January 26, 2016
Bright light treatment either alone or combined with the antidepressant fluoxetine hydrochloride was an effective and well-tolerated treatment for adults with nonseasonal major depressive disorder (MDD), according to a recent clinical trial (Lam RW et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.2235 [published online November 18, 2015]).
Anita Slomski, MA
A recent clinical trial suggests light therapy improves nonseasonal major depression.
The 8-week trial randomized 122 patients to receive 1 of 4 interventions: light therapy (30 min/d exposure to a 10 000-lux fluorescent light box on awakening) and placebo pill, fluoxetine (20 mg daily) and placebo device (an inactive negative ion generator for 30 min/d), combination light and fluoxetine treatment, or placebo device and placebo pill. Participants were diagnosed with MDD by a psychiatrist, did not have seasonal affective disorder, scored 20 or higher on the Hamilton Depression Rating Scale, and had not taken psychotropic medications for at least 2 weeks prior to the baseline visit.
The primary outcome was a reduction in depression as measured by the change in the Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to 8 weeks; secondary outcomes included response (at least a 50% reduction in MADRS score) and remission rates at the end of the trial. Combination therapy and light monotherapy, but not fluoxetine monotherapy, were significantly superior to placebo in the MADRS change score. The mean change in MADRS score was 16.9 in those who received combination therapy, 13.4 in the light monotherapy group, 6.5 in the placebo group, and 8.8 in those who received fluoxetine monotherapy. The response and remission rate was highest for combination therapy (75.9% and 58.6%, respectively), relative to light monotherapy (50% and 43.8%), fluoxetine monotherapy (29% and 19.4%), and placebo (30% and 29%). Only combination therapy was superior to placebo in secondary outcomes.
Limitations of the study include an underpowered sample size and possible underdosing of fluoxetine and light therapy that may have precluded detection of clinically significant effects of monotherapy.