Helping Patients Handle Seasonal Affective Disorder with Custom Compounded Treatments
As winter approaches and days get shorter, everyone feels a little disoriented by the diminishing sunlight. But some people may have a more extreme neurobiological response that disrupts levels of serotonin and skews their circadian rhythms. The resulting depression, known as seasonal affective disorder, can plague them until spring. Compounding pharmacists are often the first point of contact for these patients. You can improve their quality of life, protect their health and build your business by helping relieve seasonal affective disorder with compounded treatments.
Prevalence of Seasonal Affective Disorder
DSM-5 states that depression qualifies as seasonal affective disorder—or depressive disorder with seasonal pattern—if it begins in fall or winter and ends in spring. Additionally, the depression must occur for two or more consecutive years without episodes of non-seasonal depression. SAD is a major depressive disorder marked by low levels of serotonin, higher than normal melatonin, and disrupted circadian rhythms.
Familiarity with the essential characteristics of SAD is the best way to anticipate the patients you may encounter and how compounded treatments can help.
- About 1 percent to 10 percent of the general population have SAD, depending on the geographical region in which they live.1
- Three out of four patients are women.
- Average age of onset is 18 to 30, but it can occur at any age.
- Classic symptoms of SAD are oversleeping, overeating, carb craving, and weight gain. Patients may also have other typical symptoms of depression such as hopelessness, social withdrawal, and suicidal thoughts.
- Symptoms usually begin in October or November and don’t subside until March or April.
Multiple Treatment Options
Experts have long acknowledged the role of low serotonin in seasonal affective disorder, but the effect of seasonal light changes on serotonergic neurons wasn’t verified until May 2015.2 Even though we’re closer to targeting the neurobiology, we still don’t know why serotonin regulation is affected in some people but not in others. The two primary treatments for SAD—antidepressants and phototherapy—are both effective. However, about half of all patients don’t respond to phototherapy alone, so they need combination treatment with medication.
Pharmacologic treatments: Selective serotonin reuptake inhibitors are the preferred medication because they boost serotonin more than tricyclic antidepressants. The atypical antidepressant, bupropion is also FDA-approved for seasonal affective disorder. In spite of their benefits, SSRIs and bupropion can also worsen depression. Patients who can’t tolerate these medications may be candidates for tricyclic antidepressants such as amitriptyline.
Phototherapy: Morning treatment with sunlight or light boxes improves SAD. It’s important to counsel patients about purchasing light boxes specifically designed to treat SAD, as not every light box on the market is at least 25 times brighter than normal living room light (the brightness needed to impact SAD). Patients can often return to a normal circadian rhythm by combining phototherapy in the morning with melatonin supplements at night.
Supplements: Compounding pharmacists can uniquely help people with seasonal affective disorder by combining treatments that target each person’s symptoms. Some patients may prefer to try natural antidepressants rather than medications, so don’t hesitate to discuss options such as 5-HTP, tyrosine, SAMe and St. Johns Wort.3
Challenges Facing Compounding Pharmacists
When compounding pharmacists participate in patient care for chronic diseases, their roles—and medical protocols—are well defined. Guidelines are still being developed for their participation in mental health disorders, but patients can’t afford to wait and studies show pharmacists are vital for early detection of depression and promoting medication adherence.4
Many people with seasonal affective disorder don’t seek treatment from their physician. Even when they consult a doctor, they may remain untreated because primary care physicians fail to diagnose about half of all patients with depression.5 The next stop is often their local pharmacy. Compounding pharmacists must be prepared to reach out with information and to identify patients in need of a mental health referral.
Reaching out to patients: These patients aren’t likely to walk up and ask what you recommend for seasonal affective disorder. While it’s helpful to have handouts available that cover the basics—and you can ask staff to pass along information to anyone buying OTC remedies for depression—more creative efforts will yield better results:
- Invest in a therapy lamp or ask a distributor to lend one. Put up a display, demonstrate its use, and build on the interaction by talking about SAD and compounding options. Experts recommend seeing a doctor before using light therapy to ensure an accurate diagnosis.6
- Put up an eye-catching poster listing the symptoms of SAD. Make sure the poster says that the pharmacist is available to talk. Keep the language informal by avoiding words like “consult.”
- If you’re located in northern latitudes with a higher prevalence of SAD, invite a specialist to talk and host an information session for the public.
Extra Effort Yields Results for Patients and Pharmacists
The willingness to step beyond your comfort zone and assist people with mental health challenges is the true sign of a trusted community pharmacist. Many patients with seasonal affective disorder don’t see their doctor. They may worry about the backlash of stigma, figure that “winter blues” affect everyone, or hear experts debate whether seasonal affective disorder is even a real disease. But their need is real and compounding pharmacists are in the perfect spot to help them relieve seasonal affective disorder.
Pharmaceutica North America provides over-the-counter dietary supplements such as a calming melatonin blend and a variety of bulk APIs that can be used in formulations for patients with seasonal affective disorder. Please contact us today to talk about our relaxing blend of melatonin the counter dietary supplements.
- “Seasonal Affective Disorder,” March 2013, http://www.jccmi.edu/info/HealthClinic/docs/March%202013%20-%20Seasonal%20Affective%20Disorder.pdf ↩
- “Locating the Brain’s SAD Center,” May 2015, http://www.sciencedaily.com/releases/2015/05/150507122659.htm ↩
- “Five Dietary Supplements for Seasonal Affective Disorder,” January 2015, http://www.pharmacytimes.com/contributor/gopesh-patel-rph/2015/01/5-dietary-supplements-for-seasonal-affective-disorder ↩
- “New Roles for Pharmacists in Community Mental Health Care: A Narrative Review,” October 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211017/ ↩
- “Seasonal Affective Disorder,” November 2006, http://www.aafp.org/afp/2006/1101/p1521.html ↩
- “Seasonal Affective Disorder Treatment: Choosing a Light Box,” March 2013, http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/ART-20048298 ↩