Light therapy for seasonal affective disorder in primary care

BackgroundStudies of light therapy have not been conducted previously in primary care.AimsTo evaluate light therapy in primary care.MethodFifty-seven participants with seasonal affective disorder were randomly allocated to 4 weeks of bright white or dim red light. Baseline expectations for treatment were assessed. Outcome was assessed with the Structured Interview Guide for the Hamilton Depression Scale, Seasonal Affective Disorder Version.ResultsBoth groups showed decreases in symptom scores of more than 40%. There were no differences in proportions of responders in either group, regardless of the remission criteria applied, with around 60% (74% white light, 57% red light) meeting broad criteria for response and 31% (30% white light, 33% red light) meeting strict criteria. There were no differences in treatment expectations.ConclusionsPrimary care patients with seasonal affective disorder improve after light therapy, but bright white light is not associated with greater improvements.

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Hypericum in the Treatment of Seasonal Affective Disorders

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/089198879400701s09 ◽

1994 ◽

Vol 7 (1_suppl) ◽

pp. 29-33 ◽

Cited By ~ 21

Author(s):

B. Martinez ◽

S. Kasper ◽

S. Ruhrmann ◽

H.-J. Möller

Keyword(s):

Major Depression ◽

Affective Disorder ◽

Seasonal Affective Disorder ◽

Seasonal Pattern ◽

Depression Scale ◽

Light Condition ◽

Light Therapy ◽

Hamilton Depression Scale ◽

Full Remission ◽

Significant Difference

Seasonal affective disorder (SAD) represents a subgroup of major depression with a regular occurrence of symptoms in autumn/winter and full remission in spring/summer. Light therapy (LT) has become the standard treatment of this type of depression. Apart from this, pharmacotherapy with antidepressants also seems to provide an improvement of SAD symptoms. The aim of this controlled, single-blind study was to evaluate if hypericum, a plant extract, could be beneficial in treating SAD patients and whether the combination with LT would be additionally advantageous. Patients who fulfilled DSM-III-R criteria for major depression with seasonal pattern were randomized in a 4-week treatment study with 900 mg of hypericum per day combined with either bright (3000 lux, n = 10) or dim (< 300 lux, n = 10) light condition. Light therapy was applied for 2 hours daily. We found a significant (MANOVA, P < .001) reduction of the Hamilton Depression Scale score in both groups but no significant difference between the two groups. Our data suggest that pharmacologic treatment with hypericum may be an efficient therapy in patients with seasonal affective disorder.

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Treatment expectations for cognitive-behavioral therapy and light therapy for seasonal affective disorder: Change across treatment and relation to outcome.

Journal of Consulting and Clinical Psychology ◽

10.1037/ccp0000121 ◽

2016 ◽

Vol 84 (10) ◽

pp. 898-906 ◽

Cited By ~ 5

Author(s):

Jonah Meyerhoff ◽

Kelly J. Rohan

Keyword(s):

Cognitive Behavioral Therapy ◽

Affective Disorder ◽

Seasonal Affective Disorder ◽

Behavioral Therapy ◽

Light Therapy ◽

Cognitive Behavioral ◽

Treatment Expectations

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Bright light therapy for symptoms of anxiety and depression in focal epilepsy: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.122119 ◽

2013 ◽

Vol 202 (5) ◽

pp. 352-356 ◽

Cited By ~ 14

Author(s):

Sallie Baxendale ◽

John O'Sullivan ◽

Dominic Heaney

Keyword(s):

Effective Treatment ◽

Affective Disorder ◽

Seasonal Affective Disorder ◽

Focal Epilepsy ◽

Depression Scale ◽

Bright Light ◽

Light Therapy ◽

Anxiety And Depression ◽

Bright Light Therapy ◽

Low Intensity

BackgroundBright light therapy is an effective treatment for seasonal affective disorder and non-seasonal depression. Depression and anxiety are common psychiatric comorbidities in epilepsy.AimsTo examine the efficacy of bright light therapy for symptoms of anxiety and depression in adults with focal epilepsy (trial registration at ClinicalTrials.gov: NCT01028456).MethodWe recruited 101 adults with medically intractable focal epilepsy. Participants completed the Hospital Anxiety and Depression Scale (HADS) at the beginning (T1) and end of a 12-week baseline period (T2) and again after 12 weeks of daily light therapy (T3), with 51 participants using a high-intensity light box and 50 using a low-intensity one. Seizure diaries were kept throughout the baseline and trial period.ResultsA total of 58 patients completed the trial. Anxiety and depression scores were significantly reduced following the light therapy at T3in both the high- and low-intensity groups.ConclusionsLight therapy resulted in a significant reduction in symptoms of anxiety and depression but we did not find any differences between high- v. low-intensity treatment This may, therefore, be an effective treatment for symptoms of low mood in epilepsy at lower intensities than those typically used to treat seasonal affective disorder. Further work is needed to investigate this possibility with an adequate placebo condition.

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Seasonal affective disorder (SAD) and light therapy: State of the science

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.713 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S528-S528

Author(s):

C. Glod

Keyword(s):

Affective Disorder ◽

White Light ◽

Seasonal Affective Disorder ◽

Ganglion Cells ◽

Light Emitting Diode ◽

Seasonal Pattern ◽

Clinical Effectiveness ◽

Light Therapy ◽

Light Sources ◽

State Of The Science

Major depression with a fall/winter seasonal pattern, also known as seasonal affective disorder (SAD), is a recurrent and prevalent disorder. Treatment may include either pharmacological (antidepressant) or non-pharmacological options, most commonly light therapy. Over the years, light therapy has been explored using various delivery methods including light-emitting diode (LED) devices. For over 20 years, cool-white fluorescent sources that yield 10,000 lux of polychromatic white light have been the standard treatment for SAD. Many investigations have confirmed the clinical effectiveness of white light, its overall tolerability, and adverse reactions, such as agitation, insomnia, and headache. Building upon this, more recent studies have compared alternative light sources and different wavelengths of light, such as white, red, green, and blue. If certain wavelengths are more potent and effective, lower intensities of light could reduce side effects and increase tolerability and adherence. Furthermore, studies of the ocular system particularly, intrinsically photosensitive retinal ganglion cells, discovered differences among specific wavelengths of light. While some reports have suggested that 446–477 nm wavelengths of blue light may be the most potent, published clinical trials have revealed mixed results. The purpose of this session is to review the state of the science on light therapy in the treatment of SAD, and suggest recommendations for clinical practice and implications for patients.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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L-Tryptophan Augmentation of Light Therapy in Patients with Seasonal Affective Disorder

The Canadian Journal of Psychiatry ◽

10.1177/070674379704200309 ◽

1997 ◽

Vol 42 (3) ◽

pp. 303-306 ◽

Cited By ~ 19

Author(s):

Raymond W Lam ◽

Robert D Levitan ◽

Edwin M Tam ◽

Lakshmi N Yatham ◽

Sophie Lamoureux ◽

...

Keyword(s):

Side Effects ◽

Affective Disorder ◽

Rating Scale ◽

Seasonal Affective Disorder ◽

Combined Treatment ◽

Light Therapy ◽

Structured Interview ◽

Fluorescent Light ◽

Open Label ◽

Augmentation Strategy

Objective Up to one-third of patients with seasonal affective disorder (SAD) do not have a full response to light therapy. Given the evidence for serotonergic dysregulation in SAD, we examined the possible role of l-tryptophan as an augmentation strategy for nonresponders and partial responders to light therapy. Method Eligible drug-free patients meeting DSM-IV criteria for SAD were treated for 2 weeks using a standard morning light therapy regimen (10 000 lux cool-white fluorescent light for 30 minutes). Partial and nonresponders were treated for 2 weeks with open-label l-tryptophan (1 g 3 times daily) while light therapy was continued. Ratings at baseline and follow-up included the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) and the Clinical Global Impression (CGI) scale. Results Sixteen patients began the l-tryptophan augmentation phase. Two patients discontinued medications within 3 days because of side effects. In the 14 patients completing treatment, the addition of l-tryptophan resulted in significant reduction of mean depression scores. Nine of 14 patients (64%) showed very good clinical responses to combined treatment and minimal side effects. Conclusion This open-label study suggests that l-tryptophan may be an effective augmentation strategy for those patients with SAD who show limited or poor response to bright light therapy. Further placebo-controlled studies are warranted to demonstrate efficacy.

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Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder

Psychological Medicine ◽

10.1017/s0033291798006813 ◽

1998 ◽

Vol 28 (4) ◽

pp. 923-933 ◽

Cited By ~ 45

Author(s):

S. RUHRMANN ◽

S. KASPER ◽

B. HAWELLEK ◽

B. MARTINEZ ◽

G. HÖFLICH ◽

...

Keyword(s):

Affective Disorder ◽

Phase Ii ◽

Seasonal Affective Disorder ◽

Remission Rate ◽

Depression Scale ◽

Light Condition ◽

Bright Light ◽

Antidepressant Effect ◽

Hamilton Depression Scale ◽

Light Group

Background. Disturbances of serotonergic neurotransmission appear to be particularly important for the pathophysiology of winter depression. This study investigated whether fluoxetine has antidepressant effects comparable to bright light in the treatment of seasonal affective disorder (winter type).Method. A randomized, parallel design was used with rater and patients blind to treatment conditions. One week of placebo (phase I) was followed by 5 weeks of treatment (phase II) with fluoxetine (20 mg per day) and a placebo light condition versus bright light (3000 lux, 2 h per day) and a placebo drug. There were 40 patients (20 in each treatment condition) suffering from seasonal affective disorder (SAD) according to DSM-III-R who had a total score on the Hamilton Depression Scale of at least 16.Results. Forty patients entered phase II and 35 completed it (one drop-out in the fluoxetine group and four in the bright light group). Fourteen (70%) of the patients treated with bright light and 13 (65%) of those treated with fluoxetine were responders (NS). The remission rate in the bright light group tended to be superior (bright light 50%, fluoxetine 25%; P=0·10). Light therapy improved HDRS scores significantly faster, while fluoxetine had a faster effect on atypical symptoms. Light treatment in the morning produced a significantly faster onset of improvement, but at the end of treatment the time of light application seemed not to be crucial.Conclusion. Both treatments produced a good antidepressant effect and were well tolerated. An apparently better response to bright light requires confirmation in a larger sample.

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