Light therapy and antidepressants help many people with seasonal depression. This post is for the people they have not helped enough. If the winter pattern has returned two, three, or five years in a row despite a lamp, therapy, or medication, the question is not whether you tried hard enough. The question is what else exists. This post answers it in plain language.
Why it keeps coming back
Seasonal depression is a form of recurrent depression. Each episode follows the same calendar, and each one makes the next more likely. In a ten-year study of adults with major depression published in the American Journal of Psychiatry, the risk of another episode rose by about 16 percent with each successive recurrence (Solomon et al., 2000). That is the clinical reason early and complete treatment matters. Getting partly better each spring and waiting for the next fall is a pattern that tends to deepen, not fade.
The good news inside that finding is that the seasonal pattern is predictable, more so than almost any other form of depression. Treatment can be timed. A plan that starts in October, before the hardest weeks, has a better chance than one that starts in February. Post 2 in this series explains how to recognize the pattern early, and Post 1 explains why it shows up in a state as sunny as Colorado.
The first-line steps and what they do well
Three treatments are usually tried first. Each helps many people, and “many” is not “everyone.”
Light therapy
A light therapy lamp delivers bright light, usually 10,000 lux, to the eyes for 30 to 45 minutes each morning, according to the National Institute of Mental Health. It works by supplying the morning light signal that short days remove, which helps reset the body clock. It is most useful when started in early fall and used every day. Its limits are practical and clinical. It requires daily time in front of the lamp, it does not treat depression that is not driven by light, and for some people it is not enough on its own. Post 3 in this series covers how to set one up at home.
Therapy adapted for the seasonal pattern
A form of cognitive behavioral therapy built for seasonal depression, often called CBT-SAD, focuses on the specific thoughts and habits that arrive with winter, such as withdrawing from people and expecting the season to be unbearable. In research summarized by the American Academy of Family Physicians, people who received this therapy had less recurrence in the following winter than people who used light therapy alone. Its limit is access. It works best with a therapist trained in the approach and started before the season is fully underway.
Antidepressants started in early fall
For people with a clear seasonal pattern, a psychiatrist may start or adjust an antidepressant in September or October, before symptoms return, and continue it through spring. This can prevent or soften the episode. Its limits are the same as for antidepressants generally: side effects, the time it takes to know whether a medication is working, and the fact that some people do not get an adequate response from the medications they have tried.
When first-line treatment is not enough
Psychiatrists use a specific term for depression that has not responded to standard medication. Treatment-resistant depression means a person has had a fair trial of two or more antidepressants, at an adequate dose for an adequate time, without adequate improvement. It is common, it is not a personal failure, and it is the point at which the conversation moves to treatments that work differently from a daily pill. If that describes your history, our treatment-resistant depression page explains how we approach it. Post 6 in this series is written for people who are still depressed on antidepressants in winter.
Two in-clinic treatments are the most established next steps. Both are offered at Axis, and both are covered by most insurance. Neither requires stopping a medication that is partly helping, and neither requires a hospital stay.
Deep TMS
Deep transcranial magnetic stimulation, or Deep TMS, uses a magnetic coil placed against the head to stimulate the areas of the brain involved in mood. There is no anesthesia, no sedation, and no downtime. People drive themselves to and from sessions and return to work the same day. Axis uses the BrainsWay Deep TMS system.
The BrainsWay Deep TMS system is cleared by the U.S. Food and Drug Administration for the treatment of depressive episodes in adults with major depressive disorder who have not achieved satisfactory improvement from previous antidepressant medication in the current episode (FDA 510(k) K122288).
A course looks like this. Sessions are short, typically about 20 minutes, and happen on weekdays. NIMH describes a typical course of TMS as daily sessions five days a week for four to six weeks, followed by a taper (NIMH, Brain Stimulation Therapies). The most common side effects are scalp discomfort during the session and mild headache afterward.
Who it is for: adults whose depression has not responded adequately to medication, adults who cannot tolerate medication side effects, and adults who want a treatment that does not involve a daily drug.
Winter timing: a course started in early November runs through the hardest weeks of the season, which for most people in Colorado are January and February. Learn more on our Deep TMS page.
Spravato
Spravato is a prescription nasal spray taken in the clinic, under the supervision of a trained team. It is approved by the U.S. Food and Drug Administration for treatment-resistant depression in adults, either on its own or together with an oral antidepressant, and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior, together with an oral antidepressant (FDA prescribing information). It is also covered by most insurance plans.
A session looks like this. You self-administer the spray in a private treatment room, then rest while the team monitors you. Monitoring by a healthcare provider for at least two hours after each dose is required by the FDA label, and the treatment is only given in certified healthcare settings. You cannot drive afterward, so will need to plan for a ride home is arranged in advance. The label’s schedule begins with two sessions a week for the first four weeks, then once a week for four weeks, then every week or every two weeks as maintenance, based on response.
Who it is for: adults with treatment-resistant depression who want an option that acts differently from the daily antidepressants they have already tried. It is not a first-line treatment, and it is not for everyone. Learn more on our Spravato page.
How Axis decides with each patient
No one at Axis is placed on a treatment because it is the newest option. The decision starts with a 60-minute intake with a psychiatric provider that covers the full history: how many winters, which treatments have been tried, at what dose, for how long, and what happened. That history is what determines whether first-line steps have had a fair chance, whether the pattern meets the definition of treatment-resistant depression, and which next step fits.
Before anything starts, a financial consult can confirm coverage under your specific plan, so there are no surprises. If a prior authorization is needed, the Axis team handles it. Psychiatry, therapy, Deep TMS, and Spravato are all offered in one clinic, which means the plan can change without changing practices.
Intake appointments are covered by most insurance, and no referral is needed.
Not sure where to start? Call one of our four Colorado clinics or start with telehealth.
- Aurora: (720) 400-7025
- Denver Tech Center: (720) 400-7025
- Boulder / Louisville: (720) 400-7025
- Westminster: (720) 400-7025
If you are having thoughts of suicide or of not wanting to be here, call or text 988 to reach the 988 Suicide and Crisis Lifeline. It is free, confidential, and open 24 hours a day. If you are in immediate danger, call 911.
