Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T08:09:51.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Light therapy for non-seasonal depression: systematic review and meta-analysis

Published online by Cambridge University Press:  02 January 2018

Stefan Perera ,
Rebecca Eisen ,
Meha Bhatt ,
Neera Bhatnagar ,
Russell de Souza ,
Lehana Thabane  and
Zainab Samaan
Stefan Perera*
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
Rebecca Eisen
Affiliation:
MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Canada
Meha Bhatt
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
Neera Bhatnagar
Affiliation:
Health Sciences Library, McMaster University, Hamilton, Canada
Russell de Souza
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Canada
Lehana Thabane
Affiliation:
McMaster University, Hamilton, Canada Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Canada
Zainab Samaan
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Canada Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
*
Zainab Samaan, Associate Professor, Mood Disorders Program, Centre for Mountain Health, 100 West 5th Street, Hamilton, Ontario, Canada L8N 3K7. Email: samaanz@mcmaster.ca
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

Light therapy is a known treatment for patients with seasonal affective disorder. However, the efficacy of light therapy in treating patients with non-seasonal depression remains inconclusive.

Aims

To provide the current state of evidence for efficacy of light therapy in non-seasonal depressive disorders.

Method

Systematic review of randomised controlled trials (RCTs) was conducted by searching MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL from their inception to September 2015. Study selection, data abstraction and risk of bias assessment were independently conducted in duplicate. Meta-analyses were performed to provide a summary statistic for the included RCTs. The reporting of this systematic review follows the PRISMA guidelines.

Results

A meta-analysis including 881 participants from 20 RCTs demonstrated a beneficial effect of light therapy in non-seasonal depression (standardised mean difference in depression score −0.41 (95% CI −0.64 to −0.18)). This estimate was associated with significant heterogeneity (I2=60%, P=0.0003) that was not sufficiently explained by subgroup analyses. There was also high risk of bias in the included trials limiting the study interpretation.

Conclusions

The overall quality of evidence is poor due to high risk of bias and inconsistency. However, considering that light therapy has minimal side-effects and our meta-analysis demonstrated that a significant proportion of patients achieved a clinically significant response, light therapy may be effective for patients with non-seasonal depression and can be a helpful additional therapeutic intervention for depression.

Type
Review
Information
BJPsych Open , Volume 2 , Issue 2 , March 2016 , pp. 116 - 126
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Copyright
Copyright © The Royal College of Psychiatrists 2016

Footnotes

Declaration of interest

None.

References

1 World Health Organzation (WHO). Depression Fact Sheet. WHO, 2015 (http://www.who.int/mediacentre/factsheets/fs369/en/).Google Scholar
2 Lopez, AD, Murray, CJ. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Harvard School of Public Health, 1996.Google Scholar
3 Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003; 33: 395–405.Google Scholar
4 American Psychological Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder APA, 2010.Google Scholar
5 Connolly, KR, Thase, ME. If at first you don't succeed. Drugs 2011; 71: 43–64.Google Scholar
6 Fava, M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry 2003; 53: 649–59.Google Scholar
7 Rosenthal, NE, Sack, DA, Gillin, JC, Lewy, AJ, Goodwin, FK, Davenport, Y, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41: 72–80.Google Scholar
8 Terman, M, Terman, JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety and side effects. CNS Spectr 2005; 10: 647–63.Google Scholar
9 Lam, R, Levitt, A, Levitan, R, Enns, M, Morehouse, R, Michalak, E, et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry 2006; 163: 805–12.Google Scholar
10 Lee, T, Chan, C. Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand 1999; 99: 315–23.Google Scholar
11 Golden, RN, Gaynes, BN, Ekstrom, RD, Hamer, RM, Jacobsen, FM, Suppes, T, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162: 656–62.Google Scholar
12 Even, C, Schröder, CM, Friedman, S, Rouillon, F. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord 2008; 108: 11–23.Google Scholar
13 Tuunainen, A, Kripke, DF, Endo, T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004; 2: CD004050.Google Scholar
14 Pail, G, Huf, W, Pjrek, E, Winkler, D, Willeit, M, Praschak-Rieder, N, et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology 2010; 64: 152–62.Google Scholar
15 Oldham, MA, Ciraulo, DA. Bright light therapy for depression: review of its effects on chronobiology and the autonomic nervous system. Chronobiol Int 2014; 31: 305–19.Google Scholar
16 Lieverse, R, Van Someren, EJ, Nielen, MM, Uitdehaag, BM, Smit, JH, Hoogendijk, WJ. Bright light treatment in elderly patients with non-seasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry 2011; 68: 61–70.Google Scholar
17 Thalén, BE, Mørkrid, L, Kjellman, B, Wetterberg, L. Cortisol in light treatment of seasonal and non-seasonal depression: relationship between melatonin and Cortisol. Acta Psychiatr Scand 1997; 96: 385–94.Google Scholar
18 Mårtensson, B, Pettersson, A, Berglund, L, Ekselius, L. Bright white light therapy in depression: a critical review of the evidence. J Affect Disord 2015; 182: 1–7.Google Scholar
19 Sit, D, McGowan, J, Wiltrout, C, Dills, J, Weingarden, J, Diler, RS, et al. Light therapy for bipolar depression: a randomized, double-blind, parallel placebo-control trial. Neuropsychopharmacology 2014; 39: S56–67.Google Scholar
20 Wirz-Justice, A, Bader, A, Frisch, U, Stieglitz, R-D, Alder, J, Bitzer, J, et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry 2011; 72: 986–93.Google Scholar
21 Franchini, L, Ballan, S, Colombo, C, Smeraldi, E. Light therapy and fluvoxamine in the treatment of bipolar psychotic depression: a pilot study. Clin Neuropsychiatry 2009; 6: 166–74.Google Scholar
22 Corral, M, Wardrop, A, Zhang, H, Grewal, A, Patton, S. Morning light therapy for postpartum depression. Arch Women's Ment Health 2007; 10: 221–4.Google Scholar
23 Özdemir, PG, Boysan, M, Smolensky, MH, Selvi, Y, Aydin, A, Yilmaz, E. Comparison of venlafaxine alone versus venlafaxine plus bright light therapy combination for severe major depressive disorder. J Clin Psychiatry 2015; 76: 645–54.Google Scholar
24 Lam, RW, Levitt, AJ, Levitan, RD, Michalak, EE, Morehouse, R, Ramasubbu, R, et al. Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial. JAMA Psychiatry 2016; 73: 56–63.Google Scholar
25 Martiny, K, Lunde, M, Unden, M, Dam, H, Bech, P. Adjunctive bright light in non-seasonal major depression: results from clinician-rated depression scales. Acta Psychiatrica Scandinavica 2005; 112: 117–25.Google Scholar
26 Loving, RT, Kripke, DF, Elliott, JA, Knickerbocker, NC, Grandner, MA. Bright light treatment of depression for older adults [ISRCTN55452501]. BMC Psychiatry 2005; 5: 41.Google Scholar
27 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 26–49.Google Scholar
28 Higgins, JP, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.Google Scholar
29 Viera, AJ, Garrett, JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37: 360–3.Google Scholar
30 Guyatt, GH, Oxman, AD, Kunz, R, Atkins, D, Brozek, J, Vist, G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011; 64: 395–400.Google Scholar
31 Guyatt, G, Rennie, D. Users' Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. AMA Press, 2002.Google Scholar
32 Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 55–7.Google Scholar
33 Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.Google Scholar
34 Epperson, CN, Terman, M, Terman, JS, Hanusa, BH, Oren, DA, Peindl, KS, et al. Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry 2004; 65: 421–5.Google Scholar
35 Sumaya, IC, Rienzi, BM, Deegan, JF, Moss, DE. Bright light treatment decreases depression in institutionalized older adults a placebo-controlled crossover study. J Gerontol A Biol Sci Med Sci 2001; 56: M356–60.Google Scholar
36 Goel, N, Terman, M, Terman, JS, Macchi, MM, Stewart, JW. Controlled trial of bright light and negative air ions for chronic depression. Psychol Med 2005; 35: 945–55.Google Scholar
37 Mackert, A, Volz, H-P, Stieglitz, R-D, Müller-Oerlinghausen, B. Phototherapy in nonseasonal depression. Biol Psychiatry 1991; 30: 257–68.Google Scholar
38 Kripke, DF, Mullaney, DJ, Klauber, MR, Risch, SC, Gillin, JC. Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry 1992; 31: 119–34.Google Scholar
39 Holsboer-Trachsler, E, Hemmeter, U, Hatzinger, M, Seifritz, E, Gerhard, U, Hobi, V. Sleep deprivation and bright light as potential augmenters of antidepressant drug treatment – neurobiological and psychometric assessment of course. J Psychiatr Res 1994; 28: 381–99.Google Scholar
40 Yamada, N, Martin-Iverson, MT, Daimon, K, Tsujimoto, T, Takahashi, S. Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol Psychiatry 1995; 37: 866–73.Google Scholar
41 Prasko, J, Horacek, J, Klaschka, J, Kosova, J, Ondrackova, I, Sipek, J. Bright light therapy and/or imipramine for inpatients with recurrent non-seasonal depression. Neuroendocrinol Lett 2002; 23: 109–13.Google Scholar
42 Benedetti, F, Colombo, C, Serretti, A, Lorenzi, C, Pontiggia, A, Barbini, B, et al. Antidepressant effects of light therapy combined with sleep deprivation are influenced by a functional polymorphism within the promoter of the serotonin transporter gene. Biol Psychiatry 2003; 54: 687–92.Google Scholar
43 Tsai, YF, Wong, TK, Juang, YY, Tsai, HH. The effects of light therapy on depressed elders. Int J Geriatr Psychiatry 2004; 19: 545–8.Google Scholar
44 McEnany, GW, Lee, KA. Effects of light therapy on sleep, mood, and temperature in women with nonseasonal major depression. Issues Ment Health Nurs 2005; 26: 781–94.Google Scholar
45 Loving, RT, Kripke, DF, Shuchter, SR. Bright light augments antidepressant effects of medication and wake therapy. Depress Anxiety 2002; 16: 1–3.Google Scholar
46 Higgins, JP, Green, S. CochraneHandbook for Systematic Reviews of Interventions. Wiley Online Library, 2008.Google Scholar
47 Sun, X, Briel, M, Walter, SD, Guyatt, GH. Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. BMJ 2010; 340: c117.Google Scholar
Supplementary material: PDF

Perera et al. supplementary material

Supplementary Material

Download Perera et al. supplementary material(PDF)
PDF 280.2 KB
Submit a response

eLetters

No eLetters have been published for this article.