Treatment Of Winter Depression Research Articles

Dawn simulation vs. bright light in seasonal affective disorder: Treatment effects and subjective preference

BackgroundStudies comparing the efficacy of dawn simulation to conventional bright light for the treatment of seasonal affective disorder (in parallel groups) have yielded conflicting results. This crossover study investigated treatment outcomes and long-term treatment preference. MethodsForty winter depressives were treated for a week with bright light (4.300lx for 30–45min shortly after awakening) or dawn simulation (gradually increasing light during the last 30min of sleep achieving 100lx before alarm beep, with the dawn simulator placed closer to the open eyes for a further 15min: 250lx). The depression level was self-rated using SIGH-SAD-SR. ResultsDepression scores reduced similarly following bright light and dawn simulation: for 43.8% and 42.2% (medians), respectively; efficacy ratio was 23:17. The preference was also similar (21:19). Among those who preferred bright light, the most common reason was that they perceived the bright light to be more effective (19/21; it was more effective, p=0.0096; this subgroup tended to have more severe depression) and ease of use (6/21). Among those who preferred the dawn simulator, the reasons were a more “natural” action (9/19), device compactness and/or time-saving (10/19) and in 4 cases where bright light caused eyestrain. LimitationsNot overhead naturalistic light for dawn simulation, self-rating of depression. ConclusionsDawn simulation is similarly effective to bright light in the treatment of winter depression. Patients with more severe depression tended to report greater improvement with bright light; in such cases, this would outweigh the non-clinical advantages of dawn simulation.

Melatonin marks circadian phase position and resets the endogenous circadian pacemaker in humans.

Measuring the dim light melatonin onset (DLMO) is a useful and practical way to assess circadian phase position in humans. As a marker for the phase and period of the endogenous circadian pacemaker, the DLMO has been shown to advance with exposure to bright light in the morning and to delay with exposure to bright light in the evening. This 'phase response curve' (PRC) to light has been applied in the treatment of winter depression, jet lag and shift work, as well as circadian phase sleep disorders. Exogenous melatonin has phase-shifting effects described by a PRC that is about 12 h out of phase with the PRC to light. That is, melatonin administration in the morning causes phase delays and in the afternoon causes phase advances. All of the circadian phase disorders that have been successfully treated with appropriately timed exposure to bright light can be treated with appropriately scheduled melatonin administration. Melatonin administration is more convenient and therefore may be the preferred treatment.

Involvement of melatonin and serotonin in winter depression

The phase of circadian rhythms can be shifted by exposure to light. Most patients with winter depression are suggested to have a phase delay in their circadian rhythms. The efficacy of light in treatment of winter depression is thought to be associated with the phase shifting effect of light. In addition to light, melatonin and serotonin can cause phase shifts of the rhythms. The concerted action of these indoleamines may underly the finding that light has an antidepressant effect, independently of time of day or circadian phase of an individual.

Dawn simulation compared with a dim red signal in the treatment of winter depression

In a randomized, parallel design, 19 patients with winter depression were treated with either a week of a white 1.5-hr dawn simulation peaking at 250 lux or a week of a red, 1.5-hr dawn signal peaking at 2 lux. The subjects were told that they would receive either a white or red dawn reaching in intenity that would be dimmer than standard bright light treatment. At the end of both the baseline week and the treatment week subjects were blindly assessed with the Hamilton Rating Scale for Depression (HDRS). Analysis of covariance was used to compare the two dawn treatments. The white, 1.5-hr, 250 lux dawn simulation resulted in significantly ( p < 0.05) lower HDRS scores compared to the red, 1.5-hr, 2 lux down. This is the second controlled study which indicates that dawn simulation is an effective treatment for winter depression.

Treatment of winter depression in Norway

Thirty-four patients with seasonal affective disorder, winter depression type (WD) were randomly distributed to receive the selective monoamine oxidase-A inhibitor moclobemide (400 mg daily) or placebo in a double-blind, parallel group study lasting for up to 14 weeks. Severity measures were the Montgomery-Asberg Depression Rating Scale (MADRS) extended with characteristic symptoms of WD; summed score of the "atypical" symptoms hypersomnia, hyperphagia and carbohydrate craving; and Clinical Global Impressions (CGI). After 3 weeks, patients with unsatisfactory response were switched to open moclobemide. Three patients on placebo dropped out before 3 weeks. Extended MADRS and CGI showed no significant difference between the groups at 3 weeks, whereas the atypical score was reduced significantly more on moclobemide than on placebo already after one week. Nonresponders after 3 weeks (9 of 16 on moclobemide and 7 of 15 on placebo) improved rapidly after being given open moclobemide. Predictor analysis showed a remarkably high negative correlation between improvement at 3 weeks (extended MADRS) and age in the placebo group and a strong, nonsignificant trend in the same direction in the moclobemide group. Dichotomizing the patients according to the median age (45 years) resulted in a somewhat better effect of moclobemide than placebo in the older age group. There were no significant differences in side effects between moclobemide and placebo.

Treatment of winter depression in Norway. I. Short- and long-term effects of 1500-lux white light for 6 days.

Patients with seasonal affective disorder (winter depression) from the Oslo area (at about 60 degrees N) recruited through mass media advertising were treated with 1500-lx white full-spectrum light for 2 h in the morning for 6 days. Their clinical state was assessed at baseline and 1, 3, 6, 10 and 14 weeks after commencement of treatment with an extended version of Montgomery-Asberg Depression Rating Scale (MADRS) and Clinical Global Impression. Forty patients (35 women, 5 men, age range 24 to 64 years) completed 1 week of light treatment. A subgroup of 9 patients received light in addition to ongoing drug treatment. The mean reduction in total extended MADRS score at week 1 was 48% in patients receiving only light and 56% in patients receiving light in addition to drugs. In spite of the low dose of light given, this is comparable to other reported results using light treatment for winter depression. In contrast to most other studies, however, the improvement at week 1 was maintained for the rest of the season in most patients. Only 5 patients were given another light treatment course, and another 5 were switched to drug treatment due to their unsatisfactory response to light treatment.

The efficacy of bupropion in the treatment of winter depression : Valerie J. Del Medico, Steven C. Dilsaver, Amjed B. Qamar University of Texas, Harris Country Psychiatric Center, Houston, TX 77225-0249

The efficacy of bupropion in the treatment of winter depression : Valerie J. Del Medico, Steven C. Dilsaver, Amjed B. Qamar University of Texas, Harris Country Psychiatric Center, Houston, TX 77225-0249

Bright light treatment of winter depression: Am compared to PM light

bright light treatment of winter depression: Am compared to PM light