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Dr. Bob is Robert Hsiung, MD,
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Posted by jrbecker on September 2, 2005, at 10:28:14
Psychiatric News September 2, 2005
Volume 40, Number 17, page 14
© 2005 American Psychiatric Association
Clinical & Research News
In Treating Nonseasonal Depression, Let the Light Shine In
Joan Arehart-TreichelLight can speed up the ability of SSRI antidepressants to counter nonseasonal major depression. Whether sunlight might be just as effective as a light box in achieving this result, however, remains to be determined.
The ability of light to heal the psyche is receiving increasing recognition. The latest finding is that light combined with an SSRI antidepressant is more efficacious than an SSRI antidepressant alone in treating nonseasonal major depression.
This finding was reported in a study led by Klaus Martiny, M.D., Ph.D., a psychiatrist affiliated with the Frederiksborg General Hospital in Hilleroed, Denmark. Results appeared in the August Acta Psychiatrica Scandinavica.
The objective of the study, Martiny and his coworkers explained, was to determine whether light is an effective adjunct in the treatment of nonseasonal major depression, "using the greatest possible difference in light dosage between active and placebo light and using the most sensitive clinicianrated depression scales as outcome measures of treatment."
Specifically, over a five-week period, 102 patients diagnosed with nonseasonal major depression according to DSM-IV criteria received the SSRI antidepressant sertraline (50 mg daily). In addition, half of the subjects were exposed to active light—10,000 lux of bright white light one hour daily—and the other half were exposed to placebo light—50 lux of red dim light 30 minutes daily. Subjects' responses to treatment were then tracked on a weekly basis using the Hamilton Rating Scale for Depression, the Hamilton six-item subscale, and two other depression rating scales. At the end of the five-week period, depression scores for the two light groups were compared.
The active light group showed significantly less depression than the placebo light group on all four scales. For example, on the Hamilton six-item subscale, 71 percent of the active light group, but only 39 percent of the placebo light group, were found to have responded to treatment—a highly significant difference. Response was defined as a 50 percent or greater reduction of baseline scores on the scale.
Forty-two percent of the active light group, but only 19 percent of the placebo light group, were found to have achieved remission from depression—a significant difference. Remission was defined as a Hamilton six-item subscale score of 4 or less.
Furthermore, the investigators examined their results to see whether they might have been confounded by the season of year in which subjects were treated. They found that light was somewhat more efficacious in subjects who had been exposed to light during the winter than in subjects who had been exposed to light in months outside of winter, but the difference was not significant.
Moreover, the group treated with active light did not seem to have experienced an earlier awakening because of it. "As sleep deprivation is a powerful antidepressant," the scientists pointed out in their study report, "even small sleep deprivations induced by treatment design could have obscured the effect of the light therapy."
"The study results support the use of bright light as an adjunct treatment to antidepressants in nonseasonal depression," Martiny and his group concluded, especially as depressed patients often have to take an SSRI four to six weeks before receiving any relief.
In fact, the scientists found that after only one week of active light exposure, subjects had significantly less depression than the subjects who did not receive it. (When light is used to treat seasonal affective disorder, it also has an onset of action after only a few days of treatment.)
Some questions about using light as an adjunct to antidepressant therapy, however, need to be answered, Martiny and his colleagues noted in their report. For example, Martiny told Psychiatric News, they would like to investigate whether exposure to natural sunlight instead of to a light box in one's home works just as well in enhancing antidepressant effectiveness. They also would like to investigate whether light therapy combined with sleep deprivation brings about an even more rapid remission from depression than light alone can achieve. He and his group are launching a project to get the answer, Martiny said.
The study was financed by the Danish Medical Research Council, the Danish Psychiatric Association, the Frederiksborg General Hospital, and seven other foundations.
Posted by gardenergirl on September 2, 2005, at 22:20:12
In reply to Evenfor Nonseasonal Depression, Let the LightShine, posted by jrbecker on September 2, 2005, at 10:28:14
I do not have seasonal depression, but using light therapy helped me tremendously with regulating my sleep patterns. Excessive sleep is one of the signs of depression for me.
gg
Posted by KaraS on September 3, 2005, at 18:53:56
In reply to You betcha! » jrbecker, posted by gardenergirl on September 2, 2005, at 22:20:12
> I do not have seasonal depression, but using light therapy helped me tremendously with regulating my sleep patterns. Excessive sleep is one of the signs of depression for me.
>
> ggHi gg,
How are you using your lightbox to help with your sleep? How long do you use it each day and do you always use it at the same time of day? I keep meaning to use it every morning around the same time for about 30 minutes but I can't seem to get up early enough to start using it to begin with.
K
Posted by gardenergirl on September 4, 2005, at 18:15:49
In reply to Re: You betcha! » gardenergirl, posted by KaraS on September 3, 2005, at 18:53:56
When I was using it over the winter and spring, I did use it for about 30 minutes a day, roughly at the same time (give or take an hour). This worked well. I stopped using it when summer rolled around, although I think I would benefit from using it year round, maybe at less intensity or shorter duration.
I think it's about time I got back to it, though. The days are getting shorter.
It IS hard to get up at the same time everyday if you don't need to be anywhere. Weekends, too. But I used to go back to sleep after that, and that didn't usually hurt anything.
gg
Posted by KaraS on September 4, 2005, at 18:47:31
In reply to Re: You betcha! » KaraS, posted by gardenergirl on September 4, 2005, at 18:15:49
> When I was using it over the winter and spring, I did use it for about 30 minutes a day, roughly at the same time (give or take an hour). This worked well. I stopped using it when summer rolled around, although I think I would benefit from using it year round, maybe at less intensity or shorter duration.
>
> I think it's about time I got back to it, though. The days are getting shorter.
>
> It IS hard to get up at the same time everyday if you don't need to be anywhere. Weekends, too. But I used to go back to sleep after that, and that didn't usually hurt anything.
>
> gg
Thanks. Now if I could just get up early in order to use the darn light box...btw, how are you doing in trying to find the right balance of Nardil and Lamictal?
k
Posted by gardenergirl on September 4, 2005, at 20:47:39
In reply to Re: You betcha! » gardenergirl, posted by KaraS on September 4, 2005, at 18:47:31
Hi,
I'm currently at 45 mg Nardil and 50 mg Lamictal. What's interesting is that since I've been going to therapy twice a week, I've really been knocking holes in my defenses, so I'm finding I have a great deal of anxiety. For some reason, I feel better able to cope with anxiety than with depression, so I have hope that I will not always be on Nardil. :)Of course I don't want to make any major changes until I finish my education, and I'm in a critical period right now.
Thanks for asking.
gg
Posted by KaraS on September 4, 2005, at 23:03:44
In reply to Re: You betcha! » KaraS, posted by gardenergirl on September 4, 2005, at 20:47:39
> Hi,
> I'm currently at 45 mg Nardil and 50 mg Lamictal. What's interesting is that since I've been going to therapy twice a week, I've really been knocking holes in my defenses, so I'm finding I have a great deal of anxiety. For some reason, I feel better able to cope with anxiety than with depression, so I have hope that I will not always be on Nardil. :)
>
> Of course I don't want to make any major changes until I finish my education, and I'm in a critical period right now.
>
> Thanks for asking.
>
> gg
I think I prefer depression - if I had to choose. I'm glad that your therapy is helping.k
Posted by gardenergirl on September 5, 2005, at 20:01:30
In reply to Re: You betcha! » gardenergirl, posted by KaraS on September 4, 2005, at 23:03:44
Thanks.
I wonder if light therapy would help at later times in the morning, as long as you did it at the same time every day?
gg
Posted by KaraS on September 5, 2005, at 23:53:53
In reply to Re: You betcha! » KaraS, posted by gardenergirl on September 5, 2005, at 20:01:30
I've wondered that too. If I could get up even late morning I'd be willing to try it but I've been getting up in the afternoon lately. I am afraid to use it then as it might make it even harder for me to get back on an earlier schedule.
What I really need is for someone to come to my apartment and drag me out of bed in the morning.
k
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