ArticleLiterature Review

Bright Light Therapy for Nonseasonal Depression: Meta-analysis of Clinical Trials

March 2016
Journal of Affective Disorders 198(264–269)

DOI:10.1016/j.jad.2016.03.016

Authors:

Campaspe Family Practice

Background: 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. Methods: 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 I(2) index. Results: 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, I(2)=37%). In particular, BLT appears to be efficacious when administered for 2-5 weeks (SMD=-0.78, P<0.001, I(2)=0%), and as monotherapy (SMD=-0.71, P<0.001, I(2)=18%). Studies of BLT for perinatal depression have found statistically insignificant improvement (SMD=-0.17, P>0.05, I(2)=44%). Limitations: 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. Conclusions: 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.

The Use of Phototherapy for the Treatment of Non-Seasonal Depression: A Systematic Review of Efficacy and Safety

Article

Full-text available

Mar 2025

Background: Phototherapy, which has traditionally been used for seasonal affective disorder, is now being investigated for its effectiveness in treating non-seasonal depression. This systematic review aims to evaluate the efficacy and safety of phototherapy in this new context, providing a comprehensive overview of its therapeutic potential and limitations. Methods: The review followed PRISMA guidelines and included studies from databases such as Google Scholar, PubMed, and UpToDate. Studies were selected based on their focus on phototherapy’s efficacy, safety, and application methods for non-seasonal depression. Various administration methods were examined, particularly the effects of multiple daily sessions and personalized treatment plans. Results: The findings indicate that while phototherapy alone has limited effectiveness, combining it with antidepressants significantly improves outcomes. The most effective protocols featured multiple daily sessions tailored to individual patient needs, even at lower light intensities. Safety assessments have shown that phototherapy is well tolerated, with no serious side effects reported, only minor and transient reactions. Conclusions: Phototherapy appears to be a promising adjunct therapy for non-seasonal depression, offering safety and flexibility in treatment customization. It provides consistent therapeutic benefits, mainly when used in conjunction with conventional antidepressant treatments.

Overcoming treatment gaps in the management of depression with non-pharmacological adjunctive strategies

Article

Full-text available

Nov 2023

There is considerable evidence that simple, cost-effective, non-pharmaceutical strategies can be readily implemented to improve outcomes in the treatment of depression. It is estimated that 4.4% of the world’s population suffers from depression. Despite being a major public health concern and the availability of both pharmacological and non-pharmacological treatments, many depressed people remain undiagnosed and receive no or inappropriate treatment. Several possible underlying factor of treatment gap can be identified in relation to pharmacotherapy and psychotherapy of depression, including side effects, partial remission, treatment-resistant depression and the limited availability of psychotherapy. In addition to developing new therapeutic options, much more could be done to optimise the use of existing therapies, including combining available drug treatments with quick, simple and cost-effective non-pharmacological methods: low-intensity psychological interventions, online self-help tools and lifestyle medicine. In addition to increasing the effectiveness of treatments, prevention is equally important: awareness programs to further reduce the treatment gap, and community dissemination of the life skills that help maintain positive mental health.

Lighting Intervention with Different Colors on Emotion: A Bayesian Network Meta-Analysis

Conference Paper

Feb 2023

Evaluating the impact of a daylight-simulating luminaire on mood, agitation, rest-activity patterns and social wellbeing parameters in a care home for people with dementia: A pilot study (Preprint)

Article

Jan 2024

Background Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect ( P =.03), social isolation ( P =.048), and feeling at home ( P =.047) after 5‐10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity–related parameters of interdaily stability ( P <.001), intradaily variation ( P< .001), and relative amplitude ( P =.03) from baseline to weeks 5‐10, with the effect propagating for interdaily stability at weeks 10‐16 as well ( P< .001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters.

Molecular Genetic Mechanisms of Circadian Rhythm Regulation and Their Role in Psychopathology

Article

Full-text available

Nov 2023
Fiziol Z Im M Sechenova

Circadian rhythms are cyclic fluctuations in the intensity of biological processes associated with the change of day and night, to which many organisms have adapted during the evolution. Disturbances in circadian rhythms are triggered by both environmental factors (e.g., altering the time zone or the length of day/night) and disrupted internal regulation of cycles (e.g., mutations of key clock genes). These changes can lead to the pathogenesis of various diseases, including psychopathologies. Since the mechanisms underlying circadian regulation are rather evolutionarily conservative, experimental animal models are actively used to probe these processes and their relationship with psychopathologies. Here, we discuss the regulation of circadian rhythms, as well as their cross-taxon similarities and differences between mammals and teleost fish (zebrafish, Danio rerio). We also discuss recent findings on molecular genetic mechanisms underlying the regulation of circadian rhythms and their link to pathogenesis of mental disorders in humans and model organisms.

The sleep-circadian interface: A window into mental disorders

Article

Full-text available

Feb 2024
P NATL ACAD SCI USA

Sleep, circadian rhythms, and mental health are reciprocally interlinked. Disruption to the quality, continuity, and timing of sleep can precipitate or exacerbate psychiatric symptoms in susceptible individuals, while treatments that target sleep—circadian disturbances can alleviate psychopathology. Conversely, psychiatric symptoms can reciprocally exacerbate poor sleep and disrupt clock-controlled processes. Despite progress in elucidating underlying mechanisms, a cohesive approach that integrates the dynamic interactions between psychiatric disorder with both sleep and circadian processes is lacking. This review synthesizes recent evidence for sleep—circadian dysfunction as a transdiagnostic contributor to a range of psychiatric disorders, with an emphasis on biological mechanisms. We highlight observations from adolescent and young adults, who are at greatest risk of developing mental disorders, and for whom early detection and intervention promise the greatest benefit. In particular, we aim to a) integrate sleep and circadian factors implicated in the pathophysiology and treatment of mood, anxiety, and psychosis spectrum disorders, with a transdiagnostic perspective; b) highlight the need to reframe existing knowledge and adopt an integrated approach which recognizes the interaction between sleep and circadian factors; and c) identify important gaps and opportunities for further research.

Evaluating the Impact of a Bespoke Daylight-simulating Luminaire on Mood, Agitation, Sleep-wake Cycles, Rest-activity Patterns and Social Wellbeing Parameters in a Care Home for People with Dementia (Preprint)

Preprint

Jan 2024

BACKGROUND Living with a diagnosis of dementia can involve managing certain behavioural and psychological symptoms. As such, the evolution of technology has enabled many smart home or digital health solutions to monitor different aspects of one’s health on a daily basis. This paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioural and psychological symptoms and wellbeing of people living with dementia. OBJECTIVE The aim is to understand how dynamic lighting as opposed to static lighting may impact the wellbeing of those who are living with dementia. METHODS An ethically approved trial is conducted within a care home for people with dementia. Data is collected in both quantitative and qualitative formats using environmentally-deployed radar sensing technology and the validated QUALIDEM wellbeing scale respectively. Metrics are collected for 11 participants on mood, social interactions, agitation, sense of feeling, sleep and rest-activity over a period of 16 weeks. RESULTS Results highlight that dynamic lighting shows statistically significant improvement with a moderate effect size in wellbeing parameters including positive affect (p = 0.030), social isolation (p = 0.048) and feeling at home (p = 0.047) after 5-10 weeks of dynamic lighting. Results also highlight statistically significant improvements in rest-activity related parameters of inter-daily stability (p < 0.001), intra-daily variation (p<0.001) and relative amplitude (p=0.033) from baseline to weeks 5-10, with the effect propagating for inter-daily stability at weeks 10-16 as well (p < 0.001). Non-significant improvements are also noted for sleep metrics with a small effect size, however the affect in agitation does not reflect this improvement. CONCLUSIONS Dynamic lighting has the potential to support wellbeing in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. CLINICALTRIAL Pilot study registered under IRAS ID 311547

Circadian light therapy and light dose for depressed young people: a systematic review and meta-analysis

Article

Full-text available

Jan 2024

Background Empirical evidence has shown that light therapy (LT) can reduce depression symptoms by stimulating circadian rhythms. However, there is skepticism and inconclusive results, along with confusion regarding dosing. The purpose of this study is to quantify light as a stimulus for the circadian system and create a dose-response relationship that can help reduce maladies among adolescents and young adults (AYAs). This will provide a reference for light exposure and neural response, which are crucial in the neuropsychological mechanism of light intervention. The study also aims to provide guidance for clinical application. Methods The latest quantitative model of CLA (circadian light) and CSt,f (circadian stimulus) was adopted to quantify light dose for circadian phototransduction in youth depression-related light therapy. Articles published up to 2023 through Web of Science, Cochrane Library, Medline (OVID), CINAHL, APA PsycINFO, Embase, and Scholars were retrieved. A meta-analysis of 31 articles (1,031 subjects) was performed using Stata17.0, CMA3.0 (comprehensive meta-analysis version 3.0) software, and Python 3.9 platform for light therapy efficacy comparison and dose-response quantification. Results Under various circadian stimulus conditions (0.1 < CSt,f < 0.7) of light therapy (LT), malady reductions among AYAs were observed (pooled SMD = −1.59, 95%CI = −1.86 to −1.32; z = −11.654, p = 0.000; I² = 92.8%), with temporal pattern (p = 0.044) and co-medication (p = 0.000) suggested as main heterogeneity sources. For the efficacy advantage of LT with a higher circadian stimulus that is assumed to be influenced by visualization, co-medication, disease severity, and time pattern, sets of meta-analysis among random-controlled trials (RCTs) found evidence for significant efficacy of circadian-active bright light therapy (BLT) over circadian-inactive dim red light (SMD = −0.65, 95% CI = −0.96 to −0.34; z = −4.101, p = 0.000; I² = 84.9%) or circadian-active dimmer white light (SMD = −0.37, 95% CI = −0.68 to −0.06; z = −2.318, p = 0.02; I² = 33.8%), whereas green-blue, circadian-active BLT showed no significant superiority over circadian-inactive red/amber light controls (SMD = −0.21, 95% CI = −0.45 to 0.04; z = −2.318, p = 0.099; I² = 0%). Overall, circadian-active BLT showed a greater likelihood of clinical response than dim light controls, with increased superiority observed with co-medication. For pre-to-post-treatment amelioration and corresponding dose-response relationship, cumulative duration was found more influential than other categorical (co-medication, severity, study design) or continuous (CSt,f) variables. Dose-response fitting indicated that the therapeutic effect would reach saturation among co-medicated patients at 32–42 days (900–1,000 min) and 58–59 days (1,100–1,500 min) among non-medicated AYAs. When exerting high circadian stimulus of light therapy (0.6 < CSt,f < 0.7), there was a significantly greater effect size in 1,000–1,500 min of accumulative duration than <1,000 or >1,500 min of duration, indicating a threshold for practical guidance. Limitations The results have been based on limited samples and influenced by a small sample effect. The placebo effect could not be ignored. Conclusions Although the superiority of LT with higher circadian stimulus over dimmer light controls remains unproven, greater response potentials of circadian-active BLT have been noticed among AYAs, taking co-medication, disease severity, time pattern, and visual characteristics into consideration. The dose-response relationship with quantified circadian stimulus and temporal pattern had been elaborated under various conditions to support clinical depression treatment and LT device application in the post-pandemic era.

Molecular Genetic Mechanisms of Circadian Rhythm Regulation and Their Role in Psychopathology

Article

Full-text available

Jan 2024

Circadian Rhythms Disrupted by Light at Night and Mistimed Food Intake Alter Hormonal Rhythms and Metabolism

Article

Full-text available

Feb 2023
INT J MOL SCI

Availability of artificial light and light-emitting devices have altered human temporal life, allowing 24-hour healthcare, commerce and production, and expanding social life around the clock. However, physiology and behavior that evolved in the context of 24 h solar days are frequently perturbed by exposure to artificial light at night. This is particularly salient in the context of circadian rhythms, the result of endogenous biological clocks with a rhythm of ~24 h. Circadian rhythms govern the temporal features of physiology and behavior, and are set to precisely 24 h primarily by exposure to light during the solar day, though other factors, such as the timing of meals, can also affect circadian rhythms. Circadian rhythms are significantly affected by night shift work because of exposure to nocturnal light, electronic devices, and shifts in the timing of meals. Night shift workers are at increased risk for metabolic disorder, as well as several types of cancer. Others who are exposed to artificial light at night or late mealtimes also show disrupted circadian rhythms and increased metabolic and cardiac disorders. It is imperative to understand how disrupted circadian rhythms alter metabolic function to develop strategies to mitigate their negative effects. In this review, we provide an introduction to circadian rhythms, physiological regulation of homeostasis by the suprachiasmatic nucleus (SCN), and SCN-mediated hormones that display circadian rhythms, including melatonin and glucocorticoids. Next, we discuss circadian-gated physiological processes including sleep and food intake, followed by types of disrupted circadian rhythms and how modern lighting disrupts molecular clock rhythms. Lastly, we identify how disruptions to hormones and metabolism can increase susceptibility to metabolic syndrome and risk for cardiovascular diseases, and discuss various strategies to mitigate the harmful consequences associated with disrupted circadian rhythms on human health.

Insomnia increases the risk for specific autoimmune diseases: a large-scale retrospective cohort study

Article

Apr 2025

Objective The global rise of autoimmune diseases presents a significant medical challenge, with inadequate treatment options, high morbidity risks, and escalating healthcare costs. While the underlying mechanisms of autoimmune disease development are not fully understood, both genetic predispositions and lifestyle factors, particularly sleep, play critical roles. Insomnia and circadian rhythm sleep disorders not only impair sleep but also disrupt multi-organ interactions by dysregulating sympathetic nervous system activity, altering immune responses, and influencing neuroendocrine function. These disruptions can contribute to immune system dysregulation, increasing the risk of autoimmune disease development. Methods To assess the impact of impaired sleep on the risk of developing autoimmune diseases, a global population-based retrospective cohort study was conducted using electronic health records from the TriNetX US Global Collaborative Network, including 351,366 subjects in each propensity score matched group. Twenty autoimmune diseases were examined, and propensity score matching was employed to reduce bias. Three sensitivity analyses were conducted to test the robustness of the results. Results The study identified significantly increased risks for several autoimmune diseases associated with impaired sleep, likely mediated by dysregulated neuroimmune and autonomic interactions. Specifically, cutaneous lupus erythematosus [hazard ratio (HR) = 2.119; confidence interval (CI) 1.674–2.682; p < 0.0001], rheumatoid arthritis (HR = 1.404; CI 1.313–1.501; p < 0.0001), Sjögren syndrome (HR = 1.84; CI 1.64–2.066; p < 0.0001), and autoimmune thyroiditis (HR = 1.348; CI 1.246–1.458; p < 0.0001) showed significantly increased risks. No diseases demonstrated reduced risks, and 4 out of 20 tested diseases did not show significant HR increases in any analysis. Conclusion This study highlights the integral role of sleep in maintaining immune homeostasis through multi-organ interactions involving the autonomic nervous system, immune signalling pathways, and endocrine regulation. Disruptions in these systems due to chronic sleep impairment may predispose individuals to autoimmune diseases by altering inflammatory responses and immune tolerance. These findings underscore the necessity of recognizing and treating sleep disorders not only for general wellbeing but also as a potential strategy to mitigate the long-term risk of autoimmune disease development.

Effect of bright-light therapy on depression and anxiety of a patient with Alzheimer’s disease combined with sleep disorder: A case report

Article

Full-text available

Dec 2024

BACKGROUND Alzheimer’s disease (AD) is a common type of dementia due to neuronal impairment. In addition, psychobehavioral symptoms including severe sleep disorders, depression and anxiety can occur in most patients with AD. CASE SUMMARY We report a case of a 68-year-old woman with a 2-year history of AD. She initially presented with memory loss, progressively more severe, leading to a depressive and anxious status. The clinical symptoms also included severe sleep disturbances. Considering the age and health state of the patient, a non-pharmacological treatment of bright light therapy was used to improve her sleep quality. The treatment was provided for 30 minutes twice a day, during 8:30 am to 9:00 am and 16:30 pm to 17:00 pm. After 4 weeks of therapy, the sleep quality notably improved, with a marked decrease in daytime sleep, increase in nighttime sleep, and disappearance of nocturnal activity. The depression and anxiety were also suppressed significantly. CONCLUSION This case report suggested that bright light therapy can have a positive effect on sleep quality in elderly patients with AD and can be used as an effective and safe non-pharmacological treatment.

Behavioural determinants of physiologically-relevant light exposure

Article

Full-text available

Nov 2024

Light exposure triggers a range of physiological and behavioural responses that can improve and challenge health and well-being. Insights from laboratory studies have recently culminated in standards and guidelines for measuring and assessing healthy light exposure, and recommendations for healthy light levels. Implicit to laboratory paradigms is a simplistic input-output relationship between light and its effects on physiology. This simplified approach ignores that humans actively shape their light exposure through behaviour . This article presents a novel framework that conceptualises light exposure as an individual behaviour to meet specific, person-based needs. Key to healthy light exposure is shaping behaviour, beyond shaping technology.

Circadian lighting effect for inpatients with schizophrenia: A prospective cohort study

Article

Full-text available

Aug 2024

Objectives In schizophrenia, nonspecific lighting likely causes sleep timing disturbances, leading to distress and poorer clinical status. However, the effect of exposure to circadian lighting on psychopathology outcome in schizophrenia remains unknown. Hence, this study aimed to develop such an intervention and investigate its impact on schizophrenia. Methods Twenty schizophrenia patients at a psychiatric nursing institute were monitored over 10 weeks, with assessments using the Brief Psychiatric Rating Scale (BPRS) and Mini‐Mental State Examination (MMSE) conducted at baseline, weeks 3 (T1), 7 (T2), and 10 (T3). Results Circadian lighting significantly improved BPRS scores between T1–T2 (p < .05) and T1–T3 (p < .001), with affectivity scores also showing significant enhancements postintervention. Notably, female participants exhibited substantial improvements in BPRS scores from T1 to T3 (p < .01), while male participants demonstrated significant gains in MMSE scores from T1 to T2 (p < .01). Conclusions Circadian lighting presents a promising intervention for improving psychiatric outcomes in schizophrenia, with distinct benefits observed across different psychopathological aspects and genders. These findings underscore the potential of lighting chronotherapy in psychiatric clinical practice and warrant further exploration in related research.

Depression clinical trials worldwide: a systematic analysis of the ICTRP and comparison with ClinicalTrials.gov

Article

Full-text available

Jul 2024

Major depressive disorder (MDD), commonly known as depression, affects over 300 million people worldwide as of 2018 and presents a wide range of clinical symptoms. The international clinical trials registry platform (ICTRP) introduced by WHO includes aggregated data from ClinicalTrials.gov and 17 other national registers, making it the largest clinical trial platform. Here we analysed data in ICTRP with the aim of providing comprehensive insights into clinical trials on depression. Applying a novel hidden duplicate identification method, 10,606 depression trials were identified in ICTRP, with ANZCTR being the largest non- ClinicalTrials.gov database at 1031 trials, followed by IRCT with 576 trials, ISRCTN with 501 trials, CHiCTR with 489 trials, and EUCTR with 351 trials. The top four most studied drugs, ketamine, sertraline, duloxetine, and fluoxetine, were consistent in both groups, but ClinicalTrials.gov had more trials for each drug compared to the non-ClinicalTrials.gov group. Out of 9229 interventional trials, 663 unique agents were identified, including approved drugs (74.5%), investigational drugs (23.2%), withdrawn drugs (1.8%), nutraceuticals (0.3%), and illicit substances (0.2%). Both ClinicalTrials.gov and non-ClinicalTrials.gov databases revealed that the largest categories were antidepressive agents (1172 in ClinicalTrials.gov and 659 in non-ClinicalTrials.gov) and nutrients, amino acids, and chemical elements (250 in ClinicalTrials.gov and 659 in non-ClinicalTrials.gov), indicating a focus on alternative treatments involving dietary supplements and nutrients. Additionally, 26 investigational antidepressive agents targeting 16 different drug targets were identified, with buprenorphine (opioid agonist), saredutant (NK2 antagonist), and seltorexant (OX2 antagonist) being the most frequently studied. This analysis addresses 40 approved drugs for depression treatment including new drug classes like GABA modulators and NMDA antagonists that are offering new prospects for treating MDD, including drug-resistant depression and postpartum depression subtypes.

Morning light treatment for inflammatory bowel disease: a clinical trial

Article

Full-text available

May 2024
BMC GASTROENTEROL

Background Inflammatory bowel disease (IBD) affects over 3 million Americans and has a relapsing and remitting course with up to 30% of patients experiencing exacerbations each year despite the availability of immune targeted therapies. An urgent need exists to develop adjunctive treatment approaches to better manage IBD symptoms and disease activity. Circadian disruption is associated with increased disease activity and may be an important modifiable treatment target for IBD. Morning light treatment, which advances and stabilizes circadian timing, may have the potential to improve IBD symptoms and disease activity, but no studies have explored these potential therapeutic benefits in IBD. Therefore, in this study, we aim to test the effectiveness of morning light treatment for patients with IBD. Methods We will recruit sixty-eight individuals with biopsy-proven IBD and clinical symptoms and randomize them to 4-weeks of morning light treatment or 4-weeks of treatment as usual (TAU), with equivalent study contact. Patient-reported outcomes (IBD-related quality of life, mood, sleep), clinician-rated disease severity, and a biomarker of gastrointestinal inflammation (fecal calprotectin) will be assessed before and after treatment. Our primary objective will be to test the effect of morning light treatment versus TAU on IBD-related quality of life and our secondary objectives will be to test the effects on clinician-rated disease activity, depression, and sleep quality. We will also explore the effect of morning light treatment versus TAU on a biomarker of gastrointestinal inflammation (fecal calprotectin), and the potential moderating effects of steroid use, restless leg syndrome, and biological sex. Discussion Morning light treatment may be an acceptable, feasible, and effective adjunctive treatment for individuals with active IBD suffering from impaired health-related quality of life. Trial registration The study protocol was registered on ClinicalTrials.gov as NCT06094608 on October 23, 2023, before recruitment began on February 1, 2024.

Bright light therapy versus physical exercise to prevent co-occurring depression in adolescents and young adults with attention-deficit/hyperactivity disorder: a multicentre, three-arm, randomised controlled, pilot phase-IIa trial

Article

Full-text available

Apr 2024
EUR ARCH PSY CLIN N

Depression is common in attention-deficit/hyperactivity disorder (ADHD), but preventive behavioural interventions are lacking. This randomised controlled, pilot phase-IIa trial aimed to study a physical exercise intervention (EI) and bright light therapy (BLT)—both implemented and monitored in an individual, naturalistic setting via a mobile health (m-health) system—for feasibility of trial design and interventions, and to estimate their effects on depressive symptoms in young people with ADHD. Two hundred seven participants aged 14–45 years were randomised to 10-week add-on intervention of either BLT (10,000 lx; daily 30-min sessions) (n = 70), EI (aerobic and muscle-strengthening activities 3 days/ week) (n = 69), or treatment-as-usual (TAU) (n = 68), of whom 165 (80%) were retained (BLT: n = 54; EI: n = 52; TAU: n = 59). Intervention adherence (i.e. ≥ 80% completed sessions) was very low for both BLT (n = 13, 22%) and EI (n = 4, 7%). Usability of the m-health system to conduct interventions was limited as indicated by objective and subjective data. Safety was high and comparable between groups. Changes in depressive symptoms (assessed via observer-blind ratings, Inventory of Depressive Symptomatology) between baseline and end of intervention were small (BLT: −0.124 [95% CI: −2.219, 1.971], EI: −2.646 [95% CI: −4.777, −0.515], TAU: −1.428 [95% CI: −3.381, 0.526]) with no group differences [F(2,153) = 1.45, p = 0.2384]. These findings suggest that the m-health approach did not achieve feasibility of EI and BLT in young people with ADHD. Prior to designing efficacy studies, strategies how to achieve high intervention adherence should be specifically investigated in this patient group. Trial registration ClinicalTrials.gov, NCT03371810, 13 December 2017.

Chronotherapy synchronization strategies in borderline personality disorders

Article

Apr 2024
ANN MED-PSYCHOL

Introduction. – It is now evident that the disruption of circadian rhythm is one of the clinical phenotypes in individuals with Borderline Personality Disorder (BPD). Therefore, the use of chronotherapy in BPD is growing day by day. Consequently, in this systematic review, we assess chronotherapies either individually or in combination with conventional therapeutic interventions to determine the best possible therapy for the improvement of BPD symptomatology. Method. – A systematic online literature search of PubMed, Google Scholar, Cochrane Central Register of Control Trials, Clinical Trials Registry (ClinicalTrials.gov), APA PsycNET, and BMJ Evidence-Based Medicine was conducted between 2000 and 2022. In these databases, search terms describing borderline personality disorder and circadian rhythm restoration were combined with the term of treatment. Results. – From five selected studies, there are three types of chronotherapeutic interventions that were practiced: bright light therapy, physical exercise, and triple chronotherapy. Four out of the five studies we selected concluded that chronotherapy was a successful adjunctive therapy to pharmacotherapy and/or psychotherapy in improving the traits of BPD, especially depression (mean Hamilton Depression Rating Scale score decreased from 19.5 to 7.2) and suicidal thoughts (mean Columbia suicide severity rating scale score decreased from 19.5 to 7.2). Conclusion. – According to the literature we evaluated, chronotherapy, particularly bright light therapy, could be a safe and effective addition to conventional therapeutic interventions for BPD. However, the predominant emphasis on depression and suicidal ideation in the studies might limit the broad applicability of the findings to encompass other symptomatic aspects related to BPD.

Überblick zu chronobiologischen und schlafmedizinischen Aspekten bei Depressionen im Jugendalter

Article

Full-text available

Mar 2024
BUNDESGESUNDHEITSBLA

Bei Jugendlichen mit Depression werden mit einer Häufigkeit von bis zu 71 % Veränderungen des Schlafes berichtet. In dieser narrativen Übersichtsarbeit werden chronobiologische und schlafmedizinische Aspekte bei Depressionen im Jugendalter basierend auf der aktuellen Forschungsliteratur zusammenfassend dargestellt. Die circadiane Uhr des Menschen ermöglicht die Synchronisierung unseres Organismus mit der Licht-Dunkel-Struktur der Umwelt. Die individuelle Synchronisierung wird als Chronotyp bezeichnet. Der Chronotyp verändert sich u. a. altersabhängig und Jugendliche weisen die spätesten Chronotypen auf. Wenn es durch frühe Schul‑/Arbeitszeiten zu einer Diskrepanz zwischen Chronotyp und Außenzeit kommt, entsteht der sog. soziale Jetlag. Dieser soziale Jetlag tritt im Jugendalter vermehrt auf und ist mit zahlreichen gesundheitlichen Risiken, wie zum Beispiel Depressionen, verbunden. Veränderungen des Schlafes sind im Zusammenhang mit Depressionen gut beschrieben und treten im hohen Maße komorbid zu affektiven Erkrankungen auf. In diesem Artikel werden zu Beginn grundlegende Konzepte der Chronobiologie und schlafmedizinischer Aspekte zusammengefasst. Anschließend werden Gesundheitsrisiken und Zusammenhänge zu Depressionen spezifisch für Jugendliche erläutert, bevor dieser Artikel mit Empfehlungen für die klinische Versorgung bei Schlafstörungen und Depressionen im Jugendalter sowie für weitere Forschungsvorhaben schließt.

The Effect of Light on Negative Emotion and Cognitive Regulation in Individuals with Depressive Tendencies

Article

Feb 2024
LEUKOS

Light has been demonstrated to influence transient mood states in healthy populations and can be used as a treatment for clinical mood disorders. However, it is still interesting to know whether stimulus with relatively low light levels can moderate the transient mood state of people with depressive tendencies, and what are the effects respectively from light levels and light color. In this study, 10 subjects with depressive tendencies were recruited and screened to receive a typical lighting intervention, including five crossover conditions with the 300 l×-isoluminance groups (red, 6500 K-white, blue) and 6500 K-isospectral groups (50 lx, 300 lx, and 1500 lx). Negative cognitive bias, high-frequency heart rate variability, and subjective emotion were measured at different stages during the lighting intervention. Statistical results demonstrated that the lighting condition of 1500 lx-6500 K was associated with a transient positive mood state (p < 0.001) and had a significant positive moderating effect on the negative cognitive biases compared with the other groups (p = .017). Colored lights are more likely to trigger negative emotions and negative cognitive biases.

The Potential Role of Peripheral Somatosensory Stimulation in the Treatment of Mental Health Symptoms following Traumatic Brain Injury

Article

Dec 2023

Eric S. Nussbaum

Background Patients with traumatic brain injury (TBI) may develop symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety. Despite decades of research investigating treatment options, these mental health symptoms remain a major cause of quality-of-life impairment. In a series of patients with PTSD being treated with peripheral somatosensory stimulation (PSS), we further evaluated 3 patients who had suffered from TBI to detail their clinical response to therapy. Methods Three patients with TBI and PTSD underwent daily PSS therapy over a 4-week period. Patients were evaluated using a Veterans Affairs TBI scale of cognitive impairment and subjective mental health symptoms at baseline and then at the conclusion of the treatments. All data were obtained through a self-reported survey. Results Three men with TBI and PTSD completed one month of daily PSS therapy. No adverse events were described by the patients. All patients demonstrated improvement in terms of their scores assessing cognitive impairment and subjective symptoms. The Patients beginning with greater impairment appeared to derive more benefit from therapy. Conclusions PSS stimulation appeared to improve symptoms in three patients with TBI and PTSD. Symptoms related to both anxiety and depression were improved. We suggest that further investigation into the potential usefulness of PSS therapy in patients with TBI and mental health symptoms is warranted.

Delivery of bright light therapy within the Veterans Health Administration

Article

Dec 2023
J AFFECT DISORDERS

Antidepressant effect of bright light therapy on patients with Alzheimer’s disease and their caregivers

Article

Full-text available

Nov 2023

Background: As a non-pharmacologic treatment, bright light therapy (BLT) is often used to improve affective disorders and memory function. In this study, we aimed to determine the effect of BLT on depression and electrophysiological features of the brain in patients with Alzheimer’s disease (AD) and their caregivers using a light-emitting diode device of 14000 lux. Methods: A 4-week case-control trial was conducted. Neuropsychiatric and electroencephalogram (EEG) examination were evaluated at baseline and after 4 weeks. EEG power in delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–30 Hz) bands was calculated for our main analysis. Demographic and clinical variables were analyzed using Student’s t test and the chi-square test. Pearson’s correlation was used to determine the correlation between electrophysiological features, blood biochemical indicators, and cognitive assessment scale scores. Results: In this study, 22 in-patients with AD and 23 caregivers were recruited. After BLT, the Hamilton depression scale score decreased in the fourth week. Compared with the age-matched controls of their caregivers, a higher spectral power at the lower delta and theta frequencies was observed in the AD group. After BLT, the EEG power of the delta and theta frequencies in the AD group decreased. No change was observed in blood amyloid concentrations before and after BLT. Conclusion: In conclusion, a 4-week course of BLT significantly suppressed depression in patients with AD and their caregivers. Moreover, changes in EEG power were also significant in both groups.

Responses to bright light exposure in individuals with binge-spectrum eating disorders characterized by high dietary restraint and negative affect

Article

Aug 2023
INT J EAT DISORDER

Objective: Circadian rhythm disruptions are associated with binge eating, can be causal of negative mood, and may be corrected with bright light exposure. A subtype of individuals with binge-spectrum eating disorders are characterized by combined high dietary restraint and negative affect. These individuals have higher eating disorder psychopathology and poorer treatment response. We aimed to test the targeted effects of morning bright light exposure on individuals with binge-spectrum eating disorders, hypothesizing significant reductions in binge eating for those characterized by high dietary restraint and negative affect. Methods: Participants (N = 34 females with binge-eating disorder and bulimia nervosa) used a morning bright light and normal light for 10 consecutive days each, in randomized order. They completed the Change in Eating Disorder Symptoms (CHEDS) scale at baseline, day 12 (when they switched lamps), and day 22. We conducted moderation analyses, clustering data by person, controlling for order, and examining the effect of light condition on binge eating according to baseline restraint and negative affect. Results: At high levels of combined dietary restraint and negative affect, participants experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. There were no changes in restrictive eating, body preoccupation, body dissatisfaction, or body checking following exposure to morning bright light for these individuals. Discussion: These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult to treat restraint/negative affect subtype. Public significance: At high levels of combined dietary restraint and negative affect, participants with binge-spectrum eating disorders experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult-to-treat restraint/negative affect subtype.

Effects of bright light therapy on neuroinflammatory and neuroplasticity markers in a diurnal rodent model of Seasonal Affective Disorder

Article

Full-text available

Aug 2023

Background Bright light therapy (BLT) is widely used for treating Seasonal Affective Disorder (SAD). However, the neural mechanisms underlying the therapeutic effects of BLT remain largely unexplored. The present study used a diurnal rodent (Nile grass rats; Arvicanthis niloticus) to test the hypothesis that the therapeutic effects of BLT could be, in part, due to reduced neuroinflammation and/or enhanced neuroplasticity. Our previous research has demonstrated that compared to grass rats housed in a summer-like daytime bright light condition (1000 lux), those housed in a winter-like daytime dim light condition (50 lux) showed increased depression- and anxiety-like behaviours, as well as impaired sociosexual behaviours and spatial memory, similar to what is observed in patients suffering from SAD. Materials and Methods In the present study, male and female grass rats were housed under the winter-like dim daytime light condition (lights on 600–1800 hr, 50 lux). The experimental groups received daily 1-h early morning BLT from 0600-0700 using full-spectrum light (10,000 lux), while the control groups received narrowband red light (λmax, 780 nm). Following 4 weeks of treatment, the expression of several neuroinflammatory or plasticity markers was examined in the medial prefrontal cortex (mPFC), basolateral amygdala (BLA), and the CA1 of the dorsal hippocampus. Results For the neuroinflammatory markers, BLT reduced TNF-α in the BLA of females, and upregulated CD11b in the mPFC and IL6 in the BLA in males. For the neuroplasticity markers, BLT downregulated BDNF in the CA1 and TrkB in all three brain regions in females but upregulated BDNF in the BLA and CA1 in males. Conclusions These results indicate that the therapeutic effects of BLT on sleep, mood, and cognition may be attributed in part to mechanisms involving neuroinflammation and neuroplasticity in corticolimbic brain regions. Moreover, these effects appear to vary between sexes.

Zero-Shot Information Extraction for Clinical Meta-Analysis using Large Language Models

Conference Paper

Jan 2023

Postpartum Depression: Overcoming Mental Health Challenges during Parenthood

Article

Full-text available

Jan 2023

Effects of light therapy on sleep/wakefulness, daily rhythms, and the central orexin system in a diurnal rodent model of seasonal affective disorder

Article

Apr 2023
J AFFECT DISORDERS

Background: 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). Methods: 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. Results: 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. Limitations: 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. Conclusions: 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.

Impact Of Physical Activity And Health Education On The Development Of Depression

Article

Full-text available

Feb 2023

Depression is a common mental health disorder that affects the majority of the population. The exact cause of depression is not fully understood, but various factors such as genetics, environmental stressors, and psychological factors are believed to play a role. Due to the complexity of the etiopathogenesis of depression, the selection of appropriate therapeutic management is sometimes complicated. Treatment for depression typically involves a combination of medication and psychotherapy. Antidepressant medication can help alleviate symptoms by regulating neurotransmitters in the brain, while psychotherapy can help individuals understand and change negative thoughts and behaviors. Physical activity, such as sport, has been shown to have a positive impact on mental health and can help alleviate symptoms of depression. Exercise releases endorphins, reducing stress and improving mood. Health education can also play a role in preventing and managing depression by raising awareness, reducing stigma, and teaching individuals coping skills to maintain good mental health.

Efficacy evaluation and facial expressions biomarker of light therapy in youths with subthreshold depression: A randomized control trial study

Article

Mar 2025
J AFFECT DISORDERS

The effect of bright light therapy on sleep in pregnant women with major depressive disorder– a randomized controlled trial

Article

Full-text available

Mar 2025
ARCH WOMEN MENT HLTH

Purpose Bright light therapy (BLT) is a potential treatment for depression during pregnancy, which may also improve sleep. We investigated whether BLT has an effect on self-reported and actigraphy-estimated sleep in pregnant women diagnosed with depressive disorder. Method Sixty-seven pregnant women with a DSM-5 diagnosis of depressive disorder during pregnancy were randomly allocated to treatment with BLT (9,000 lx, 5,000 K) or dim red light therapy (DRLT, 100 lx, 2,700 K), which is considered placebo. For six weeks, both groups were treated daily at home for 30 min upon awakening. Follow-up took place at various time points. We collected data on sleep with the Pittsburgh Sleep Quality Index and with actigraphy wearables. Results We found no statistically significant differences in treatment groups across any of the sleep parameters measured, namely sleep efficiency, duration, onset latency, fragmentation, and total sleep health as measured by self-report and actigraphy. Moreover, we observed no overall improvements in sleep during the treatment period. Conclusions The results suggest that any potential therapeutic effects of BLT might have on sleep are too small for the current study to detect. Clinical trial number NTR5476; November 5th, 2015

Violet light photobiomodulation therapy for depression: A double-blind randomized crossover trial

Article

Feb 2025
J AFFECT DISORDERS

In nonseasonal depressive disorders, bright light therapy improves response and remission rates

Article

Feb 2025
ANN INTERN MED

Lucinda Leung

Mental Health: [Formula: see text] GIM/FP/GP: [Formula: see text].

A review of integrative dynamic lighting and associated well-being impact for people living with dementia

Article

Feb 2025
LIGHTING RES TECHNOL

Integrative lighting considers light for both visual and non-visual impact and can therefore benefit human health and well-being. More specifically, it can benefit circadian-related well-being, an umbrella term which within dementia cohorts considers factors such as sleep, rest-activity, mood, agitation and activities of daily living. As people living with dementia experience disruptions to their circadian rhythms and spend large amounts of time indoors, the understanding of how integrative interior lighting could influence their body clock could help support their well-being. A review of 18 studies found that papers are difficult to compare due to unsystematic study designs and reporting of study characteristics, light characteristics and participant characteristics. The findings at most imply that indoor integrative lighting could be beneficial to these aspects of well-being. This review finds suggestion that for this cohort there may be a relationship between colour variation and mood and agitation, alongside a relationship between intensity variation and sleep, and that the influence on rest-activity may be more unpredictable. These findings are inferred and due to heterogeneous study designs they are inconclusive. The outcome of this review therefore recommends future studies that follow systematic checklists for study designs which seek to test these inferred hypotheses within this cohort.

Circadian realignment and depressed mood: A systematic review

Article

Nov 2024
SLEEP MED REV

Attenuated melanopsin-mediated post-illumination pupillary response (PIPR) is associated with reduced actigraphic amplitude and mesor in older adults

Article

Oct 2024
SLEEP

Study Objectives This study aimed to explore the relationship between post-illumination pupillary response (PIPR) with sleep and circadian measures in a community sample of healthy older adults. Methods Eligible participants were invited to complete a 1 week sleep diary and actigraphy, and provide an overnight urine sample to measure urinary 6-sulfatoxymelatonin (aMT6s). PIPR was defined as the (1) pupil constriction at 6 second poststimulus (PIPR-6s) and (2) for -30s beginning 10 seconds after stimulus (PIPR-30s), normalized as a percentage to the baseline pupil diameter, after 1 second of blue and 1 second of red light stimulus, respectively. The Net-PIPRs were reported by subtracting the PIPR to red stimulus from the PIPR to blue stimulus. The relationship between PIPR metrics to aMT6s and actigraphic rest-activity rhythm parameters was examined by generalized linear models. Results A total of 48 participants were recruited (mean age: 62.6 ± 7.1 years, male: 44%). Both Net PIPR-6s and Net PIPR-30s were significantly associated with actigraphic rest-activity amplitude (B = 0.03, p = .001 and B = 0.03, p = .01, respectively) and actigraphic rest-activity mesor (B = 0.02, p = .001 and B = 0.03, p = .004, respectively). Additionally, the Net PIPR-30s were positively associated with overnight aMT6s level (B = 0.04, p = .03) and negatively associated with actigraphic rest-activity acrophase (B = −0.01, p = .004) in the fully adjusted models. Conclusions Attenuated PIPR is associated with a reduced actigraphic amplitude and mesor. The reduced retinal light responsivity may be a potential pathway contributing to impaired photic input to the circadian clock and resulted in age-related circadian changes in older adults.

A 4-Week Morning Light Treatment Reduces Amygdala Reactivity and Clinical Symptoms in Adults with Traumatic Stress

Article

Sep 2024
PSYCHIAT RES

Experiences of adult patients living with depression-related insomnia: a qualitative systematic review

Article

Full-text available

Sep 2024

Objective The objective of this review was to identify and synthesize the best available evidence on how adult patients experience living with depression-related insomnia, and their experiences related to pharmacological and non-pharmacological interventions aimed at improving sleep. Introduction Insomnia affects 80% to 90% of patients with depression. The costs of insomnia are considerable for the individual and society alike. To understand the role and consequences of insomnia for an individual with depression and to optimize sleep interventions, an in-depth understanding of patients’ experiences is needed. Therefore, this review addresses how adult patients experience living with depression-related insomnia, along with the experiences of pharmacological and non-pharmacological sleep interventions among patients with depression-related insomnia. Inclusion criteria Studies focusing on adult patients aged 18 years and older with a diagnosis of depression who had experiences with insomnia and pharmacological and/or non-pharmacological sleep interventions were included. All studies with qualitative research findings from inpatient and outpatient populations were considered. Methods The following databases were searched: MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (ProQuest), Cochrane CENTRAL, SveMed+, Scopus, and Web of Science Core Collection. Google Scholar and ProQuest Dissertations and Theses were searched for eligible dissertations and theses. The searches were conducted on May 3–5, 2022, and updated on June 13–19, 2023. Studies published in English, Danish, German, Norwegian, and Swedish were considered. Databases were searched from their inception to the search date. All studies were screened against the inclusion criteria and critically and independently appraised by 2 reviewers for methodological quality. Findings were pooled using meta-aggregation, and a ConQual Summary of Findings was created. Results Ten qualitative studies were included. The studies were conducted in 6 countries and counted a total of 176 participants. In all, 127 findings were extracted and aggregated into 11 categories. From the 11 categories, 3 synthesized findings were developed: 1) Disruption of sleep challenges coping with everyday life by depleting both physical and mental resources; 2) Sleep is an escape and a protective factor against suicide; and 3) Choices, support, and personalized interventions from non-pharmacological approaches addressing depression-related insomnia are valued. Conclusions This review underlined the relationship between depression-related insomnia, its profound impact on individuals’ lives, and the value of non-pharmacological sleep interventions to address these issues. Specifically, the study revealed the physical and emotional consequences of insomnia while emphasizing how wakefulness during night hours may exacerbate feelings of loneliness and vulnerability to negative thoughts and suicide. Moreover, it provides an overview of patients’ experiences of non-pharmacological approaches to address depression-related insomnia and highlights their diverse treatment experiences and preferences. Supplemental Digital Content A Danish-language version of the abstract of this review is available as Supplemental Digital Content [http://links.lww.com/SRX/A64]. Systematic Review Registration Number PROSPERO CRD42021276048

Apparative Therapien in der Kinder- und Jugendpsychiatrie

Chapter

Aug 2024

Martin Holtmann

Rhythmic gamma frequency light flickering ameliorates stress-related behaviors and cognitive deficits by modulating neuroinflammatory response through IL-12-Mediated cytokines production in chronic stress-induced mice

Article

Jul 2024
BRAIN BEHAV IMMUN

Multisensorische Stimulation und psychische Gesundheit – „Anima Mentis“ ein evidenzbasiertes PraxisprojektMultisensory stimulation and mental health—“Anima Mentis” an evidence-based practical project

Article

Full-text available

Apr 2024

Roland Eßl-Maurer

Zusammenfassung Hintergrund Die psychische Gesundheit ist ein wesentlicher Bestandteil der allgemeinen Gesundheit, und Präventionsmaßnahmen mit dem Ziel, diese Komponente der Gesundheit zu erhalten und zu fördern, haben in den letzten Jahrzehnten zunehmend an Bedeutung gewonnen. In Europa sind Depressionen der wichtigste Einzelfaktor für psychische Gesundheitsprobleme. Die hohe Prävalenz und die besonders hohe Krankheitslast von Depressionen begründen ein großes Interesse an wirksamen, früh einsetzenden, niedrigschwelligen und individuellen Präventionsmaßnahmen für die Allgemeinbevölkerung. Ziel Ziel dieses Beitrages ist es, einen Überblick über die Entwicklung und Struktur des evidenzbasierten Anwendungsprogramms „Anima Mentis“ zur Förderung der psychischen Gesundheit und Prävention psychischer Erkrankungen zu geben. Ergebnis Basierend auf einer narrativen Literaturrecherche zur Identifizierung evidenzbasierter Interventionen wurden Erkenntnisse zu monosensorischen und multisensorischen Stimulationen zur Reduktion depressiver Symptome und zur Förderung des psychischen Wohlbefindens in das Programm „Anima Mentis“ überführt. Dieses modular aufgebaute Programm wird in einem Behandlungszentrum mit verschiedenen Raumkonzepten wie Bewegungsraum, Lichtraum, Virtual Reality (VR)-Raum, Nature-360°-Kino und Sinnesraum umgesetzt. Schlussfolgerung Das Praxisprojekt „Anima Mentis“ verfolgt einen personalisierten Ansatz zur Förderung der psychischen Gesundheit. Dieses Konzept bietet das Potenzial, in verschiedene Versorgungseinrichtungen wie z. B. die betriebliche Gesundheitsförderung integriert zu werden. Um die Evidenzlage zur multisensorischen Stimulation zu erweitern und Einblicke in spezifische Nutzergruppen, insbesondere im präventiven Kontext, zu gewinnen, ist zukünftige Forschung notwendig.

Drug and Physical Treatments of Depression

Chapter

Apr 2024

Classification of drug treatments for depression is described noting the ambiguities of current terminology and the move towards standardised nomenclature based on pharmacology and mode of action, such as that proposed by the Neuroscience-based Nomenclature group. Antidepressant drugs are described in terms of background, mechanism of action, pharmacokinetics, side effects, interactions, contraindications and toxicity in overdose. Groups include selective serotonin re-uptake inhibitors (SSRI), serotonin and noradrenaline re-uptake inhibitors (SNRI), tricyclics, noradrenergic and specific serotoninergic antidepressants (NaSSA), monoamine oxidase inhibitors (MAOI) and others such as buproprion, agomelatine, reboxetine, trazadone and vortioxetine. Augmentary medications are also described, including antipsychotics, antiepileptics and lithium. Developments with the use of ketamine and other compounds are discussed. The classification of physical treatments for depression is into neuromodulatory (e.g. electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation and phototherapy) and neuroablative techniques (e.g. stereotactic psychosurgery).

Noise Robust Recognition of Depression Status and Treatment Response from Speech via Unsupervised Feature Aggregation

Conference Paper

Jul 2023

Diurnal Intervention Effects of Electric Lighting on Alertness, Cognition, and Mood in Healthy Individuals: A Systematic Review and Meta-Analysis

Article

Full-text available

Dec 2023

Non-image forming effects of electric light can be employed to address problems related to individuals' productivity in isolated and confined extreme environments (ICEs). A systematic review and meta-analysis, registered at PROSPERO (Registration ID: CRD 42022326269), were conducted to thoroughly evaluate the efficacy of the daytime artificial light intervention on alertness, cognition, and mood using psychological, cognitive performance, and physiological multimodal measures. Twenty-eight studies were identified after an extensive search scope of major electronic databases including Web of Science, Embase, PubMed, Scopus, and PsycINFO. Results revealed that the use of daytime light interventions significantly improved alertness and cognition, and reduced the alpha wave of electroencephalogram, whereas no significant difference was observed for mood. Subgroup analyses by intervention attribute suggested that light parameters and time characteristics affected the efficacy of diurnal light intervention with varying degrees. Future work investigating the correlation between the two variables is needed to further our understanding of the impact of daytime electric light on human responses. This study and its methodology can be useful for researchers as they establish lighting design guidelines capable of improving human functions in ICEs. ARTICLE HISTORY

The effects of light therapy on depression and sleep in women during pregnancy or the postpartum period: A systematic review and meta‐analysis

Article

Full-text available

Nov 2023

Background In recent years, light therapy has been tried for the treatment of depression and sleep in pregnancy or postnatal period women, but the results have been inconclusive. This meta‐analysis is the first to systematically review the effects of light therapy on depression and sleep disturbances in women during pregnancy and the postnatal period. Methods We searched for randomized controlled studies in PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Chinese Biomedical Database up to January 2023. The standardized mean difference (SMD) was used to assess the efficacy of the outcome indicators. Results Eight studies were eventually included in the analysis. The results showed that light therapy was more effective than the placebo group in terms of depression (SMD = .34, CI = .08–.61) and sleep (SMD = .64,95%CI = .28–1.00). Subgroup analysis could not explain the significant heterogeneity. There were no serious adverse effects in either the light therapy or placebo groups. Conclusions Light therapy could be considered an effective treatment for depression and sleep disturbances in women during pregnancy and the postnatal period. However, future high‐quality trials with larger sample sizes are still needed.

Apparative Therapien in der Kinder- und Jugendpsychiatrie

Chapter

Nov 2023

Martin Holtmann

Illuminating the way: the role of bright light therapy in the treatment of depression

Article

Oct 2023

Introduction: Despite the growing number of different therapeutic options, treatment of depression is still a challenge. A broader perspective reveals the benefits of bright light therapy (BLT). It stimulates intrinsically photosensitive retinal ganglion cells, which induces a complex cascade of events, including alterations in melatonergic, neurotrophic, GABAergic, glutamatergic, noradrenergic, serotonergic systems, and HPA axis, suggesting that BLT effects expand beyond the circadian pacemaker. Areas covered: In this review, the authors present and discuss recent data of BLT in major depressive disorder, non-seasonal depression, bipolar depression or depressive phase of bipolar disorder, and seasonal affective disorder, as well as in treatment-resistant depression (TRD). The authors further highlight BLT effects in various depressive disorders compared to placebo and report data from several studies suggesting a response to BLT in TRD. Also, the authors report data showing that BLT can be used both as a monotherapy or in combination with other pharmacological treatments. Expert opinion: BLT is an easy-to-use and low-budget therapy with good tolerability. Future studies should focus on clinical and biological predictors of response to BLT, on defining specific populations which may benefit from BLT and establishing treatment protocols regarding timing, frequency, and duration of BLT.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Article

Full-text available

Aug 2023

Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventions could augment medications but have not been adequately examined. This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD. We identified 83 reviews and meta-analyses concerning the treatment of RCBD. Additionally, we found 42 reports on adjunctive nonpharmacological treatments in RCBD. Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment. There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications. The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation, cognitive behavioural therapy, family interventions, and supportive psychotherapy may be helpful. The overall quality of evidence was poor and suffered from several methodological shortcomings. There is a need for more methodologically sound research in this area, although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD. Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Mood Disorders in Youth

Article

Apr 2023
CHILD ADOL PSYCH CL

Omega-3 polyunsaturated fatty acids, probiotics, vitamin C, vitamin D, folic acid and L-methyl folate, broad-spectrum micronutrients, N-acetylcysteine, physical activity, herbs, bright light therapy, melatonin, saffron, meditation, school-based interventions, and transcranial photobiomodulation are reviewed, with a focus on their use for treating mood disorders in children and adolescents. For each treatment, all published randomized controlled trials are summarized.

Research progress in control strategies of biological clock disorder

Article

Apr 2023
Acta Physiol Sin

Circadian clock is an internal mechanism evolved to adapt to cyclic environmental changes, especially diurnal changes. Keeping the internal clock in synchronization with the external clock is essential for health. Mismatch of the clocks due to phase shift or disruption of molecular clocks may lead to circadian disorders, including abnormal sleep-wake cycles, as well as disrupted rhythms in hormone secretion, blood pressure, heart rate, body temperature, etc. Long-term circadian disorders are risk factors for various common critical diseases such as metabolic diseases, cardiovascular diseases, and tumor. To prevent or treat the circadian disorders, scientists have conducted extensive research on the function of circadian clocks and their roles in the development of diseases, and screened hundreds of thousands of compounds to find candidates to regulate circadian rhythms. In addition, melatonin, light therapy, exercise therapy, timing and composition of food also play a certain role in relieving associated symptoms. Here, we summarized the progress of both drug- and non-drug-based approaches to prevent and treat circadian clock disorders.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Article

Full-text available

Jan 2014

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial

Article

Full-text available

Nov 2015

Importance Bright light therapy is an evidence-based treatment for seasonal depression, but there is limited evidence for its efficacy in nonseasonal major depressive disorder (MDD).Objective To determine the efficacy of light treatment, in monotherapy and in combination with fluoxetine hydrochloride, compared with a sham-placebo condition in adults with nonseasonal MDD.Design, Setting, and Participants Randomized, double-blind, placebo- and sham-controlled, 8-week trial in adults (aged 19-60 years) with MDD of at least moderate severity in outpatient psychiatry clinics in academic medical centers. Data were collected from October 7, 2009, to March 11, 2014. Analysis was based on modified intent to treat (randomized patients with ≥1 follow-up rating).Interventions Patients were randomly assigned to (1) light monotherapy (active 10 000-lux fluorescent white light box for 30 min/d in the early morning plus placebo pill); (2) antidepressant monotherapy (inactive negative ion generator for 30 min/d plus fluoxetine hydrochloride, 20 mg/d); (3) combination light and antidepressant; or (4) placebo (inactive negative ion generator plus placebo pill).Main Outcomes and Measures Change score on the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to the 8-week end point. Secondary outcomes included response (≥50% reduction in MADRS score) and remission (MADRS score ≤10 at end point).Results A total of 122 patients were randomized (light monotherapy, 32; fluoxetine monotherapy, 31; combination therapy, 29; placebo, 30). The mean (SD) changes in MADRS score for the light, fluoxetine, combination, and placebo groups were 13.4 (7.5), 8.8 (9.9), 16.9 (9.2), and 6.5 (9.6), respectively. The combination (effect size [d] = 1.11; 95% CI, 0.54 to 1.64) and light monotherapy (d = 0.80; 95% CI, 0.28 to 1.31) were significantly superior to placebo in the MADRS change score, but fluoxetine monotherapy (d = 0.24; 95% CI, −0.27 to 0.74) was not superior to placebo. For the respective placebo, fluoxetine, light, and combination groups at the end point, response was achieved by 10 (33.3%), 9 (29.0%), 16 (50.0%), and 22 (75.9%) and remission was achieved by 9 (30.0%), 6 (19.4%), 14 (43.8%), and 17 (58.6%). Combination therapy was superior to placebo in MADRS response (β = 1.70; df = 1; P = .005) and remission (β = 1.33; df = 1; P = .02), with numbers needed to treat of 2.4 (95% CI, 1.6 to 5.8) and 3.5 (95% CI, 2.0 to 29.9), respectively. All treatments were generally well tolerated, with few significant differences in treatment-emergent adverse events.Conclusions and Relevance Bright light treatment, both as monotherapy and in combination with fluoxetine, was efficacious and well tolerated in the treatment of adults with nonseasonal MDD. The combination treatment had the most consistent effects.Trial Registration clinicaltrials.gov Identifier: NCT00958204

Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression

Article

Full-text available

Mar 2012
PSYCHIAT RES

Treatment of bipolar disorder often results in patients taking several drugs in an attempt to alleviate residual depressive symptoms, which can lead to an accumulation of side effects. New treatments for bipolar depression that do not increase the side effect burden are needed. One nonpharmacological treatment with few side effects, bright light therapy, has been shown to be an effective therapy for seasonal affective disorder, yet has not been extensively studied for other forms of depression. Forty-four adults with bipolar disorder, depressed phase were randomized to treatment with bright light therapy, low-density or high-density negative ion generator for 8 weeks. The primary measure of efficacy was the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement (SIGH-ADS). Adverse events were assessed using the Young Mania Rating Scale (YMRS) and Systematic Assessment for Treatment Emergent effects (SAFTEE). All outcome variables were statistically analyzed using a mixed model repeated measure analysis of variance (ANOVA). The results showed no statistically significant differences between groups in any outcome measures at study end point; adverse events, including switches into hypomania, were rare. Further research is needed to determine the efficacy of bright light therapy in this population.

Bias in Meta-Analysis Detected by a Simple, Graphical Test

Article

Full-text available

Sep 1997

Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30

New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum

Article

Full-text available

Mar 2011

Samantha Meltzer-Brody

Maternal perinatal mental health has enormous consequences for the well-being of the mother, her baby, and the family. Although it is well documented that perinatal depression is both common and morbid, with a prevalence of 10% to 15% in the general population, there remain many critically important unanswered questions about the pathogenesis of perinatal depression and most effective treatment regimens. Current lines of evidence from both human and animal models implicate hormonal dysregulation, abnormalities in hypothalamic-pituitary-adrenal axis activity, and the contributions of genetics and epigenetics as playing key roles in the development of perinatal reproductive mood disorders. Investigations into both human and animal models of perinatal depression offer much promise for the future identification of the underlying pathophysiology and subsequent early identification and/or prevention and appropriate treatment for women at risk for postpartum depression. Lastly, although it is generally accepted that pregnancy is not protective with regard to new onset or relapse of depression, the way to best treat maternal depression during pregnancy and lactation remains hotly debated. Future research in this area will more clearly elucidate the underlying pathogenesis, the potential long-term impact of perinatal depression on the developing fetus, and how best to counsel pregnant women about the risks of untreated major depressive disorder versus the risks of psychopharmacologic treatment during pregnancy and lactation.

Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive Disorder A Randomized Placebo-Controlled Trial

Article

Full-text available

Jan 2011

Major depressive disorder (MDD) in elderly individuals is prevalent and debilitating. It is accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus, the biological clock of the brain. Circadian rhythm disturbances are common in the elderly. Suprachiasmatic nucleus stimulation using bright light treatment (BLT) may, therefore, improve mood, sleep, and hormonal rhythms in elderly patients with MDD. To determine the efficacy of BLT in elderly patients with MDD. Double-blind, placebo-controlled randomized clinical trial. Home-based treatment in patients recruited from outpatient clinics and from case-finding using general practitioners' offices in the Amsterdam region. Eighty-nine outpatients 60 years or older who had MDD underwent assessment at baseline (T0), after 3 weeks of treatment (T1), and 3 weeks after the end of treatment (T2). Intervention Three weeks of 1-hour early-morning BLT (pale blue, approximately 7500 lux) vs placebo (dim red light, approximately 50 lux). Mean improvement in Hamilton Scale for Depression scores at T1 and T2 using parameters of sleep and cortisol and melatonin levels. Intention-to-treat analysis showed Hamilton Scale for Depression scores to improve with BLT more than placebo from T0 to T1 (7%; 95% confidence interval, 4%-23%; P = .03) and from T0 to T2 (21%; 7%-31%; P = .001). At T1 relative to T0, get-up time after final awakening in the BLT group advanced by 7% (P < .001), sleep efficiency increased by 2% (P = .01), and the steepness of the rise in evening melatonin levels increased by 81% (P = .03) compared with the placebo group. At T2 relative to T0, get-up time was still advanced by 3% (P = .001) and the 24-hour urinary free cortisol level was 37% lower (P = .003) compared with the placebo group. The evening salivary cortisol level had decreased by 34% in the BLT group compared with an increase of 7% in the placebo group (P = .02). In elderly patients with MDD, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment. clinicaltrials.gov Identifier NCT00332670.

Weak evidence of bright light effects on human LH and FSH

Article

Full-text available

May 2010

Most mammals are seasonal breeders whose gonads grow to anticipate reproduction in the spring and summer. As day length increases, secretion increases for two gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH). This response is largely controlled by light. Light effects on gonadotropins are mediated through effects on the suprachiasmatic nucleus and responses of the circadian system. There is some evidence that seasonal breeding in humans is regulated by similar mechanisms, and that light stimulates LH secretion, but primate responses seem complex. To gain further information on effects of bright light on LH and FSH secretion in humans, we analyzed urine samples collected in three experiments conducted for other goals. First, volunteers ages 18-30 years and 60-75 commenced an ultra-short 90-min sleep-wake cycle, during which they were exposed to 3000 lux light for 3 hours at balanced times of day, repeated for 3 days. Urine samples were assayed to explore any LH phase response curve. Second, depressed participants 60-79 years of age were treated with bright light or dim placebo light for 28 days, with measurements of urinary LH and FSH before and after treatment. Third, women of ages 20-45 years with premenstrual dysphoric disorder (PMDD) were treated to one 3-hour exposure of morning light, measuring LH and FSH in urine before and after the treatments. Two of the three studies showed significant increases in LH after light treatment, and FSH also tended to increase, but there were no significant contrasts with parallel placebo treatments and no significant time-of-day treatment effects. These results gave some support for the hypothesis that bright light may augment LH secretion. Longer-duration studies may be needed to clarify the effects of light on human LH and FSH.

Seasonal Affective-Disorder - a Description of the Syndrome and Preliminary Findings with Light Therapy

Article

Full-text available

Feb 1984
ARCH GEN PSYCHIAT

Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depressions that occur annually at the same time each year. We describe 29 patients with SAD; most of them had a bipolar affective disorder, especially bipolar II, and their depressions were generally characterized by hypersomnia, overeating, and carbohydrate craving and seemed to respond to changes in climate and latitude. Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect.

Light Suppresses Melatonin Secretion in Humans

Article

Full-text available

Jan 1981

Bright artificial light suppressed nocturnal secretion of melatonin in six normal human subjects. Room light of less intensity, which is sufficient to suppress melatonin secretion in other mammals, failed to do so in humans. In contrast to the results of previous experiments in which ordinary room light was used, these findings establish that the human response to light is qualitatively similar to that of other mammals.

The Hamilton Depression Rating Scale: Has the Gold Standard Become a Lead Weight?

Article

Full-text available

Jan 2005

The Hamilton Depression Rating Scale has been the gold standard for the assessment of depression for more than 40 years. Criticism of the instrument has been increasing. The authors review studies published since the last major review of this instrument in 1979 that explicitly examine the psychometric properties of the Hamilton depression scale. The authors' goal is to determine whether continued use of the Hamilton depression scale as a measure of treatment outcome is justified. MEDLINE was searched for studies published since 1979 that examine psychometric properties of the Hamilton depression scale. Seventy studies were identified and selected, and then grouped into three categories on the basis of the major psychometric properties examined-reliability, item-response characteristics, and validity. The Hamilton depression scale's internal reliability is adequate, but many scale items are poor contributors to the measurement of depression severity; others have poor interrater and retest reliability. For many items, the format for response options is not optimal. Content validity is poor; convergent validity and discriminant validity are adequate. The factor structure of the Hamilton depression scale is multidimensional but with poor replication across samples. Evidence suggests that the Hamilton depression scale is psychometrically and conceptually flawed. The breadth and severity of the problems militate against efforts to revise the current instrument. After more than 40 years, it is time to embrace a new gold standard for assessment of depression.

Controlled trial of bright light and negative air ions for chronic depression

Article

Full-text available

Jul 2005

This randomized controlled trial investigates the efficacy of two non-pharmacologic treatments, bright light and high-density negative air ions for non-seasonal chronic depression. Both methods have shown clinical success for seasonal affective disorder (SAD). Patients were 24 (75%) women and 8 (25%) men, ages 22-65 years (mean age +/- S.D., 43.7 +/- 12.4 years), with Major Depressive Disorder, Single Episode (DSM-IV code, 296.2), Chronic (episode duration > or = 2 years). Patients were entered throughout the year and randomly assigned to exposure to bright light (10 000 lux, n = 10), or high-density (4.5 x 10(14) ions/s flow rate, n = 12) or low-density (1.7 x 10(11) ions/s, n = 10, placebo control) negative air ions. Home treatment sessions occurred for 1 h upon awakening for 5 weeks. Blinded raters assessed symptom severity weekly with the Structured Interview Guide for the Hamilton Depression Rating Scale--Seasonal Affective Disorder (SIGH-SAD) version. Evening saliva samples were obtained before and after treatment for ascertainment of circadian melatonin rhythm phase. SIGH-SAD score improvement was 53.7% for bright light and 51.1% for high-density ions v. 17.0% for low-density ions. Remission rates were 50%, 50% and 0% respectively. The presence or severity of atypical symptoms did not predict response to either treatment modality, nor were phase advances to light associated with positive response. Both bright light and negative air ions are effective for treatment of chronic depression. Remission rates are similar to those for SAD, but without a seasonal dependency or apparent mediation by circadian rhythm phase shifts. Combination treatment with antidepressant drugs may further enhance clinical response.

Therapeutic Mechanism in Seasonal Affective Disorder: Do Fluoxetine and Light Operate Through Advancing Circadian Phase?

Article

Full-text available

Feb 2005

In the context of Lewy's phase delay hypothesis, the present study tested whether effective treatment of winter Seasonal Affective Disorder (SAD) is mediated by advancing of circadian phase. Following a baseline week, 78 outpatients with SAD were randomized into 8 weeks of treatment with either fluoxetine and placebo light treatment or light treatment and placebo pill. Depression levels were measured on the Ham17+7 and the BDI-II, and circadian phase was estimated on the basis of daily sleep logs and self-reported morningness-eveningness. Among the 61 outpatients with complete data, both treatments were associated with significant antidepressant effect and phase advance. However, pre- and post-treatment comparisons found that the degree of symptom change did not correlate with the degree of phase change associated with treatment. The study therefore provides no evidence that circadian phase advance mediates the therapeutic mechanism in patients with SAD. Findings are discussed in terms of the limitations of the circadian measures employed.

Light therapy for non‐seasonal depression

Article

Nov 2002

Methods of systematic reviews and meta-analysis preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Article

Jan 2009
J CLIN EPIDEMIOL

Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration

Article

Jan 2011

J.P.T. Higgins

Bright white light therapy in depression: A Critical Review of the Evidence

Article

Apr 2015

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Light treatment for nonseasonal depression: speed, efficacy, and combined treatment 1 Presented at American Psychiatric Association Symposium 54, San Diego, California, May 20, 1997. Supported by AG12364, HL55983, ES08930, and the Sam and Rose Stein Institute for Research on Aging. 1

Article

May 1998

Daniel F. Kripke

Background: Using bright light for treating major depressive disorders which are not seasonal needs reassessment. Methods: Clinical trials of light treatment for nonseasonal major depressive disorders were compared with selected trials of light treatment of winter depression and with antidepressant clinical drug trials. Results: Light treatment of nonseasonal depression produces net benefits in the range of 12–35%, often within 1 week. Conclusions: Light's value for nonseasonal and seasonal depression are comparable. Light appears to produce faster antidepressant benefits than psychopharmacologic treatment. Limitations: Direct randomizing comparisons between light and medications for nonseasonal depression are not available. Clinical relevance: Bright light can be combined with standard therapies for treating nonseasonal depressions and appears synergistic.

Side effects of adjunct light therapy in patients with major depression

Article

Oct 1997

Adjunct bright-light therapy has been suggested to augment antidepressant drug treatment in patients with non-seasonal major depression. Side effects of the combined therapy have not been investigated thus far. Therefore, somatic complaints and side effects of combined therapy were evaluated in 28 patients with major depression (DSM-III-R) randomly assigned to either trimipramine or trimipramine and serially applied adjunct bright-light therapy. Response rates were comparable in both treatment groups and rates of newly emergent side effects during treatment were generally low. The most prominent unfavourable side effects of adjunct bright-light therapy as compared with trimipramine monotherapy were aggravated sedation, persisting restlessness, emerging sleep disturbance and decreased appetite as well as the worsening of vertigo. Discriminant analysis revealed that the combination of trimipramine with bright light results in a different side effect profile compared with drug monotherapy.

Bright-Light Therapy in the Treatment of Mood Disorders

Article

Jul 2011
NEUROPSYCHOBIOLOGY

Bright-light therapy (BLT) is established as the treatment of choice for seasonal affective disorder/winter type (SAD). In the last two decades, the use of BLT has expanded beyond SAD: there is evidence for efficacy in chronic depression, antepartum depression, premenstrual depression, bipolar depression and disturbances of the sleep-wake cycle. Data on the usefulness of BLT in non-seasonal depression are promising; however, further systematic studies are still warranted. In this review, the authors present a comprehensive overview of the literature on BLT in mood disorders. The first part elucidates the neurobiology of circadian and seasonal adaptive mechanisms focusing on the suprachiasmatic nucleus (SCN), the indolamines melatonin and serotonin, and the chronobiology of mood disorders. The SCN is the primary oscillator in humans. Indolamines are known to transduce light signals into cells and organisms since early in evolution, and their role in signalling change of season is still preserved in humans: melatonin is synthesized primarily in the pineal gland and is the central hormone for internal clock circuitries. The melatonin precursor serotonin is known to modulate many behaviours that vary with season. The second part discusses the pathophysiology and clinical specifiers of SAD, which can be seen as a model disorder for chronobiological disturbances and the mechanism of action of BLT. In the third part, the mode of action, application, efficacy, tolerability and safety of BLT in SAD and other mood disorders are explored.

A Randomized, Double-Blind, Placebo-Controlled Study of Light Therapy for Antepartum Depression

Article

Apr 2011
J CLIN PSYCHIAT

Affective disorder during pregnancy is a common condition requiring careful judgment to treat the depression while minimizing risk to the fetus. Following up on promising pilot trials, we studied the efficacy of light therapy. Twenty-seven pregnant women with nonseasonal major depressive disorder according to DSM-IV (outpatients, university polyclinic) were randomly assigned to 7,000 lux fluorescent bright white or 70 lux dim red (placebo) light administered at home in the morning upon awakening for 1 h/d in a 5-week double-blind trial carried out between October 2004 and October 2008. Clinical state was monitored weekly with the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale (HDRS) with Atypical Depression Supplement (SIGH-ADS). Changes of rating scale scores over time were analyzed with the general linear model. Differences from baseline of SIGH-ADS and 17-item HDRS scores at every time point were the dependent variables, time was the within-subjects factor, and treatment was the between-subjects factor. The model also included baseline score of depression and gestational age at intervention start. The superiority of bright light over dim light placebo was shown for both SIGH-ADS (R² = 0.251; F(3,23) = 3.91; P < .05) and HDRS (R² = 0.338; F(3,23) = 5.42; P < .01) when analyzing the week-by-week change from baseline, and HDRS scores showed a significant interaction of treatment with time (F(4,92) = 2.91; P < .05). Categorical analysis revealed that the response rate (HDRS ≥ 50% improvement) at week 5 was significantly greater for bright light (81.3%, n = 16) than for placebo light (45.5%, n = 11) (P < .05). Remission (final score ≤ 8) was attained by 68.6% versus 36.4%, respectively (P < .05). Expectation ratings did not differ significantly between groups. Bright white light treatment for 5 weeks improved depression during pregnancy significantly more than placebo dim red light. The study provides evidence that light therapy, a simple, cost-effective antidepressant modality with minimal side effects for the mother and no known risk for the unborn child, may be a useful nonpharmacologic approach in this difficult situation. clinicaltrials.gov Identifier: NCT01043289.

Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified

Article

Nov 2008
INT J EPIDEMIOL

Julian P T Higgins

Controlled trial of bright light for non-seasonal major depressive disorder

Article

Feb 1992
BIOL PSYCHIAT

Psychotropic drug-free hospitalized veterans with nonseasonal major depressive disorders or depressed forms of bipolar disorder were treated with light for 1 week. Twenty-five patients were randomly assigned to bright white light treatment (2000-3000 lux), and 26 patients were randomized to dim red light placebo control treatment. Unlike those treated with dim red light, those treated with bright white light showed declines in three measures of depression during treatment. Partial relapse appeared within 2 days. A global depression score showed a statistically significant (p = 0.02) difference favoring bright white light treatment. Two bright-light-treated patients became mildly hypomanic, but side effects were mild. Improvement was not correlated with patient expectations; indeed, patients expected somewhat greater benefit from the placebo. Patients treated in summer responded as well as those treated in winter. Baseline electroencephalogram (EEG) sleep stage data (e.g., rapid eye movement; REM latency) did not predict treatment responses. These 1-week treatment results suggest that bright light might produce benefits for patients with nonseasonal depression. Bright light should not be recommended for routine clinical application before additional assessments with longer treatment durations are done.

Effects of phototherapy on non-seasonal unipolar and bipolar depressive spectrum disorders

Article

Jan 1992
J AFFECT DISORDERS

In a group of 17 patients with non-SAD depressive disorders we compared the response of bipolar spectrum versus unipolar patients to treatment with light therapy. The main hypothesis was that bipolar spectrum depressed patients would preferentially respond to bright light therapy as compared to unipolar depressed patients. All patients were treated with either 400 or 2500 lux phototherapy for 2 h on seven consecutive days. All outcome measures, which included the SIGH-SAD, CGI, and the Anxiety and Depressive Factors of the SCL-90, showed significant improvement in the bipolar vs. the unipolar spectrum patients. Unexpected this occurred regardless of the intensity of the light. These changes were judged to be quite clinically significant. All patients showing response were noted to have maintained their response at a 3-month follow-up.

Phototherapy in nonseasonal depression

Article

Sep 1991
BIOL PSYCHIAT

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 nonseasonal 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 Analogue 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, phototherapy administered over one week for two hr daily is not effective in nonseasonal major depressive disorder.

The phase shift hypothesis for bright light's therapeutic mechanism of action: Theoretical considerations and experimental evidence

Article

Feb 1987
Psychopharmacol Bull

Meta-Analysis in Clinical Trials

Article

Oct 1986
Contr Clin Trials

This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.

Sleep deprivation and bright light as potential augmenters of antidepressant drug treatment—Neurobiological and psychometric assessment of course

Article

Jul 1994
J PSYCHIATR RES

The present study was designed to investigate the clinical efficacy of trimipramine with adjunct sleep deprivation (SD) or bright light (BL) and to evaluate psychometric and neurobiological variables that might be of predictive value for treatment response. We used (1) the combined dexamethasone-corticotropin releasing hormone test (DEX-CRH test) to characterize alterations of the hypothalamic-pituitary-adrenal (HPA) system; (2) polysomnography to evaluate sleep disturbances; and (3) a standardized test battery to assess cognitive psychomotor functions after study initiation and after 5 weeks of treatment. The overall response rate (> or = 50% decrease in score on Hamilton Rating Scale for Depression [HRS]) was 55% (N = 42). The response rate in the group with trimipramine monotherapy (N = 14) was 79%, whereas in the groups with adjunct SD (N = 14) and BL (N = 14), respectively, it was only 43%. All three groups showed significant improvement at the end of the third week of treatment. Neither of the adjunct treatments hastened the onset of antidepressant action as measured by HRS. A significantly higher proportion of nonresponders than responders (p < .05) had HPA dysregulation, disturbed rapid eye movement (REM) sleep (REM latency, REM% first third of night) and decreased non-REM sleep (% stage 2). The non-responders showed significantly more corticotropin (ACTH) secretion after CRH stimulation in the DEX-CRH test than the responders and a less rapid normalization of the neuroendocrine dysregulation (cortisol secretion) (p < .01). In addition, REM latency was significantly shorter in the BL group than in the monotherapy group and estimated duration of illness significantly longer in the SD group than in the monotherapy group. REM latency, percentage of REM sleep during the first third of the total sleep period, percentage of non-REM sleep stage 2 and ACTH release after a DEX-CRH challenge predicted response across all three treatment groups. The neurobiological symptoms were unevenly distributed, among the three groups, thus creating heterogeneity in these measures. This heterogeneity may have contributed to the different treatment response rates as defined by psychopathology (HRS). In contrast, the neuropsychological tests and some of the sleep-EEG investigations revealed different response patterns for different groups: The onset of improvement in simple cognitive functions and in sleep continuity was earlier in the adjunct treatment groups. This study underlines the need for a multidimensional approach including use of neurobiological and neuropsychological measures to identify the therapeutic profiles of different treatment strategies and predictors of outcome.

Bright light therapy stabilizes the antidepressant effect of partial sleep deprivation

Article

Feb 1996
BIOL PSYCHIAT

Partial sleep deprivation (PSD) results in a pronounced decrease of depressive symptoms in the majority of patients with major depressive disorder. Generally this acute antidepressant effect is not stable, relapse usually occurs after one night of recovery sleep. We therefore studied whether light therapy, beginning in the morning after PSD, is able to prevent the relapse after sleep deprivation, using a controlled, balanced, parallel design. All patients received an antidepressant medication, which was kept constant before and during the study period. Fourteen of 20 patients (70%) showed a reduction of at least 40% in the Hamilton Depression Rating Scale (HDRS) in the morning after PSD and were classified as PSD responders. Responders as well as nonresponders were randomly assigned to receive either bright light (BL/3000 lux) or dim light (DL/100 lux) therapy during the following 6 days after PSD. In the responder group BL therapy prevented significantly (p = 0.005) the relapse after the next night of sleep and prolonged significantly (p = 0.011) the antidepressant effects of PSD up to 7 days. In contrast, patients in the DL condition relapsed after the recovery night and showed no further improvement of the depressive syndrome after 1 week of DL therapy. PSD nonresponders did not benefit from light treatment. These findings indicate that BL therapy might be efficacious to prevent relapse after PSD.

Serum concentrations of thyroid hormones in patients with nonseasonal affective disorders during treatment with bright and dim light

Article

Dec 1996
BIOL PSYCHIAT

Serum concentrations of thyroxine (T4), triiodothyronine (T3), and thyrotropine were measured in 34 patients with nonseasonal affective disorders before and after 1 week of light treatment. Nineteen of these patients received bright white light (2500 lx) and 15 dim red light (50 lx) for 2 hours daily in the mornings over a 1-week period. Slight but significant reductions in the rating scores for the depressive symptomatology were found for both the bright-and dim-light groups, but there were no significant differences between the two groups. The improvement is thus most likely a placebo effect. Surprisingly, the small changes in the severity of the depressive symptoms in the group as a whole were significantly correlated to the changes in the serum levels of T4 during the weeks of bright- and dim-light treatment, respectively. The more a patient improved, the further his or her T4 level fell and vice versa. The fluctuations in the concentrations of T4 during light treatment were significantly greater in the depressed patients than in a group of 12 healthy controls who also received bright or dim light, whereas the changes in T3 were significantly smaller than those of the healthy controls. The pronounced fluctuations in T4 levels were probably not secondary to changes in mood. Rather, they are likely to reflect changes in tissue (intracellular) metabolism of T4, which may be involved in the mechanisms underlying the fluctuations in mood in these patients.

Phototherapy is a useful adjunct in the treatment of depressed in-patients

Article

May 1997

Phototherapy is regularly used in the treatment of seasonal affective disorder. There is evidence that it is also useful in the treatment of non-seasonal depression, but relevant controlled experiments are difficult to design. In this study we randomly assigned depressed in-patients to high and low levels of artificial light, the high levels exceeding those most commonly used in earlier reported trials. Both unipolar and bipolar depressions responded when phototherapy was used as an adjunct to pharmacotherapy, and mood improvement was related to the intensity of illumination, that is, patients treated with high levels of illumination improved significantly more than those who received low levels (P < 0.02). Our findings suggest that light therapy is generally applicable to depressive illnesses, and that the light intensities commonly used are suboptimal.

Light treatment for nonseasonal depression: speed, efficacy, and combined treatment

Article

Jun 1998
J AFFECT DISORDERS

Daniel F. Kripke

Using bright light for treating major depressive disorders which are not seasonal needs reassessment. Clinical trials of light treatment for nonseasonal major depressive disorders were compared with selected trials of light treatment of winter depression and with antidepressant clinical drug trials. Light treatment of nonseasonal depression produces net benefits in the range of 12-35%, often within 1 week. Light's value for nonseasonal and seasonal depression are comparable. Light appears to produce faster antidepressant benefits than psychopharmacologic treatment. Direct randomizing comparisons between light and medications for nonseasonal depression are not available. Bright light can be combined with standard therapies for treating nonseasonal depressions and appears synergistic.

Sleep deprivation as a predictor of response to light therapy in major depression

Article

Mar 2001
J AFFECT DISORDERS

While the majority of depressed patients benefit from total sleep deprivation (TSD), light therapy is regarded as a first-line treatment only for seasonal affective disorder (SAD). The results of light therapy in nonseasonal major depressive disorder have been non-conclusive. We examined the correlation of TSD response and light therapy response in major depressed patients. 40 inpatients with major depressive disorder (seven with seasonal pattern, 33 without seasonal pattern) were deprived of a night's sleep. The TSD responders, as well as the TSD nonresponders, were randomly assigned to receive adjunct light therapy either with bright white light (2500 lux) or dim red light (50 lux) during 2 weeks beginning on the third day after TSD. The 20 TSD responders improved significantly better under the light therapy than the 20 TSD nonresponders (according to the Hamilton Depression Rating Scale and the self-rating depression scale Bf-S; v. Zerssen). No significant difference could be found between the two light intensities. Since the patients were additionally treated with medication an interaction with the two adjunctive therapies cannot be excluded. Our results indicate that a positive TSD response in major depressed patients can be predicative of beneficial outcome of subsequent light therapy.

[Sleep deprivation as a predictor of response to light therapy in major depression].

Article

May 2001

Light therapy (LT) is regarded as the treatment of choice for seasonal affective disorder (SAD). In nonseasonal depression the results of light therapy are nonconclusive. Sleep deprivation (SD), however, is effective in 50-60% of the patients with major depression. The predictive value of Total Sleep Deprivation (TSD) for the treatment outcome of antidepressiva has been already examined. Purpose of the present study was to test whether light therapy is more beneficial in TSD responders than in TSD nonresponders. 40 inpatients with major depressive disorder completed one night of TSD. Twenty TSD responders and 20 TSD nonresponders were randomly assigned to 14 days of bright light therapy (2500 lux, 7-9 a.m.) or 14 days of dim light therapy (red light 50 lux, 7-9 a.m.). Manova with repeated measurements revealed a significant difference in the course of depression over the time between TSD responders and nonresponders, but no significant difference between bright and dim light. Questions of placebo effect, of SAD and of personality variables as predictors of response to SD and LT are being discussed.

Circadian Rhythms and the Circadian Organization of Living Systems

Article

Feb 1960

Colin S. Pittendrigh

Excerpt The writing of this paper has been influenced by strongly held convictions. This does not concern the validity of the theoretical scheme it offers; it concerns the need at this juncture in the study of “daily” rhythms for bold and explicit theory formation. We are beset rather than blessed with an enormous number of observations about a great diversity of organisms that range from unicellulars through African violets to man. Moreover, the fact that a majority of these observations is highly fascinating is itself a danger—the common danger threatening the biologist of mistaking acquisition of more fascinating facts, and more concrete detail, for analytic progress. To make progress analyzing circadian rhythms we must perceive what the problems are—or rather state what we take them to be—and proceed with accumulation of new information only as it tests, and alas probably eliminates, theory. The low life-expectancy of any detailed explanatory scheme in...

Daily Light Sensitivity Rhythm in a Rodent

Article

Feb 1960

Patricia J. De Coursey

Single 10-minute light periods can cause a phase shift in the rhythm of the daily locomotor activity of flying squirrels otherwise maintained in constant darkness. A daily rhythm of sensitivity to these standard light periods was found.

Light Therapy for Non-Seasonal Depression (Cochrane Review)

Article

Apr 2004

Efficacy of light therapy for non-seasonal depression has been studied without any consensus on its efficacy. To evaluate clinical effects of bright light therapy in comparison to the inactive placebo treatment for non-seasonal depression. We searched the Depression Anxiety & Neurosis Controlled Trials register (CCDANCTR January 2003), comprising the results of searches of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 -), EMBASE (1980 -), CINAHL (1982 -), LILACS (1982 -), National Research Register, PsycINFO/PsycLIT (1974 -), PSYNDEX (1977 -), and SIGLE (1982 - ) using the group search strategy and the following terms: #30 = phototherapy or ("light therapy" or light-therapy). We also sought trials from conference proceedings and references of included papers, and contacted the first author of each study as well as leading researchers in the field. Randomized controlled trials comparing bright light with inactive placebo treatments for non-seasonal depression. Data were extracted and quality assessment was made independently by two reviewers. The authors were contacted to obtain additional information. Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. In general, the quality of reporting was poor, and many reviews did not report adverse effects systematically. The treatment response in the bright light group was better than in the control treatment group, but did not reach statistical significance. The result was mainly based on studies of less than 8 days of treatment. The response to bright light was significantly better than to control treatment in high-quality studies (standardized mean difference (SMD) -0.90, 95% confidence interval (CI) -1.50 to -0.31), in studies applying morning light treatment (SMD -0.38, CI -0.62 to -0.14), and in sleep deprivation responders (SMD -1.02, CI -1.60 to -0.45). Hypomania was more common in the bright light group compared to the control treatment group (risk ratio 4.91, CI 1.66 to 14.46, number needed to harm 8, CI 5 to 20). Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. Treatment For patients suffering from non-seasonal depression, bright light therapy offers modest though promising antidepressive efficacy, especially when administered during the first week of treatment, in the morning, and as an adjunctive treatment to sleep deprivation responders. Hypomania as a potential adverse effect needs to be considered. Due to limited data and heterogeneity of studies these results need to be interpreted with caution.

The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence

Article

May 2005

The purpose of this study was to assess the evidence base for the efficacy of light therapy in treating mood disorders. The authors systematically searched PubMed (January 1975 to July 2003) to identify randomized, controlled trials of light therapy for mood disorders that fulfilled predefined criteria. These articles were abstracted, and data were synthesized by disease and intervention category. Only 13% of the studies met the inclusion criteria. Meta-analyses revealed that a significant reduction in depression symptom severity was associated with bright light treatment (eight studies, having an effect size of 0.84 and 95% confidence interval [CI] of 0.60 to 1.08) and dawn simulation in seasonal affective disorder (five studies; effect size=0.73, 95% CI=0.37 to 1.08) and with bright light treatment in nonseasonal depression (three studies; effect size=0.53, 95% CI=0.18 to 0.89). Bright light as an adjunct to antidepressant pharmacotherapy for nonseasonal depression was not effective (five studies; effect size=-0.01, 95% CI=-0.36 to 0.34). Many reports of the efficacy of light therapy are not based on rigorous study designs. This analysis of randomized, controlled trials suggests that bright light treatment and dawn simulation for seasonal affective disorder and bright light for nonseasonal depression are efficacious, with effect sizes equivalent to those in most antidepressant pharmacotherapy trials. Adopting standard approaches to light therapy's specific issues (e.g., defining parameters of active versus placebo conditions) and incorporating rigorous designs (e.g., adequate group sizes, randomized assignment) are necessary to evaluate light therapy for mood disorders.

Adjunctive bright light in non-seasonal major depression: Results from clinician-rated depression scales

Article

Sep 2005

To investigate the use of bright light therapy as an adjunct treatment to sertraline in non-seasonal major depression. In a randomised double-blind trial, 102 patients were treated for 5 weeks with either white bright light (10 000 lux, 1 h daily) or red dim light (50 lux, 30 min daily). All patients were treated with sertraline in a fixed dose of 50 mg daily. The clinician-rated depression scales used were the Hamilton Depression Rating Scale (HAM-D17), Hamilton six-item subscale (HAM-D6), Melancholia Scale (MES) and the seven 'atypical' items from the SIGH-SAD. One-hundred and two patients were included in the study. Analyses showed that the reduction in depression scores in the bright light group was statistically significantly larger than in the dim light group on all scales. The scale most sensitive at endpoint was the HAM-D(6), which includes the core symptoms of depression. The study results support the use of bright light as an adjunct treatment to antidepressants in non-seasonal depression.

Bright light exposure during acute tryptophan depletion prevents a lowering of mood in mildly seasonal women

Article

Feb 2008
EUR NEUROPSYCHOPHARM

We investigated the influence of bright light exposure on the mood-lowering effect of acute tryptophan depletion (ATD). Mildly seasonal healthy young women without a personal or family history of psychiatric disorders remained in either dim or bright light during two test days. Tryptophan-deficient and nutritionally balanced amino acid mixtures were administered in counterbalanced order. Mood state was assessed using the Profile of Mood States (POMS) and Visual Analogue Scales (VAS). In dim light, ATD decreased POMS scores across most subscales, indicating a worsening of mood. In bright light, mood was unaffected by ATD. Thus, bright light blocked the worsening of mood caused by ATD. This was also observed on the positive mood VAS. These results indicate a direct, immediate interaction between bright light and serotonin function. Bright light might help protect against ATD-induced mood change by increasing serotonin above the threshold level below which there is a lowering of mood.

Morning light therapy for postpartum depression

Article

Feb 2007

Postpartum depression (PPD) is a frequent complication of childbirth, but many women refuse pharmacological treatment. Little data exists on bright light therapy for PPD. Fifteen outpatient women with PPD were randomly assigned to bright light (10,000 lux, n = 10) or dim red light (600 lux, n = 5) and completed a 6-week trial and weekly assessments using self-report depression scales and clinician ratings of symptom course. Both groups showed significant improvement over time on all measures, with no significant difference between conditions.

Efficacy of light therapy in nonseasonal depression: A systematic review

Article

Jun 2008
J AFFECT DISORDERS

The efficacy of bright light therapy is well established for winter depression but its status in depression without seasonal pattern is unclear. We systematically evaluated available data on the efficacy of light therapy in nonseasonal depression. We identified 62 reports among which 15 met our predefined selection criteria. The available data show evidence for the efficacy of light therapy as an adjuvant treatment to antidepressants. Trials that evaluated light therapy alone (without antidepressants) in nonseasonal depression yielded inconsistent results. Most of the studies extracted poorly controlled the issue of blindness and were limited by small sample sizes. Publication bias may have distorted our estimation of the effect of light therapy. Overall, bright light therapy is an excellent candidate for inclusion into the therapeutic inventory available for the treatment of nonseasonal depression today, as adjuvant therapy to antidepressant medication. Future clinical trials of light therapy should distinguish homogenous subgroups of depressed patients in order to evaluate whether light therapy may eventually be considered as stand-alone treatment for specific subgroups of patients with nonseasonal depression.

Bright Light Therapy for Nonseasonal Depression: Meta-analysis of Clinical Trials

Abstract

No full-text available

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