Thursday, October 13, 2011
depression
Commentary
Contemporary psychiatry has been surprised and chagrined by recent meta-analyses demonstrating that antidepressant drugs have statistically weak benefits among those with mild or moderate depressions, or perhaps total lack of benefit. The benefits of antidepressant drugs have only been consistently demonstrable for the most severe depressions, leaving clinicians without a mainstay for treating mild–moderate depression.
The study of Lieverse and colleagues is therefore extremely welcome, for it demonstrates that bright light can benefit outpatients aged above 60 years with mild major depressions. The bright light benefits were confirmed by a range of rating scales. Moreover, there were no adverse effects significantly more common in the bright light treated group.
Although bright light showed some superiority of response during 3 weeks of treatment, it was peculiar that greater relative benefit was observed in the bright light intervention group at 6 weeks, 3 weeks after the bright light was withdrawn. This was unexpected based on previous light treatment studies. One would like to know more about the results that would likely be obtained with longer intervals of treatment, as well as longer intervals of post-treatment follow-up.
A number of previous studies of bright light treatment (BLT) have suggested promising antidepressant benefits, particularly the inpatient studies of Martiny1 which combined bright light with antidepressants. The current study provides the strongest evidence for bright light benefits in outpatients, particularly in the older age group. More trials and longer term trials are needed.
As the costs and adverse effects of BLT seem minimal, and bright light has proven its worth in treating seasonal depressions, clinicians are beginning to offer BLT now to patients with non-seasonal depression. This study will encourage treatment with bright light for patients aged above 60 years.
Daniel F Kripke
Professor of Psychiatry Emeritus, University of California San Diego, La Jolla, California, USA
