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 Depression is one of the most common mental health disorders and a
leading cause of disability and reduced quality of life worldwide,
the researchers note in JAMA Psychiatry.
While many people with depression may be helped by medication or
psychotherapy, these options don’t work for everybody and some
patients don’t stick with treatment due to side effects or
challenges related to access or affordability.
“This study is the first to show that light therapy alone is
effective versus a placebo, and the first to compare combination
light and drug to light alone,” said lead study author Dr. Raymond
Lam of the University of British Columbia.
“The combination of light therapy and antidepressant was the most
effective,” Lam added by email. “However, some people may prefer to
try a non-medication treatment first, and may elect to start with
light therapy.”
To test the effectiveness of light therapy for non-seasonal
depression, Lam and colleagues randomly assigned 122 patients to one
of four groups for eight weeks: only medication, only light, a
combination of drugs and light therapy, or a control group that
received no active treatments.
The active treatments in the study included a daily 20-milligram
dose of fluoxetine (Prozac) and daily exposure to a fluorescent
light box for 30 minutes after waking up each morning.
Researchers gave people assigned only light therapy a placebo, or
inactive pill, and they provided participants assigned only to drug
treatment with an inactive device instead of a working light box.
The control group received both the placebo pill and the inactive
device.
At the start of the study, researchers used a standard questionnaire
to assess the severity of depression by asking participants about
sadness, inner tension, reduced sleep, reduced appetite,
concentration difficulties, lack of energy, inability to feel, and
pessimistic or suicidal thoughts.
The highest score is 60, indicating the most severe depression. On
average, participants had scores of about 26 or 27 at the start of
the study, pointing to moderate depression.
After eight weeks, the group receiving both medication and light
therapy had the biggest average drop in depression scores, with a
16.9 point decline.
People who got only light therapy had an average 13.4 point decline
in depression scores, while people who had only medication
experienced an 8.8 point drop and the control group getting only
inactive treatments had a 6.5 point decrease.
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While the exact reason light therapy might ease depression is
unknown, it may have worked by helping to reset the biological clock
in the brain, or circadian rhythms, the researchers hypothesized.
One shortcoming of the study is that researchers lacked data on how
much exposure people had to natural light during the study, the
authors acknowledge. It’s also possible that a higher dose of
medication or light therapy might have made a bigger impact.
Normally, if an antidepressant doesn’t work in a low dose,
clinicians will gradually increase the dose to help achieve the
right amount of medicine to ease symptoms, noted Dr. Teodor
Postolache, a psychiatry researcher at the University of Maryland
School of Medicine in Baltimore who wasn’t involved in the study.
“Light treatment could be an adequate agent that in combination with
medications may make the response to treatment more complete,”
Postolache said by email. “However, I would emphasize that patients
should not buy a light treatment device and start adding it to their
antidepressants on their own.”
The best time in the course of treatment to consider light therapy
may also depend on the severity of symptoms, said Sue Penckofer, a
researcher at Loyola University in Chicago who wasn’t involved in
the study.
“If somebody has more mild depression they might try light therapy
first, but if they have more moderate or serious depression
medication might be recommended instead,” Penckofer said.
SOURCE: http://bit.ly/1MppYER JAMA Psychiatry, online November 18,
2015.
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