Biomedical approaches

OTs can play a large role in educating their clients on biomedical interventions, which can be very effective in minimizing symptoms that impact occupational performance issues in the areas of leisure, productivity and self-care. OTs should be knowledgeable about the most commonly used biomedical treatment approaches, which are light therapy and pharmacotherapy, to address SAD.

Light Therapy

Bright light therapy, or phototherapy, has been used for over 20 years to treat SADwith numerous studies citing its effectiveness. Light therapy is recommended as a first-line treatment for SAD in Canadian, American, and international clinical guidelines. The mood of individuals with SAD can improve with as little as 20 minutes of bright light exposure. Bright light is more effective than dim light in protecting against “mood lowering” which commonly occurs in SAD.

Light boxes are widely available devices which typically provide fluorescent light as a treatment for SAD.

OTs should be familiar with typical usage guidelines provided to users of light boxes and emphasize to clients the need for clinical monitoring to ensure the appropriate doses of light. Effective doses of light therapy vary depending on the individual. Studies have shown effective doses ranging between 3,000 lux 2 hours/day for 5 weeks to 10,000 lux 30 minutes/day for 8 weeks. Patients are typically advised to sit “within several yards” of the device and glance occasionally (rather than stare) at it. Commercial light boxes are not regulated by U.S. law and, as such, OTs should recommend medical consultation and advise caution when selecting and using them. Only 41% of SAD patients comply with clinical practice guidelines and use light therapy regularly due to reasons of inconvenience and ineffectiveness. As such, OTs can help clients develop methods for incorporating light therapy effectively into their daily routines and complying with clinical guidelines.

Effectiveness

Light therapy does not work for everyone. Twenty to fifty percent of those diagnosed with SAD do not gain adequate relief from it. In addition to the lack of efficacy, the required time commitment and the tendency for recurrence are additional reasons why individuals with SAD explore alternative treatments to light therapy. In a study comparing the effectiveness of light therapy and an antidepressant medication, fluoxetine, evidence was found to support the effectiveness and tolerability of both treatments for SAD.

Antidepressant Medications (Pharmacotherapy)

Antidepressant medication (ADM) has been shown to be effective in treating various forms of depression. Of the various types of ADMs used to treat SAD, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline appear to be most effective. OTs play a role in helping their clients understand how such medications, if prescribed, can decrease acute symptoms and lead to enhanced engagement in daily occupations.

ADMs are considered to be largely compensatory in nature. In other words, ADMs may suppress depressive symptoms while they are being used, but lasting changes are not guaranteed once treatment is discontinued. A growing body of evidence is showing that psychosocial approaches to therapy, such as cognitive and behavioural interventions, may have more enduring effects than biomedical interventions.