title: Enhanced inflammatory and T-helper-1 type responses but suppressed lymphocyte proliferation in patients with seasonal affective disorder and treated by light therapy.
abstract: BACKGROUND
  Animals show seasonal changes in the endocrine and immune system in response to winter stressors. Even though increased inflammation has been implicated in the pathophysiology of depression, whether immune disorder is a key mediator in seasonal affective depression (SAD) is unknown. Here, we hypothesized that short photoperiods in winter may induce inflammatory response, which contributes to SAD, and that light treatments should normalize immune function and improve depressive symptoms.
  
  
  METHODS
  Twenty patients with a diagnosis of SAD, and a score on the HAM-29 of 20 or higher were recruited for this study. Twenty-one healthy subjects with no personal and family history of psychiatric disorder were matched to patients according to age and sex. Patients and controls were sampled during winter between November and January, inclusive. A subset of SAD patients (N=13) was re-sampled after 4 weeks of light therapy. Blood samples were assayed for macrophage activity, lymphocyte proliferation and cytokine release.
  
  
  RESULTS
  SAD patients showed significantly higher macrophage activity and lower lymphocyte proliferation in winter compared to healthy subjects. The concentrations of macrophage-produced proinflammatory cytokines interleukin-1β and tumour necrosis factor-α, and T-helper (Th)-1 produced cytokine, interferon-γ were all significantly increased. In contrast, no significant changes in Th2-produced cytokines were observed. Light therapy significantly improved depressive scores, which was associated with attenuation of decreased lymphocyte functions, increased macrophage activity and level of proinflammatory cytokines.
  
  
  CONCLUSIONS
  SAD patients have increased macrophage and Th1 type responses in winter, and light therapy normalized immune functions and depressive symptoms. These results support an inflammatory hypothesis for SAD and an immunomodulatory role of light therapy.
authors.affiliation: Research Institute for Marine Drugs and Nutrition, College of Food Science and Technology, Guangdong Ocean University, Zhanjiang, Guangdong, China; Graduate Institute of Neural and Cognitive Sciences, China Medical University Hospital, Taichung, Taiwan; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. Electronic address: cai.song@dal.ca.
authors.forename: Cai
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Biomedical Sciences, University of Prince Edward Island, Charlottetown, Canada; Neurology Department, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Luchtman
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Kang
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Tam
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
authors.affiliation: Graduate Institute of Neural and Cognitive Sciences, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Kuan-Pin
authors.initials: KP
authors.lastname: Su
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. Electronic address: rlam@ubc.ca.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000818:Animals; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications; D007371:Interferon-gamma / Q000097:blood; D007375:Interleukin-1 / Q000097:blood*; D008214:Lymphocytes; D008297:Male; D010789:Phototherapy; D016574:Seasonal Affective Disorder / Q000097:blood* / Q000150:complications / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D016207:Cytokines; D007375:Interleukin-1; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma
keywords: Light therapy; Lymphocyte proliferation; Macrophage activity; Proinflammatory cytokines; Seasonal affective disorder; Th1 and Th2 cytokines