title: Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder.
abstract: OBJECTIVE
  The central public health challenge for winter seasonal affective disorder (SAD) is recurrence prevention. Preliminary studies suggest better long-term outcomes following cognitive-behavioral therapy tailored for SAD (CBT-SAD) than light therapy. The present study is a large, randomized head-to-head comparison of these treatments on outcomes one and two winters after acute treatment.
  
  
  METHODS
  Community adults with major depression, recurrent with seasonal pattern (N=177) were followed one and two winters after a randomized trial of 6 weeks of CBT-SAD (N=88) or light therapy (N=89). Prospective follow-up visits occurred in January or February of each year, and major depression status was assessed by telephone in October and December of the first year. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD). Other outcomes were depression severity on the SIGH-SAD and the Beck Depression Inventory-Second Edition (BDI-II), remission status based on severity cutoff scores, and major depression status from tracking calls.
  
  
  RESULTS
  The treatments did not differ on any outcome during the first year of follow-up. At the second winter, CBT-SAD was associated with a smaller proportion of SIGH-SAD recurrences (27.3% compared with 45.6%), less severe symptoms on both measures, and a larger proportion of remissions defined as a BDI-II score ≤8 (68.3% compared with 44.5%) compared with light therapy. Nonrecurrence at the next winter was more highly associated with nonrecurrence at the second winter among CBT-SAD participants (relative risk=5.12) compared with light therapy participants (relative risk=1.92).
  
  
  CONCLUSIONS
  CBT-SAD was superior to light therapy two winters following acute treatment, suggesting greater durability for CBT-SAD.
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Rohan
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Jonah
authors.initials: J
authors.lastname: Meyerhoff
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Sheau-Yan
authors.initials: SY
authors.lastname: Ho
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Maggie
authors.initials: M
authors.lastname: Evans
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Teodor T
authors.initials: TT
authors.lastname: Postolache
authors.affiliation: From the Department of Psychological Science, University of Vermont, Burlington, Vt.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, and VISN 19 Rocky Mountain MIRECC, Denver; and the Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Vacek
mesh_terms: D000328:Adult; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D057186:Comparative Effectiveness Research; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010789:Phototherapy / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D016574:Seasonal Affective Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D055502:Secondary Prevention / Q000379:methods