an entire season, and none experienced withdrawal symptoms upon discontinuation. Alprazolam may represent an effective and well-tolerated alternative treatment for SAD.