Bright light treatment of depression for older adults [ISRCTN55452501].
BACKGROUND
The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery.


METHODS
In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (<10 Lux) light for one hour a day at three different times (morning, mid-wake and evening). A placebo response washout was used for the first week. Wake treatment was conducted prior to the initiation of treatment, to explore antidepressant response and the interaction with light treatment. Urine and saliva samples were collected during a 24-hour period both before and after treatment and assayed for aMT6s and melatonin respectively to observe any change in circadian timing. Subjects wore a wrist monitor to record light exposure and wrist activity. Daily log sheets and weekly mood (GDS) and physical symptom (SAFTEE) scales were administered. Each subject was given a SCID interview and each completed a mood questionnaire (SIGH-SAD-SR) before and after treatment. Also, Hamilton Depression Rating (SIGH-SAD version) interviews were conducted by a researcher who was blind to the treatment condition. A control group of healthy, age-matched, volunteers was studied for one day to obtain baseline data for comparison of actigraphy and hormone levels.


RESULTS
Eighty-one volunteers, between 60 and 79 years old, completed the study. Both treatment and placebo groups experienced mood improvement. Average GDS scores improved 5 points, the Hamilton Depression Rating Scale (HDRS) 17 scores (extracted from the self-rated SIGH-SAD-SR) improved 6 points. There were no significant treatment effects or time-by-treatment interactions. No significant adverse reactions were observed in either treatment group. The assays of urine and saliva showed no significant differences between the treatment and placebo groups. The healthy control group was active earlier and slept earlier but received less light than the depressed group at baseline.


CONCLUSIONS
Antidepressant response to bright light treatment in this age group was not statistically superior to placebo. Both treatment and placebo groups experienced a clinically significant overall improvement of 16%.
Loving
Richard T
RT
Department of Psychiatry, University of California, San Diego, USA. rloving@ucsd.edu
Kripke
Daniel F
DF
Elliott
Jeffrey A
JA
Knickerbocker
Nancy C
NC
Grandner
Michael A
MA
D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000502:physiology; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008029:Lighting / Q000379:methods; D008297:Male; D008499:Medical Records; D008550:Melatonin / Q000032:analysis / Q000378:metabolism / Q000652:urine; D008875:Middle Aged; D010789:Phototherapy / Q000379:methods*; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000737:chemistry; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000928:Antidepressive Agents; D010919:Placebos; D008550:Melatonin