Reference
Lam RW, Levitt AJ, Levitan RD, et al. Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2016;73(1):56-63.
Design
Randomized, double-blind, placebo- and sham-controlled trial
Participants
This trial included 122 participants aged 19 to 60 years who were diagnosed with nonseasonal major depressive disorder. The duration of the current major depressive disorder episode ranged from 45 to 90 weeks. Participants came from outpatient psychiatry clinics in academic centers. Data was collected from October 2009 to March 2014.
Intervention
Participants were randomly assigned to receive 30 minutes per day of full-spectrum light therapy plus a placebo; 30 minutes of full-spectrum light therapy plus fluoxetine (Prozac, 20 mg/d); fluoxetine (20 mg/day) without light therapy; or placebo (inactive light therapy plus placebo pill).
Outcomes Measurement
The Montgomery-Asberg Depression Rating Scale (MADRS) was taken at baseline and at the end of the 8-week trial. Remission was also used as a secondary outcome.
Key Findings
At the end of the 8-week trial, mean changes in MADRS scores from baseline were significantly greater in those who received the full-spectrum light therapy compared to fluoxetine. Of the patients receiving the light therapy, 43.8% went into remission compared to 19.4% of the patients who were taking fluoxetine alone. There was a 58.6% remission rate in the patients who received both the light therapy and the fluoxetine.
Practice Implications
For years, full-spectrum light has been used as an effective treatment for seasonal affective disorder.1,2 This recent clinical trial adds to the growing body of evidence indicating that full-spectrum light can also be efficacious in nonseasonal forms of depression. These results are consistent with previous studies. A 2005 meta-analysis of randomized, controlled trials consistently found a significant reduction in depression symptom severity in both seasonal and nonseasonal disorders.3 In a 2013 randomized controlled trial, Baxendale et al found that bright light therapy significantly reduced symptoms of anxiety and depression in epileptic patients.4 Research also demonstrates that bright light therapy is safe despite previous reports of adverse effects.5 In rare cases, eye strain and blurred vision can occur.
Light boxes that are similar to those used in this clinical trial are easily available at a cost of $69 to $199. An alternative to light boxes is getting outdoors in the sunlight for 30 minutes a day. Standard light bulbs can also be replaced with full-spectrum light bulbs in areas of the home or office in which patients spend most of their time.
Light therapy should be considered as a first-line or adjuvant treatment in patients with nonseasonal major depression. This is significant as these cases of depression can be difficult to treat, and pharmaceutical drugs can produce significant side effects.6,7
