A 34-year-old woman reports recurrent depressive episodes every autumn and winter for four years, with hypersomnia, increased appetite with carbohydrate craving, low energy, and weight gain, followed by spontaneous full remission each spring. There is no history of mania or hypomania. In addition to an SSRI, the non-pharmacological intervention with the best evidence for her condition is:

• A Sleep deprivation therapy on alternate nights
• B Bright light therapy administered in the early morning ✓
• C Electroconvulsive therapy twice weekly
• D Transcranial magnetic stimulation over the right dorsolateral prefrontal cortex

Explanation

Seasonal pattern depression with atypical vegetative features responds well to bright light therapy, typically 10,000 lux for 30 minutes in the early morning during the symptomatic season. Morning administration phase-advances circadian rhythms and corrects the delayed phase seen in these patients. Sleep deprivation produces only transient benefit lasting until recovery sleep, and ECT is reserved for severe or psychotic illness, so neither is appropriate first-line management for seasonal depression.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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