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Meta-Analysis
. 2004;2004(2):CD004050.
doi: 10.1002/14651858.CD004050.pub2.

Light therapy for non-seasonal depression

A Tuunainen  1 , D F Kripke, T Endo
Affiliations
Meta-Analysis

Light therapy for non-seasonal depression

A Tuunainen et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Efficacy of light therapy for non-seasonal depression has been studied without any consensus on its efficacy.

Objectives: To evaluate clinical effects of bright light therapy in comparison to the inactive placebo treatment for non-seasonal depression.

Search strategy: We searched the Depression Anxiety & Neurosis Controlled Trials register (CCDANCTR January 2003), comprising the results of searches of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 -), EMBASE (1980 -), CINAHL (1982 -), LILACS (1982 -), National Research Register, PsycINFO/PsycLIT (1974 -), PSYNDEX (1977 -), and SIGLE (1982 - ) using the group search strategy and the following terms: #30 = phototherapy or ("light therapy" or light-therapy). We also sought trials from conference proceedings and references of included papers, and contacted the first author of each study as well as leading researchers in the field.

Selection criteria: Randomized controlled trials comparing bright light with inactive placebo treatments for non-seasonal depression.

Data collection and analysis: Data were extracted and quality assessment was made independently by two reviewers. The authors were contacted to obtain additional information.

Main results: Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. In general, the quality of reporting was poor, and many reviews did not report adverse effects systematically. The treatment response in the bright light group was better than in the control treatment group, but did not reach statistical significance. The result was mainly based on studies of less than 8 days of treatment. The response to bright light was significantly better than to control treatment in high-quality studies (standardized mean difference (SMD) -0.90, 95% confidence interval (CI) -1.50 to -0.31), in studies applying morning light treatment (SMD -0.38, CI -0.62 to -0.14), and in sleep deprivation responders (SMD -1.02, CI -1.60 to -0.45). Hypomania was more common in the bright light group compared to the control treatment group (risk ratio 4.91, CI 1.66 to 14.46, number needed to harm 8, CI 5 to 20). Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. Treatment

Reviewers' conclusions: For patients suffering from non-seasonal depression, bright light therapy offers modest though promising antidepressive efficacy, especially when administered during the first week of treatment, in the morning, and as an adjunctive treatment to sleep deprivation responders. Hypomania as a potential adverse effect needs to be considered. Due to limited data and heterogeneity of studies these results need to be interpreted with caution.

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Conflict of interest statement

Arja Tuunainen ‐ None known.

Daniel F. Kripke ‐ No ownership interest in makers of lighting devices or light treatment. Past collaboration on grants with Apollo Lighting Systems and Synchrony Applied Health Sciences. Contribution of light boxes from Sunbox.

Takuro Endo ‐ None known.

Figures

1
1
Clinician‐rated.
2
2
Drop‐outs.
3
3
High‐quality studies.
4
4
Light box.
5
5
Light only.
6
6
Low‐quality studies.
7
7
Mood change.
8
8
Mood endpoint.
9
9
Mood follow‐up.
10
10
Morning light.
11
11
Non‐seasonals only.
12
12
Not improved.
13
13
Relapse.
14
14
SD responders.
15
15
Self‐rated.
1.1
1.1. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 1 Global state: 1. CGI endpoint score (high = poor) ‐ medium term.
1.2
1.2. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 2 Mental state: 1. Clinically not improved (less than 50% decrease in HDRS).
1.3
1.3. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 3 Mental state: 2. Deterioration in mental state or relapse ‐ short term.
1.4
1.4. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 4 Mental state: 3. Mood rating scale endpoint score (high = poor).
1.5
1.5. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 5 Mental state: 4. Mood rating scale change score (baseline minus endpoint).
1.6
1.6. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 6 Mental state: 5. Clinician‐rated mood rating scale endpoint score (high = poor).
1.7
1.7. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 7 Mental state: 6. Self‐rated mood rating scale endpoint score (high = poor).
1.8
1.8. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 8 Mental state: 7. Mood rating scale endpoint score (light only) (high = poor).
1.9
1.9. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 9 Mental state: 8. Mood rating scale follow‐up score (high = poor).
1.10
1.10. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 10 Mental state: 9. Mood rating scale endpoint score (concomitant SD) (high = poor).
1.13
1.13. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 13 Mental state: 10. Mood rating scale endpoint score (SD responders) (high = poor).
1.14
1.14. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 14 Mental state: 11. Mood rating scale endpoint score (SD nonresponders) (high = poor).
1.15
1.15. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 15 Mental state: 12. Mood rating scale endpoint score (concomitant drug) (high = poor).
1.16
1.16. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 16 Mental state: 13. Mood rating scale endpoint score (time of day of bright light) (high = poor).
1.17
1.17. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 17 Mental state: 14. Mood rating scale endpoint score (concomitant SD and morning light) (high = poor).
1.18
1.18. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 18 Mental state: 15. Mood rating scale endpoint score (concomitant drug and morning light) (high = poor).
1.19
1.19. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 19 Mental state: 16. Mood rating scale endpoint score (type of device) (high = poor).
1.20
1.20. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 20 Mental state: 17. Mood rating scale endpoint score (intensity of bright light) (high = poor).
1.21
1.21. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 21 Mental state: 18. Mood rating scale endpoint score (duration of bright light) (high = poor).
1.22
1.22. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 22 Mental state: 19. Mood rating scale endpoint score (methdological quality) (high = poor).
1.23
1.23. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 23 Mental state: 20. Mood rating scale endpoint score (mixed study sample) (high = poor).
1.25
1.25. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 25 Acceptability of treatment: 1. Number of persons dropping out.
1.26
1.26. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 26 Adverse effects: 1. Cardiovascular system related.
1.27
1.27. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 27 Adverse effects: 2. Endocrinologic system related.
1.28
1.28. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 28 Adverse effects: 3. Gastrointestinal system related.
1.29
1.29. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 29 Adverse effects: 4. Mood related.
1.30
1.30. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 30 Adverse effects: 5. Nervous system related.
1.31
1.31. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 31 Adverse effects: 6. Sleep related.
1.32
1.32. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 32 Adverse effects: 7. Urinary system related.
1.33
1.33. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 33 Adverse effects: 8. Vision related.
1.34
1.34. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 34 Adverse effects: 9. Complaint List or FSUCL endpoint score (high = poor).
1.35
1.35. Analysis
Comparison 1 BRIGHT LIGHT versus CONTROL TREATMENT, Outcome 35 Death.
See this image and copyright information in PMC

Update of

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Prasko 1988b {published and unpublished data}
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    1. Prasko J, Foldmann P, Prasková H, Zindr V. Hastened onset of the effect of antidepressive drugs when using three types of timing of intensive white light [Urychlení nástupu úcinku antidepresiv pri pouzití trí druhu nacasování intensívního bílého svetla]. Ceskoslovenska Psychiatrie 1988;84(6):373‐83. - PubMed
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Reide 1994 {published and unpublished data}
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Stewart 1990 {published data only}
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Stinson 1990 {published data only}
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Thalén 2001 {published data only}
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Wehr 1985 {published data only}
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References to studies awaiting assessment

Deltito 1991 {published data only}
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References to ongoing studies

Goel 2001 {published and unpublished data}
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Zirpoli 2002 {published and unpublished data}
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