Adjunctive bright light treatment with gradual advance in unipolar major depressive disorder with evening chronotype – A randomized controlled trial

Sep 14, 2020Psychological medicine

Bright light treatment with gradual timing shift for major depression in evening-type individuals: A randomized trial

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Abstract

The cumulative remission rate for bright light therapy (BLT) was 67.4%, compared to 46.7% for dim red light (DRL).

Participants receiving BLT achieved remission more quickly than those receiving DRL, with a significant difference noted in time to remission.
Cox proportional hazard analysis indicated that patients in the BLT group were 1.9 times more likely to achieve remission compared to the DRL group.
Greater improvements in depression severity were observed in the BLT group, particularly among participants who adhered to the light therapy regimen.
The study involved 93 participants, with an average age of 46.4 years and a predominance of female participants (80%).

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BACKGROUND: Unipolar non-seasonal depressed patients with concomitant evening chronotype were associated with poor clinical outcomes and higher non-remission rate. This study aims to examine the efficacy of adjunctive bright light therapy with gradual timing advance in a randomized, assessor and prescriber-blinded controlled trial.

METHOD: Participants were randomly allocated to receive 5 weeks of either bright white light therapy (BLT) or dim red light (DRL) with the same advancement protocol. Participants were followed up till 5 months after treatment. Primary outcomes included (i) remission rate and (ii) the severity of depression. The analysis was conducted using Kaplan-Meier survival analysis, Cox proportional hazard analysis and linear mixed models.

RESULTS: A total of 93 participants (46.4 ± 11.7 years old, 80% female) were randomized. The cumulative remission rate for the BLT and the DRL groups was 67.4% and 46.7%, respectively. Time to remission was shorter for the BLT group relative to the DRL group (log-rank test= 0.024). Cox proportional hazard survival analysis showed that patients in the BLT group had a higher probability of achieving remission relative to patients in the DRL group [hazard ratio = 1.9 (95% CI = 1.1- 3.4),= 0.026]. Further sensitivity analysis demonstrated greater improvement in 17-Hamilton Depression Score (group × time interaction,= 0.04) in the BLT group for those who were adherent to light therapy. p p p

CONCLUSIONS: The use of bright light therapy with gradual advance protocol is an effective adjunctive treatment resulting in quicker and a higher rate of remission of depression in patients with non-seasonal unipolar depression and evening-chronotype.

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Adjunctive bright light treatment with gradual advance in unipolar major depressive disorder with evening chronotype – A randomized controlled trial

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