The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials

Pjrek, Edda; Friedrich, Michaela-Elena; Cambioli, Luca; Dold, Markus; Jäger, Fiona; Komorowski, Arkadiusz; Lanzenberger, Rupert; Kasper, Siegfried; Winkler, Dietmar

doi:10.1159/000502891

Cited by 82 publications

(63 citation statements)

References 73 publications

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“…Bright light therapy is an effective treatment for symptomatic seasonal depression 75 . The recurrent pattern of this subtype of depression provides a unique opportunity to examine preventive strategies.…”

Section: Clinical Subtypesmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

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Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial‐and‐error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta‐analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self‐report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above‐mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.

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Section: Clinical Subtypesmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

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“…We used the entire SIGH-SAD questionnaire as primary measure, since this is the current benchmark for assessment of depression severity in light therapy trials. 63 We chose the original 17-item HAM-D questionnaire as a secondary measure, since it is more commonly used in clinical practice and research. Blinded assessors conducted the SIGH-SAD interviews (including HAM-D questions) by telephone weekly in the intervention period and at follow-up.…”

Section: Primary and Secondary Outcome Measuresmentioning

confidence: 99%

Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial

et al. 2020

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ObjectivesApproximately 11%–13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy.DesignRandomised, double-blind controlled trial.SettingPrimary and secondary care in The Netherlands, from November 2016 to March 2019.Participants67 pregnant women (12–32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders).InterventionsParticipants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum.Primary and secondary outcome measuresDepressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale—Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models.ResultsMedian depression scores decreased by 40.6%–53.1% in the BLT group and by 50.9%–66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings.ConclusionsDepressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof.Trial registration numberNTR5476.

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“…In a recent meta-analysis, Nussbaumer-Streit et al (2019) found that the efficacy and safety of melatonin for prevention of SAD cannot be conclusively supported, owing to a lack of controlled clinical trials. Likewise, Pjrek et al (2020) remark that evidence for BL therapy comes from methodologically heterogeneous studies with small-tomedium sample sizes, but conclude that BL therapy is effective. Others take issue with the lack of effective controls in BL therapy studies (Golden et al, 2005), and larger high-quality clinical trials are clearly needed.…”

Section: The Role Of Lightmentioning

confidence: 99%

The darkness and the light: diurnal rodent models for seasonal affective disorder

Shankar

Williams

2021

Disease Models &Amp; Mechanisms

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The development of animal models is a critical step for exploring the underlying pathophysiological mechanisms of major affective disorders and for evaluating potential therapeutic approaches. Although most neuropsychiatric research is performed on nocturnal rodents, differences in how diurnal and nocturnal animals respond to changing photoperiods, combined with a possible link between circadian rhythm disruption and affective disorders, has led to a call for the development of diurnal animal models. The need for diurnal models is most clear for seasonal affective disorder (SAD), a widespread recurrent depressive disorder that is linked to exposure to short photoperiods. Here, we briefly review what is known regarding the etiology of SAD and then examine progress in developing appropriate diurnal rodent models. Although circadian disruption is often invoked as a key contributor to SAD, a mechanistic understanding of how misalignment between endogenous circadian physiology and daily environmental rhythms affects mood is lacking. Diurnal rodents show promise as models of SAD, as changes in affective-like behaviors are induced in response to short photoperiods or dim-light conditions, and symptoms can be ameliorated by brief exposure to intervals of bright light coincident with activity onset. One exciting avenue of research involves the orexinergic system, which regulates functions that are disturbed in SAD, including sleep cycles, the reward system, feeding behavior, monoaminergic neurotransmission and hippocampal neurogenesis. However, although diurnal models make intuitive sense for the study of SAD and are more likely to mimic circadian disruption, their utility is currently hampered by a lack of genomic resources needed for the molecular interrogation of potential mechanisms.

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The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials

Cited by 82 publications

References 73 publications

The clinical characterization of the adult patient with depression aimed at personalization of management

The clinical characterization of the adult patient with depression aimed at personalization of management

Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial

The darkness and the light: diurnal rodent models for seasonal affective disorder

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