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Table 2 Details on type, frequency, and timing of preventive interventions recommended in clinical practice

From: Prevention of seasonal affective disorder in daily clinical practice: results of a survey in German-speaking countries

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%)
  1. Max, highest percentage named; min, lowest percentage named; n, total number of hospitals answering this question; SAD, seasonal affective disorder