Cognitive behavioural therapy for seasonal affective disorder: a systematic review and meta-analysis

Seasonal affective disorder (SAD) is a seasonal pattern modifier to recurrent major depressive disorder. Despite cognitive behavioural therapy (CBT) having a strong evidence base of efficacy for depression, little research exists assessing CBT for SAD, especially in the acute phase of depression during winter months. The aim of this study was to determine the efficacy of CBT for acute SAD in adults. Eligible randomised controlled trials (RCTs) testing the efficacy of CBT on depression symptoms in adults with SAD were included. Depression outcomes were assessed using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. A meta-analysis using a fixed effects model was conducted to assess the effects of CBT on depression symptoms compared with light therapy (LT) at post-intervention and 1–2 years follow-up. Narrative synthesis was used for recurrence and remission rates. Three RCTs and two follow-up papers met the inclusion criteria. All RCTs measured efficacy of group-CBT for acute SAD and compared to LT. There was substantial variation in risk of bias for all outcomes across the trials. Three RCTs (n=220 participants) were included in the meta-analysis that found CBT was effective in reducing depressive symptoms compared with LT at 1–2-year follow-up post-intervention [MD=–4.5, 95% confidence interval (CI) (–6.88, –2.12), p<0.05]. There was no difference between CBT and LT at immediate post-intervention. Group-CBT appears equivalent to LT in treating acute SAD in adults at post-intervention, but appears more effective at long-term follow-up. The findings should be taken with caution due to few included studies and variation in risk of bias across studies.