Comparison of Venlafaxine Alone Versus Venlafaxine Plus Bright Light Therapy Combination for Severe Major Depressive Disorder

Abstract

ANZCTR.org.au registration number: ACTRN12614001061628.

Circadian Rhythms and Mood Disorders: A Guide for the Perplexed

“…Bright light (as in the present study 1 ) and low-dose melatonin can be given as adjunctive therapy, because they have few contraindications. However, a phase shift in the wrong direction may result if they are not scheduled at the correct time.…”

“…This recommendation is problematic because it usually curtails sleep. 20 Accordingly, if patients in the present study 1 slept completely within the approximately 10:00 pm-6:30 am window of opportunity, they would have had to have been awakened at 4:45 am, 2.5 hours after their 2:15 am midsleep time. This recommendation 20 also goes against a key requirement of the PSH, in that the requisite phase advance in the DLMO needs to be greater if wake time is concomitantly advanced, in order to correct phase-delayed circadian misalignment (a DLMO that is delayed with respect to the sleep/wake cycle).…”

“…Low-dose melatonin has also provided for concurrent testing of the photoperiod hypothesis, which failed another (serendipitous) test when patients did not do relatively worse after extending melatonin duration. 15 The authors of the present study 1 correctly assumed that the circadian misalignment component of MDD is likely to be the phase-delayed type and thus appropriately chose to schedule bright light in the morning. As mentioned above, most patients with SAD 13,15 and perhaps even a greater proportion of MDD patients [16][17][18][19] have phasedelayed circadian misalignment.…”

“…zdemir and coworkers' present contribution 1 to this journal invites the opportunity to outline some of the fundamentals concerning circadian rhythms and affective illness. Consensus or near-consensus has been reached on the tools for assessing and adjusting circadian rhythms, if not on the hypotheses for their role in seasonal affective disorder (SAD, typically winter depression), non-seasonal unipolar major depressive disorder (MDD), and bipolar disorder.…”

“…It was intended in the present study 1 to begin light exposure no later than 8.5 hours after DLMO, which was recommended by the Terman research group (Terman et al 20 ), or 2.5 hours after sleep midpoint if the DLMO could not be determined (also recommended 20(p69) [subsequently qualified 20(p74) ] by the Terman group in an article that has been previously critiqued 8,9 ). This recommendation is problematic because it usually curtails sleep.…”