Table 2 Details on type, frequency, and timing of preventive interventions recommended in clinical practice
Preventive intervention | Hospitals recommending intervention | Average percentage of SAD patients being given this recommendation (min-max) | Timing of preventive intervention | Type of preventive intervention recommended (multiple mentions possible) |
|---|---|---|---|---|
Lifestyle changes | 85% (69/81) | 83% (10%–100%) | • 12% (8/69) recommend starting with lifestyle changes by the end of summer for 4–32 weeks • 64% (44/69) recommend continuous lifestyle changes throughout the whole year • 24% (17/69) no response | Based on 69 hospitals recommending lifestyle changes: • Regular exercise (41%) • Regular exercise outdoor (14%) • Do things you like (hobbies, meeting friends) (13%) • Find ways to relax (14%) • Sleep hygiene (13%) • Ensure stable day/night rhythm (13%) • Spending time outdoor (9%) • Structured lifestyle (7%) • Redecorate rooms to make them brighter (4%) • Winter vacation in a sunny region (3%) |
Antidepressants | 84% (68/81) | 70% (10%–100%) | • 21% (14/68) recommend starting preventive treatment by the end of summer for 4–28 weeks • 62% (42/68) recommend continuous intake of antidepressants throughout the whole year • 17% (12/68) no response | Based on 68 hospitals recommending antidepressants: Selective serotonin reuptake inhibitors (SSRI) • Citalopram (10%), Escitalopram (12%), Sertraline (10%) • Not further specified (40%) Selective serotonin and norepinephrine reuptake inhibitors (SSNRI) • Venlafaxine (22%), Duloxetine (4%), Milnacipran (1%) • Not further specified (19%) Monoamine oxidase inhibitors (MAO-H) • Moclobemide (1%), Not further specified (6%) Noradrenergic and specific serotonergic antidepressant (NaSSA) • Mirtazapine (19%), Not further specified (6%) Serotonin antagonist and reuptake inhibitor (SARI) • Trazodone (3%) Norepinephrine and dopamine reuptake inhibitor (NDRI) • Bupropion (7%) Tryclic antidepressant (TZA) • Amitriptyline (3%) Serotonin modulators and stimulators: • Vortioxetine (3%) |
Psychotherapy | 73% (59/81) | 62% (10%–100%) | • 22% (13/59) recommend starting preventive psychotherapy by the end of summer for 1–30 weeks • 41% (30/59) recommend continuous psychotherapy throughout the whole year • 27% (16/59) no response | Based on 59 hospitals recommending psychotherapy: • Behavioural therapy (32%) • Analytic psychotherapy (10%) • Psychotherapy not otherwise specified (7%) • Talking therapy (3%) • Psychoeducation (2%) • Family therapy (2%) • Hypnotherapy (2%) • Systemic therapy (2%) |
Light therapy | 72% (58/81) | 64% (10%–100%) | • 47% (27/58) recommend to start preventive light therapy by the end of summer for 3–16 weeks • 31% (18/58) recommend continuous use of light therapy throughout the whole year • 22% (13/58) no response | Based on 58 hospitals recommending light therapy: • Light therapy device with 10,000 lx (40%) • Spending time in natural sunlight (12%) • Light therapy device with 6000 lx (3%) • Light therapy device with 2000 lx (2%) • Light therapy device with 200 lx (2%) • Infrared light (2%) • Light visor (2%) • “Light shower” (2%) |
Diet change | 47% (38/81) | 71% (10%–100%) | • 11% (4/38) recommend to start diet changes by the end of summer for 8–26 weeks • 61% (23/38) recommend continuous diet change throughout the whole year • 29% (11/38) no response | Based on 38 hospitals recommending diet changes: • Balanced diet, e.g. Mediterranean diet, less carbohydrates, more fibres, less meat (47%) • Less coffee (24%) • Less nicotine (11%) • Less alcohol (11%) • Vitamin D (8%) • No heavy meals in the evenings (8%) • Nutritional Supplements, e.g. Vitamin B12, iron (5%) • Increased fluid intake (3%) |
Agomelatine | 47% (38/81) | 24% (10%–70%) | • 21% (8/38) recommend to start by the end of summer for 4–36 weeks • 58% (22/38) recommend continuous intake • 21% (8/38) no response | Based on 38 hospitals recommending agomelatine: • Agomelatine (66%) |
Alternative approaches | 35% (28/81) | 57% (10%–100%) | • 18% (5/28) recommend to start preventive alternative treatments by the end of summer for 4–32 weeks • 68% (19/28) recommend continuous treatment throughout the whole year • 14% (4/28) no response | Based on 28 hospitals recommending alternative treatments: • Yoga (29%) • Relaxation techniques (29%) • Acupuncture (21%) • Meditation (14%) • Progressive muscle relaxation (14%) • Homeopathy (4%) • Aroma therapy (4%) • Sleep deprivation (4%) • Kinesiology (4%) • Tai Chi (4%) • Chi Gong (4%) • Shiatsu (4%) • Reiki (4%) |
Melatonin | 11% (9/81) | 23% (10%–70%) | • 78% (7/9) recommend to start by the end of summer for 3–30 weeks • 11% (1/9) recommend continuous treatment • 11% (1/9) no response | Based on 9 hospitals recommending melatonin: • Melatonin (33%) |
Methylphenidate | 5% (4/81) | 10% (10%–10%) | • 1 institution recommends preventive treatment for 12 weeks • 2 institutions recommend continuous treatment • 1 institution did not respond | Based on 4 hospitals recommending methylphenidate • Methylphenidate (50%) |