Nonseasonal Major Depressive Disorder Research Articles

Sleep deprivation as a predictor of response to light therapy in major depression

Background: While the majority of depressed patients benefit from total sleep deprivation (TSD), light therapy is regarded as a first-line treatment only for seasonal affective disorder (SAD). The results of light therapy in nonseasonal major depressive disorder have been non-conclusive. We examined the correlation of TSD response and light therapy response in major depressed patients. Methods: 40 inpatients with major depressive disorder (seven with seasonal pattern, 33 without seasonal pattern) were deprived of a night’s sleep. The TSD responders, as well as the TSD nonresponders, were randomly assigned to receive adjunct light therapy either with bright white light (2500 lux) or dim red light (50 lux) during 2 weeks beginning on the third day after TSD. Results: The 20 TSD responders improved significantly better under the light therapy than the 20 TSD nonresponders (according to the Hamilton Depression Rating Scale and the self-rating depression scale Bf-S; v. Zerssen). Limitations: No significant difference could be found between the two light intensities. Since the patients were additionally treated with medication an interaction with the two adjunctive therapies cannot be excluded. Conclusion: Our results indicate that a positive TSD response in major depressed patients can be predicative of beneficial outcome of subsequent light therapy.

Atypical depressive symptoms in seasonal and non-seasonal mood disorders

The authors examined the rates of atypical depression and prevalence of specific atypical symptoms in patients with seasonal versus non-seasonal depression. Fifty-three patients with seasonal affective disorder (SAD) were compared to 54 patients with non-seasonal major depressive disorder (MDD) using the atypical depression diagnostic scale (ADDS). SAD patients scored significantly higher than non-seasonal MDD patients in hyperphagia and hypersomnia, and significantly lower in interpersonal sensitivity and other rejection avoidance. There was no difference in the rate of ADDS diagnosis of atypical depression. Differences between atypical depression and SAD suggest that they are separate subtypes of depression with an overlapping symptom picture.

DSM-III-R personality disorders in seasonal affective disorder: Change associated with depression

Forty-five patients with winter Seasonal Affective Disorder (SAD) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R) in a depressed state before starting therapy (light or medication), and again 14 weeks later when the scores on the Montgomery Åsberg Depression Rating Scale (MADRS) had been reduced by an average of 74%. Prevalence and pattern of personality disorders (PDs) before treatment were similar to that found in patients with nonseasonal major depressive disorder (MDD) during a depressive episode. Number of categorical diagnoses were lower at follow-up for most PDs, but differences were not statistically significant. However, for dimensional scores (number of positive DSM-III-R criteria) significant changes were found for schizo-typal, histrionic, narcissistic, and obsessive-compulsive PD, and for total dimensional score in cluster B and total score for all PDs. These changes differ from findings in similar studies of outpatients with nonseasonal MDD. Whether this indicates a specific pattern of change for patients with SAD is discussed. Multiple regression analysis showed a significant association between changes in positive PD criteria between the depressed and nondepressed state and change in depression score. No significant relationship was found between changes in PD criteria and Global Seasonality Score (GSS), a measure reflecting the sum of ratings of seasonal variation in sleep length, social activity, mood, weight, appetite, and energy level.

Phototherapy in nonseasonal depression

Previous reports have shown that bright light exposure may benefit patients with seasonal depression. In the present study, the possible therapeutic effect of bright light in non-seasonal major depressive disorder was examined. Forty-two depressed patients not receiving additional antidepressant medication were exposed to bright white light of 2500 lux or dim red light of 50 lux over one week for two hr daily in the morning. The change in depressive symptoms was assessed by rating scales (Hamilton Depression Rating Scale, CGI) and by self-rating scales (Depression Scale, Complaint List, Visual Analgue Scale). Consistent for all ratings, the decrease in depressive symptoms after bright white light was only slight and not different from dim red-light exposure. Contrary to the findings in seasonal affective disorder, phototheraphy administered over one week for two hr daily is not effective in nonseasonal major depressive disorder.

Effect of bright white light therapy on non-seasonal depressive disorder: Preliminary results

In this study, the effect of bright white light (2500 lux) and dim light (50 lux) were assessed in 30 patients with non-seasonal major depressive disorder randomly assigned to either procedure. Patients met RDC for major depressive disorder and ICD-9 criteria (296.1 and 296.3). During a 7-day period, the patients were exposed to bright white light (2500 lux) or dim light (50 lux) from 7.00 to 9.00 h daily. The severity of depression was assessed with observer scales (AMDP system, Hamilton depression scale, CGI) and through self-evaluation by self-rating scales (depression scale and list of complaints by von Zerssen). No difference was noted between bright light therapy and dim light, though a significant reduction of depressive symptomatology was observed for all patients during the study. These findings are discussed from a clinical point of view.

Effects of bright incandescent light on seasonal and nonseasonal major depressive disorder

Previous research has indicated that exposure to bright fluorescent light can benefit clinically depressed individuals. The present study, a 1-to 2-week open trial of bright (⩾2,000 lux) incandescent light with seasonal (fall/winter) and nonseasonal depressives, produced a therapeutic effect on seasonal depression, as measured by three criteria for recovery: final score on the Hamilton Rating Scale for Depression (HRSD)<10; final HRSD score⩽50% of pretreatment HRSD score; no longer meets DSM-III criteria for major depressive disorder. Phototherapy was not effective in the nonseasonal patients, whose functioning was more impaired than that of the seasonal subjects even before the trial. No adverse effects were observed in any patient.