You know the pattern. Every October, as Boise’s daylight hours shorten and temperatures drop, you feel the familiar heaviness returning. By November, getting out of bed requires monumental effort. December through February become months you simply endure. The question isn’t whether your seasonal depression will return—research shows that people with a history of seasonal affective disorder have recurrence rates as high as 60-90% in subsequent winters—but rather when to start treatment to minimize its impact. Evidence suggests that beginning light therapy at the first signs of depressive symptoms can prevent the development of a full-blown depressive episode in the remaining part of the season, while starting treatment in autumn when no symptoms are present shows less consistent preventive benefit (Meesters & Gordijn, 2016).
Understanding the optimal timing for seasonal depression treatment requires balancing two competing considerations: starting early enough to prevent severe symptoms versus avoiding unnecessary treatment when it might not be needed. The answer depends on your individual pattern of seasonal depression, the severity you’ve experienced in previous winters, and which treatment approach you’re considering.
The Case for Preventive Treatment
Seasonal affective disorder’s predictable, recurrent pattern creates a unique opportunity. Unlike other forms of depression that may appear unpredictably, you can anticipate when your seasonal depression will likely begin based on previous years’ patterns. This predictability suggests that preventive treatment—starting before symptoms appear—could spare you weeks or months of suffering.
The theoretical advantages are compelling. If you wait until you’re already depressed to start treatment, you’ve lost valuable time. Light therapy typically requires 1-2 weeks to show benefit. Antidepressants need 2-4 weeks. Cognitive-behavioral therapy involves 6-12 weekly sessions. By the time treatment takes effect, you’ve already experienced a month or more of depression. Starting preventively could mean avoiding that period of suffering entirely.
Research on preventive approaches shows mixed but promising results. Studies examining bupropion XL—the only FDA-approved medication specifically for preventing seasonal depressive episodes—found that starting treatment in early autumn before symptom onset produced significantly lower recurrence rates compared to placebo. The medication was typically initiated in September or early October and continued through the winter into spring (Modell et al., 2005).
For light therapy, one study found that treatment offered at the first signs of a depressive episode prevented the development of a full-blown episode in the remaining part of the season. Another study showed that light therapy offered at the first signs could postpone the development of the next episode. However, offering light therapy at the start of autumn when no complaints of depressive symptoms were present did not prevent a depressive episode in the following winter period (Meesters & Gordijn, 2016).
This suggests a nuanced approach: starting treatment at the very first subtle signs of seasonal depression—perhaps increased carbohydrate cravings, slightly lower energy, or minor sleep changes—may provide preventive benefits, while starting too early when you’re still completely symptom-free may not be necessary.
The Case for Waiting Until Symptoms Appear
Preventive treatment isn’t without costs—financial, time, and potential side effects. Starting treatment when you don’t yet feel depressed means committing resources to prevent something that might not occur with the same severity this year. Several factors complicate the decision to treat preventively.
Not every winter is identical. While seasonal depression typically recurs, the severity can vary year to year based on factors like stress levels, life circumstances, winter weather patterns, and your overall health. The winter you experienced severe depression after a major life stressor might not predict similar severity this year under better circumstances.
Treatment burden matters. Daily light therapy for four months represents significant time commitment. Taking antidepressants preventively means experiencing potential side effects even during months when you’d feel fine without treatment. Attending weekly CBT sessions in September when you’re not depressed yet requires motivation that may be difficult to sustain.
False alarms waste resources. If you start preventive treatment in October every year based on previous patterns, but some years your symptoms would have been mild without treatment, you’ve committed to unnecessary intervention. This becomes particularly relevant for costly treatments or those with meaningful side effects.
The research acknowledging these trade-offs notes that given the limited comparative evidence for preventive treatments, the decision for or against initiating preventive treatment of seasonal affective disorder should be strongly based on patient preferences (Nussbaumer-Streit et al., 2019).
Finding Your Personal Timing Strategy
The optimal approach depends on your individual history and circumstances. Consider these factors when deciding when to begin treatment.
Severity of previous episodes. If your seasonal depression has been severe enough to affect your work performance, relationships, or daily functioning, preventive treatment makes more sense. The risk of experiencing another severe episode outweighs the burden of starting treatment early. Conversely, if your seasonal symptoms have been mild—noticeable but not debilitating—waiting until symptoms appear before starting treatment may be reasonable.
Predictability of your pattern. Do your symptoms begin at approximately the same time each year? If you can reliably predict that by mid-November you’ll be struggling, starting treatment in early November as the first subtle symptoms appear makes sense. If your pattern is less predictable—some years symptoms start in October, other years not until January—preventive treatment becomes more complicated.
Type of treatment you’re considering. Light therapy, with minimal side effects and immediate cessation when you stop using it, is easier to start preventively than antidepressants, which require tapering to discontinue and may cause side effects. CBT-SAD, once learned, provides skills for future winters without ongoing treatment, making it a reasonable preventive investment even if started before symptoms are severe.
Your risk tolerance. Some people strongly prefer avoiding depression risk, even if it means potentially treating unnecessarily some years. Others prefer minimizing treatment burden and will accept some depression risk to avoid treatment during symptom-free periods. Neither approach is wrong—they reflect different values about medical intervention.
Practical Guidelines for Different Treatment Types
For light therapy: Start at the very first subtle symptoms—perhaps the first week you notice increased carbohydrate cravings, slightly lower energy, or mild sleep changes. This might be September in northern Idaho, October or November for most Treasure Valley residents. Begin with 20-30 minutes of 10,000-lux light exposure each morning. If symptoms haven’t appeared by the time you’d normally expect them, you can discontinue use. If symptoms do appear, you’re already ahead of them.
For antidepressants: If previous winters involved moderate to severe depression, consider starting in early fall before symptom onset. Bupropion XL, specifically approved for seasonal depression prevention, is typically started in September and continued through early spring. SSRIs like fluoxetine or sertraline can be started similarly. The key is continuing treatment throughout the winter even as you feel better, then tapering in spring rather than stopping abruptly.
For CBT-SAD: This therapy is ideally started in late summer or early fall before symptoms appear. The cognitive and behavioral skills learned during symptom-free periods can be applied as soon as any symptoms emerge, potentially preventing full episode development. The therapy’s focus on preparing for winter and developing coping strategies works best when you’re not already depressed and overwhelmed.
For ketamine therapy: This approach is typically reserved for treatment-resistant seasonal depression rather than used preventively. If you’ve tried light therapy and antidepressants in previous winters without adequate benefit, ketamine therapy can be considered when symptoms emerge. At Boise Ketamine Clinic, we’ve specialized in treatment-resistant depression for over eight years, providing comprehensive ketamine therapy when standard interventions haven’t been sufficient.
Three Practical Steps You Can Take This Week
- Map your historical pattern. Review the past 2-3 years and note when symptoms typically began, how severe they became, and when they remitted. Look for patterns in timing and severity. This data informs when to start watching for early symptoms and whether preventive treatment makes sense for your situation.
- Identify your earliest warning signs. Seasonal depression doesn’t appear overnight. Most people experience subtle changes before full symptoms emerge—perhaps slightly increased sleep need, mild energy drops, or food preference changes. Identifying your personal early warning signs allows you to start treatment at the optimal time: when symptoms are just beginning but haven’t yet become debilitating.
- Prepare your treatment approach now. Don’t wait until you’re already depressed to figure out your treatment plan. If using light therapy, purchase and test your light box before you need it. If considering medication, schedule an appointment with a prescriber in September or October. If pursuing therapy, begin sessions while you’re still feeling well rather than waiting until you’re struggling to leave the house.
When Professional Guidance Matters Most
While you can purchase light therapy equipment without prescription and implement many self-help strategies independently, professional evaluation provides important benefits—particularly for determining whether preventive treatment is appropriate and which approach best matches your situation.
At Boise Ketamine Clinic, our team understands the unique challenges of recurrent seasonal depression. Our founder, Nykol Bailey Rice, is both a Certified Registered Nurse Anesthetist and Psychiatric Mental Health Nurse Practitioner with over eight years of specialized experience in treating depression that hasn’t responded adequately to standard interventions. We offer free 15-minute consultations at (208) 427-8596 to discuss your treatment history and whether ketamine therapy might be appropriate for your situation.
We’re a hybrid cash-and-insurance practice with flexible scheduling, including Saturday appointments, at our Boise location on West Overland Road. While ketamine therapy isn’t typically used as first-line preventive treatment, for people whose seasonal depression has proven resistant to light therapy, antidepressants, and psychotherapy, it represents an evidence-based option when symptoms emerge.
Professional evaluation becomes particularly important if your seasonal depression has been severe, if you’ve tried preventive approaches without success, or if you’re unsure whether your symptoms represent seasonal depression versus other conditions that can worsen in winter, such as bipolar disorder or chronic fatigue syndrome.
Making Peace with Uncertainty
The timing question for seasonal depression treatment doesn’t have a single correct answer that applies to everyone. You’re balancing the benefit of potentially preventing suffering against the burden of possibly treating unnecessarily. You’re weighing the value of starting early against the reality that treatment effectiveness varies between individuals and circumstances.
What matters most is making an intentional decision based on your history rather than defaulting to either always starting preventively or always waiting until you’re severely depressed. Both extremes miss the opportunity for optimized timing tailored to your pattern.
If your seasonal depression has been severe and predictable, erring on the side of early treatment makes sense. If it’s been mild and variable, waiting for clear symptom emergence is reasonable. And if you’re uncertain, seeking professional guidance to review your history and plan an individualized approach provides clarity.
You don’t have to face another Idaho winter wondering whether this will be the year seasonal depression overtakes you. With intentional planning about when to start treatment, you can approach fall and winter with a strategy rather than simply hoping this year will be different.
Legal Disclaimer: This article is for educational purposes only and does not constitute medical advice. Treatment outcomes vary by individual, and there is no guarantee of specific results. All treatment decisions should be made in consultation with qualified healthcare providers who can assess your complete medical history and individual circumstances. If you are experiencing thoughts of self-harm or suicide, call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room immediately.
References
Meesters, Y. & Gordijn, M.C.M. (2016). Seasonal affective disorder, winter type: current insights and treatment options. Psychology Research and Behavior Management, 9, 317-327. https://www.dovepress.com/seasonal-affective-disorder-winter-type-current-insights-and-treatment-peer-reviewed-fulltext-article-PRBM
Modell, J.G., Rosenthal, N.E., Harriett, A.E., et al. (2005). Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biological Psychiatry, 58(8), 658-667. https://onlinelibrary.wiley.com/doi/10.1155/2015/178564
Nussbaumer-Streit, B., Greenblatt, A., Kaminski-Hartenthaler, A., et al. (2019). Light therapy for preventing seasonal affective disorder. Cochrane Database of Systematic Reviews, 2019(3), CD011269. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011269.pub3/full