Phototherapy in nonseasonal depression

doi:10.1016/0006-3223(91)90110-8

Biological Psychiatry

Volume 30, Issue 3, 1 August 1991, Pages 257-268

https://doi.org/10.1016/0006-3223(91)90110-8 Get rights and content

Abstract

Previous reports have shown that bright light exposure may benefit patients with seasonal depression. In the present study, the possible therapeutic effect of bright light in non-seasonal major depressive disorder was examined. Forty-two depressed patients not receiving additional antidepressant medication were exposed to bright white light of 2500 lux or dim red light of 50 lux over one week for two hr daily in the morning. The change in depressive symptoms was assessed by rating scales (Hamilton Depression Rating Scale, CGI) and by self-rating scales (Depression Scale, Complaint List, Visual Analgue Scale). Consistent for all ratings, the decrease in depressive symptoms after bright white light was only slight and not different from dim red-light exposure. Contrary to the findings in seasonal affective disorder, phototheraphy administered over one week for two hr daily is not effective in nonseasonal major depressive disorder.

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Cited by (54)

Effects of light therapy on sleep/wakefulness, daily rhythms, and the central orexin system in a diurnal rodent model of seasonal affective disorder
2023, Journal of Affective Disorders
Bright light therapy (BLT) is the first-line treatment for seasonal affective disorder. However, the neural mechanisms underlying BLT are unclear. To begin filling this gap, the present study examined the impact of BLT on sleep/wakefulness, daily rhythms, and the wakefulness-promoting orexin/hypocretin system in a diurnal rodent, Nile grass rats (Arvicanthis niloticus).
Male and female grass rats were housed under a 12:12 h light/dark cycle with dim light (50 lx) during the day. The experimental group received daily 1-h early morning BLT (full-spectrum white light, 10,000 lx), while the control group received narrowband red light for 4 weeks. Sleep/wakefulness and in-cage locomotor activity were monitored, followed by examination of hypothalamic prepro-orexin and orexin receptors OX1R and OX2R expression in corticolimbic brain regions.
The BLT group had higher wakefulness during light treatment, better nighttime sleep quality, and improved daily rhythm entrainment compared to controls. The impact of BLT on the orexin system was sex- and brain region-specific, with males showing higher OX1R and OX2R in the CA1, while females showed higher prepro-orexin but lower OX1R and OX2R in the BLA, compared to same-sex controls.
The present study focused on the orexin system in a limited number of brain regions at a single time point. Sex wasn't a statistical factor, as male and female cohorts were run independently.
The diurnal grass rats show similar behavioral responses to BLT as humans, thus could be a good model for further elucidating the neural mechanisms underlying the therapeutic effects of BLT.
Light therapy in non-seasonal depression: An update meta-analysis
2020, Psychiatry Research
The effect of light therapy in treating seasonal affective disorder has been demonstrated amongst previous studies. However, the effect of light therapy in treating non-seasonal depression remains unclear. This meta-analysis aimed to determine the efficacy of light therapy in non-seasonal depression. We searched for randomized controlled trials (RCTs) in the PubMed, Web of Science, Chinese National Knowledge Infrastructure, and Chinese Biomedical Database up to February 2020. The pooled post-trial standardized mean difference in depression scores with corresponding 95% confidence intervals was calculated to evaluate the efficacy of light therapy in non-seasonal depression. A total of 23 RCTs with 1120 participants were included. The meta-analysis demonstrated the light therapy was significantly more effective than comparative treatments. Subgroup analyses revealed that none of the factors explained the significantly heterogeneity. Light therapy has a statistically significant mild to moderate treatment effect in reducing depressive symptoms, can be used as a clinical therapy in treating non-seasonal depression. But the quality of evidence is still low, more well-designed studies with larger sample size and high quality are needed to confirm the efficiency of light therapy in treating non-seasonal depression.
Rate of switch from bipolar depression into mania after morning light therapy: A historical review
2018, Psychiatry Research
Light therapy (LT) is efficacious for bipolar depression with effect sizes equivalent to those in antidepressant pharmacotherapy trials. Patients with bipolar disorder (BD) show a 15–40% rate of manic switches during antidepressant drug treatment. The rate of manic switches during LT has never been estimated.
We searched all the literature studies reporting effects of antidepressant LT in BD. 41 studies described 799 patients with BD treated with antidepressant LT, from among which 7 (0.9%) switched into mania and 11 (1.4%) switched into hypomania. The method of assessment of treatment-emergent symptoms significantly influenced the detection of switches into mania: 0% when no method was reported, 0.8% with clinical mental state examination, and 3% with rating scales (χ² = 14.805, d.f. 4, p = 0.005). The rate of switch increased to 18.8% when considering the 16 patients with rapid-cycling BD. Switches occurred independent of treatment modality (light intensity, duration, and circadian timing of administration).
The available literature shows that the highest reported rate of switch from bipolar depression into mania after LT is closely similar to the 4% switch rate expected during the placebo treatment of BD, thus not justifying specific concerns when using this treatment option.
Bright light therapy for nonseasonal depression: Meta-analysis of clinical trials
2016, Journal of Affective Disorders
Citation Excerpt :
Fig. 1 depicts the selection process of the included trials. Data were extracted and pooled from 9 clinical trials (Corral et al., 2007; Dauphinais et al., 2012; Goel et al., 2005; Kripke et al., 1992; Lam et al., 2015; Lieverse et al., 2011; Mackert et al., 1991; Martiny et al., 2005; Wirz-Justice et al., 2011). In total, 419 patients were enrolled in these trials, with 211 patients receiving BLT intervention and 208 patients receiving placebo control.
Bright light therapy (BLT) is a well-established treatment for seasonal depression. In the last two decades, the interest in BLT has expanded to involve other nonseasonal types of depression. The role of BLT for nonseasonal depression remains unsettled. In view of the growing number of studies in this area, this review aimed to assess the efficacy of BLT in nonseasonal depression.
We searched Pubmed; Scopus; PsychINFO; Evidence Based Medicine Guidelines and Cochrane Library until December 2015. The Standardized mean difference was calculated to assess the efficacy of BLT in nonseasonal depression. Data were subgrouped according to different study characteristics. Heterogeneity was assessed by examining the I² index.
Nine trials met the inclusion criteria. After employing the more conservative random-effects model, the overall model showed a significant reduction of depressive symptoms after BLT administration (SMD=−0.62, P<0.001, I²=37%). In particular, BLT appears to be efficacious when administered for 2-5 weeks (SMD=−0.78, P<0.001, I²=0%), and as monotherapy (SMD=−0.71, P<0.001, I²=18%). Studies of BLT for perinatal depression have found statistically insignificant improvement (SMD=−0.17, P>0.05, I²=44%).
The overall heterogeneity of the included trials was moderate. The participants were not adequately blinded to the intervention. The sample size was small for certain subgroups. The long-term effect of BLT on depression was not explored.
BLT appears to be efficacious, particularly when administered for 2–5 weeks’ duration and as monotherapy. There is an obvious need to optimize the duration and intensity of exposure, the timing and the duration of treatment sessions.
Bright white light therapy in depression: A critical review of the evidence
2015, Journal of Affective Disorders
Citation Excerpt :
In Fig. 3 the effect sizes of the included studies at their respective endpoint are shown with an overall SMD of −0.54 (95% CI: −0.95, −0.13), indicating an advantage for bright light therapy. Four studies met our inclusion criteria (Goel et al., 2005; Kripke et al., 1992; Mackert et al., 1991; Wirz-Justice et al., 2011), but only two of them were judged to be of sufficient quality for further analysis (Goel et al., 2005; Mackert et al., 1991). Both of these studies were considered to be of medium quality.
Light therapy is an accepted treatment option, at least for seasonal affective disorder (SAD). Our aim was to critically evaluate treatment effects of bright white light (BWL) on the depressive symptoms in both SAD and non-seasonal depression.
The systematic review was performed according to the PRISMA guidelines. PubMed, Embase, and PsycINFO were searched (December 1974 through June 2014) for randomized controlled trials published in peer-reviewed journals. Study quality was assessed with a checklist developed by the Swedish Council on Technology Assessment in Health Care. Only studies with high or medium quality were used in the meta-analyses.
Eight studies of SAD and two studies of non-seasonal depression met inclusion and quality criteria. Effects on SAD were estimated in two meta-analyses. In the first, week by week, BWL reached statistical significance only at two and three weeks of treatment (Standardized Mean Difference, SMD: −0.50 (−CI 0.94, −0.05); −0.31 (−0.59, −0.03) respectively). The second meta-analysis, of endpoint data only, showed a SMD of −0.54 (CI: −0.95, −0.13), which indicates an advantage for BWL. No meta-analysis was performed for non-seasonal depression due to heterogeneity between studies.
This analysis is restricted to short-term effects of BWL measured as mean changes in scores derived from SIGH-SAD, SIGH-SAD self-report, or HDRS rating scales.
Most studies of BWL have considerable methodological problems, and the results of published meta-analyses are highly dependent on the study selection. Even though quality criteria are introduced in the selection procedures of studies, when the results are carefully scrutinized, the evidence is not unequivocal.
Complex interaction of circadian and non-circadian effects of light on mood: Shedding new light on an old story
2012, Sleep Medicine Reviews
Citation Excerpt :
The heterogeneity of the results is more likely explained by methodological reasons. While some earlier studies failed to find light therapy effective in non-seasonal depression,80–83 mostly due to small sample sizes or treatment durations that might have been too short to observe any effect, other studies noted promising results84–86 which are more in line with recent findings. Indeed, recent state-of-the-art double-blind, placebo-controlled randomized trials confirm the ability of light therapy to not only reduce cognitive and physical decline but also depression in geriatric patients,60,61 and to be an effective treatment in antepartum depression.87
In addition to its role in vision, light exerts strong effects on behavior. Its powerful role in the modulation of mood is well established, yet remains poorly understood. Much research has focused on the effects of light on circadian rhythms and subsequent interaction with alertness and depression. The recent discovery of a third photoreceptor, melanopsin, expressed in a subset of retinal ganglion cells, allows major improvement of our understanding of how photic information is processed. Light affects behavior in two ways, either indirectly through the circadian timing system, or directly through mechanisms that are independent of the circadian system. These latter effects have barely been studied in regard to mood, but recent investigations on the direct effects of light on sleep and alertness suggest additional pathways through which light could influence mood. Based on our recent findings, we suggest that light, via melanopsin, may exert its antidepressant effect through a modulation of the homeostatic process of sleep. Further research is needed to understand how these mechanisms interplay and how they contribute to the photic regulation of mood. Such research could improve therapeutic management of affective disorders and influence the management of societal lighting conditions.

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Phototherapy in nonseasonal depression

Abstract

J Affective Disord

Psychiatry Res

Lancet

J Affective Disord

Psychiatr Res

Measuring of feelings using visual analogue scales

Light treatment in depressive illness

Eur Neurol

Elevated plasma tricyclic levels with therapeutic doses of imipramine

Am J Psychiatry

Development of a rating scale for primary depressive illness

Br J Cos Clin Psychol

Phototheraphy for seasonal affective disorder in Alaska

Am J Psychiatry

Treatment of seasonal affective disorder with light in the evening

Br J Psychiatry

Diagnostic and Drug Treatment of Psychiatric Disorders: Adults and Children

Circadian rhythm disorders in manic-depressive

Biol Psychiatry

Lighting up depression

Psychophamacol Bull

Treatment of major depressive disorders by bright white light for 5 days

Phototeraphy for non-seasonal major depressive disorder

Mehrfachwahl-Wortschatz-Test (MWT-B)

Light suppresses melatonin secretion in humans

Science

Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle

Am J Psychiatry

Assessment and treatment of chronobiologic disorders using plasma melatonin levels and bright light exposure: The clock-gate model and the phase response curve

Psychopharmacol Bull