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Meta-Analysis
. 2020 May;65(5):290-300.
doi: 10.1177/0706743719892471. Epub 2019 Dec 12.

Light Therapy for Patients With Bipolar Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Raymond W Lam  1 , Minnie Y Teng  1 , Young-Eun Jung  1   2 , Vanessa C Evans  1 , John F Gottlieb  3 , Trisha Chakrabarty  1 , Erin E Michalak  1 , Jill K Murphy  1 , Lakshmi N Yatham  1 , Dorothy K Sit  3
Affiliations
Meta-Analysis

Light Therapy for Patients With Bipolar Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Raymond W Lam et al. Can J Psychiatry. 2020 May.

Abstract
in English, French

Objective: Bipolar disorder (BD) is challenging to treat, and fewer treatments are available for depressive episodes compared to mania. Light therapy is an evidence-based nonpharmacological treatment for seasonal and nonseasonal major depression, but fewer studies have examined its efficacy for patients with BD. Hence, we reviewed the evidence for adjunctive light therapy as a treatment for bipolar depression.

Methods: We conducted a systematic review of databases from inception to June 30, 2019, for randomized, double-blind, placebo-controlled trials of light therapy in patients with BD (CRD42019128996). The primary outcome was change in clinician-rated depressive symptom score; secondary outcomes included clinical response, remission, acceptability, and treatment-emergent mood switches. We quantitatively pooled outcomes using meta-analysis with random-effects models.

Results: We identified seven trials representing 259 patients with BD. Light therapy was associated with a significant improvement in Hamilton Depression Rating Scale score (standardized mean difference = 0.43, 95% confidence interval [CI], 0.04 to 0.82, P = 0.03). There was also a significant difference in favor of light therapy for clinical response (odds ratio [OR] = 2.32; 95% CI, 1.12 to 4.81; P = 0.024) but not for remission. There was no difference in affective switches between active light and control conditions (OR = 1.30; 95% CI, 0.38 to 4.44; P = 0.67). Study limitations included different light treatment parameters, small sample sizes, short treatment durations, and variable quality across trials.

Conclusion: There is positive but nonconclusive evidence that adjunctive light therapy reduces symptoms of bipolar depression and increases clinical response. Light therapy is well tolerated with no increased risk of affective switch.

Objectif: Le trouble bipolaire (TB) est difficile à traiter et il y a moins de traitements offerts pour les épisodes dépressifs comparativement à la manie. La photothérapie est un traitement non pharmacologique fondé sur des données probantes pour la dépression majeure saisonnière et non saisonnière, mais moins d’études en ont examiné l’efficacité pour les patients souffrant de TB. Nous avons donc examiné les données probantes liées à la photothérapie d’appoint comme traitement de la dépression bipolaire.

Méthodes: Nous avons mené une revue systématique des bases de données, du début au 30 juin 2019, à la recherche d’essais randomisés, à double insu, contrôlés par placebo de photothérapie chez des patients souffrant de TB (CRD42019128996). Le résultat principal était le changement des scores de symptômes dépressifs évalués par un clinicien; les résultats secondaires étaient notamment la réponse clinique, la rémission, l’acceptabilité et les changements d’humeur attribuables au traitement. Nous avons regroupé les résultats quantitativement à l’aide d’une méta-analyse avec modèles à effets aléatoires.

Résultats: Nous avons repéré 7 essais représentant 259 patients souffrant de TB. La photothérapie était associée à une amélioration significative du score à l’échelle de dépression de Hamilton (différence moyenne normalisée = 0,43; intervalle de confiance à 95 % [IC] 0,04 à 0,82; p = 0,03). Il y avait aussi une différence significative en faveur de la photothérapie pour la réponse clinique (rapport de cotes [RC] = 2,32 (IC à 95 % 1,12 à 4,81; p = 0,024) mais pas pour la rémission. Il n’y avait pas de différence des changements affectifs entre la lumière active et les conditions des témoins (RC = 1,30; IC à 95 % 0,38 à 4,44; p = 0,67). Les limitations de l’étude étaient entre autres différents paramètres de la photothérapie, de petites tailles d’échantillons, des traitements de courte durée, et la qualité des variables parmi toutes les études.

Conclusion: Il y a des données positives mais non probantes indiquant que la photothérapie d’appoint réduit les symptômes de la dépression bipolaire et accroît la réponse clinique. La photothérapie est bien tolérée et ne comporte pas de risque accru de changement affectif.

Keywords: bipolar disorder; depression; light therapy; meta-analysis; randomized clinical trials; systematic review.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RWL has received ad hoc speaking/consulting fees or research grantsfrom: Akili, Allergan, Asia-Pacific Economic Cooperation, BC Leading Edge Foundation, Canadian Institutes of Health Research (CIHR), Canadian Network for Mood and Anxiety Treatments (CANMAT), Canadian Psychiatric Association, CME Institute, Hansoh, Healthy Minds Canada, Janssen, Lundbeck, Lundbeck Institute, Medscape, Mind.Me, MITACS, Ontario Brain Institute, Otsuka, Pfizer, St. Jude Medical, University Health Network Foundation, and VGH-UBCH Foundation. LNY has received speaking/consulting fees or research grants from Alkermes, Allergan, CANMAT, CIHR, Lundbeck, Otsuka, Sumitomo Dainippon Pharma, Sunovion, and Valeant.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for study selection (www.prisma-statement.org). PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Risk of bias assessment for included studies.
Figure 3.
Figure 3.
Forest plots from meta-analysis for standardized mean difference in Hamilton Depression Rating Scale scores for active light treatment versus control condition in bipolar depression. CI: Std diff = standardized difference; CI = confidence interval; BLT = bright light treatment; CTL = control condition.
Figure 4.
Figure 4.
Forest plots from meta-analyses for (A) clinical response and (B) clinical remission for active light treatment versus control condition in bipolar depression. CI = confidence interval; BLT = bright light treatment; CTL = control condition.
See this image and copyright information in PMC

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