Skip to main content
×
×
Home

Light therapy for non-seasonal depression: systematic review and meta-analysis

  • Stefan Perera (a1), Rebecca Eisen (a2), Meha Bhatt (a1), Neera Bhatnagar (a3), Russell de Souza (a1) (a4), Lehana Thabane (a5) (a6) and Zainab Samaan (a1) (a6) (a7)...
Abstract
Background

Light therapy is a known treatment for patients with seasonal affective disorder. However, the efficacy of light therapy in treating patients with non-seasonal depression remains inconclusive.

Aims

To provide the current state of evidence for efficacy of light therapy in non-seasonal depressive disorders.

Method

Systematic review of randomised controlled trials (RCTs) was conducted by searching MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL from their inception to September 2015. Study selection, data abstraction and risk of bias assessment were independently conducted in duplicate. Meta-analyses were performed to provide a summary statistic for the included RCTs. The reporting of this systematic review follows the PRISMA guidelines.

Results

A meta-analysis including 881 participants from 20 RCTs demonstrated a beneficial effect of light therapy in non-seasonal depression (standardised mean difference in depression score −0.41 (95% CI −0.64 to −0.18)). This estimate was associated with significant heterogeneity (I 2=60%, P=0.0003) that was not sufficiently explained by subgroup analyses. There was also high risk of bias in the included trials limiting the study interpretation.

Conclusions

The overall quality of evidence is poor due to high risk of bias and inconsistency. However, considering that light therapy has minimal side-effects and our meta-analysis demonstrated that a significant proportion of patients achieved a clinically significant response, light therapy may be effective for patients with non-seasonal depression and can be a helpful additional therapeutic intervention for depression.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Light therapy for non-seasonal depression: systematic review and meta-analysis
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Light therapy for non-seasonal depression: systematic review and meta-analysis
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Light therapy for non-seasonal depression: systematic review and meta-analysis
      Available formats
      ×
Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Corresponding author
Zainab Samaan, Associate Professor, Mood Disorders Program, Centre for Mountain Health, 100 West 5th Street, Hamilton, Ontario, Canada L8N 3K7. Email: samaanz@mcmaster.ca
Footnotes
Hide All

Declaration of interest

None.

Copyright and usage

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Footnotes
References
Hide All
1 World Health Organzation (WHO). Depression Fact Sheet. WHO, 2015 (http://www.who.int/mediacentre/factsheets/fs369/en/).
2 Lopez, AD, Murray, CJ. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Harvard School of Public Health, 1996.
3 Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003; 33: 395405.
4 American Psychological Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder APA, 2010.
5 Connolly, KR, Thase, ME. If at first you don't succeed. Drugs 2011; 71: 4364.
6 Fava, M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry 2003; 53: 649–59.
7 Rosenthal, NE, Sack, DA, Gillin, JC, Lewy, AJ, Goodwin, FK, Davenport, Y, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41: 7280.
8 Terman, M, Terman, JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety and side effects. CNS Spectr 2005; 10: 647–63.
9 Lam, R, Levitt, A, Levitan, R, Enns, M, Morehouse, R, Michalak, E, et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry 2006; 163: 805–12.
10 Lee, T, Chan, C. Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand 1999; 99: 315–23.
11 Golden, RN, Gaynes, BN, Ekstrom, RD, Hamer, RM, Jacobsen, FM, Suppes, T, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162: 656–62.
12 Even, C, Schröder, CM, Friedman, S, Rouillon, F. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord 2008; 108: 1123.
13 Tuunainen, A, Kripke, DF, Endo, T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004; 2: CD004050.
14 Pail, G, Huf, W, Pjrek, E, Winkler, D, Willeit, M, Praschak-Rieder, N, et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology 2010; 64: 152–62.
15 Oldham, MA, Ciraulo, DA. Bright light therapy for depression: review of its effects on chronobiology and the autonomic nervous system. Chronobiol Int 2014; 31: 305–19.
16 Lieverse, R, Van Someren, EJ, Nielen, MM, Uitdehaag, BM, Smit, JH, Hoogendijk, WJ. Bright light treatment in elderly patients with non-seasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry 2011; 68: 6170.
17 Thalén, BE, Mørkrid, L, Kjellman, B, Wetterberg, L. Cortisol in light treatment of seasonal and non-seasonal depression: relationship between melatonin and Cortisol. Acta Psychiatr Scand 1997; 96: 385–94.
18 Mårtensson, B, Pettersson, A, Berglund, L, Ekselius, L. Bright white light therapy in depression: a critical review of the evidence. J Affect Disord 2015; 182: 17.
19 Sit, D, McGowan, J, Wiltrout, C, Dills, J, Weingarden, J, Diler, RS, et al. Light therapy for bipolar depression: a randomized, double-blind, parallel placebo-control trial. Neuropsychopharmacology 2014; 39: S5667.
20 Wirz-Justice, A, Bader, A, Frisch, U, Stieglitz, R-D, Alder, J, Bitzer, J, et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry 2011; 72: 986–93.
21 Franchini, L, Ballan, S, Colombo, C, Smeraldi, E. Light therapy and fluvoxamine in the treatment of bipolar psychotic depression: a pilot study. Clin Neuropsychiatry 2009; 6: 166–74.
22 Corral, M, Wardrop, A, Zhang, H, Grewal, A, Patton, S. Morning light therapy for postpartum depression. Arch Women's Ment Health 2007; 10: 221–4.
23 Özdemir, PG, Boysan, M, Smolensky, MH, Selvi, Y, Aydin, A, Yilmaz, E. Comparison of venlafaxine alone versus venlafaxine plus bright light therapy combination for severe major depressive disorder. J Clin Psychiatry 2015; 76: 645–54.
24 Lam, RW, Levitt, AJ, Levitan, RD, Michalak, EE, Morehouse, R, Ramasubbu, R, 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: 5663.
25 Martiny, K, Lunde, M, Unden, M, Dam, H, Bech, P. Adjunctive bright light in non-seasonal major depression: results from clinician-rated depression scales. Acta Psychiatrica Scandinavica 2005; 112: 117–25.
26 Loving, RT, Kripke, DF, Elliott, JA, Knickerbocker, NC, Grandner, MA. Bright light treatment of depression for older adults [ISRCTN55452501]. BMC Psychiatry 2005; 5: 41.
27 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 2649.
28 Higgins, JP, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
29 Viera, AJ, Garrett, JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37: 360–3.
30 Guyatt, GH, Oxman, AD, Kunz, R, Atkins, D, Brozek, J, Vist, G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011; 64: 395400.
31 Guyatt, G, Rennie, D. Users' Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. AMA Press, 2002.
32 Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 55–7.
33 Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 5662.
34 Epperson, CN, Terman, M, Terman, JS, Hanusa, BH, Oren, DA, Peindl, KS, et al. Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry 2004; 65: 421–5.
35 Sumaya, IC, Rienzi, BM, Deegan, JF, Moss, DE. Bright light treatment decreases depression in institutionalized older adults a placebo-controlled crossover study. J Gerontol A Biol Sci Med Sci 2001; 56: M356–60.
36 Goel, N, Terman, M, Terman, JS, Macchi, MM, Stewart, JW. Controlled trial of bright light and negative air ions for chronic depression. Psychol Med 2005; 35: 945–55.
37 Mackert, A, Volz, H-P, Stieglitz, R-D, Müller-Oerlinghausen, B. Phototherapy in nonseasonal depression. Biol Psychiatry 1991; 30: 257–68.
38 Kripke, DF, Mullaney, DJ, Klauber, MR, Risch, SC, Gillin, JC. Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry 1992; 31: 119–34.
39 Holsboer-Trachsler, E, Hemmeter, U, Hatzinger, M, Seifritz, E, Gerhard, U, Hobi, V. Sleep deprivation and bright light as potential augmenters of antidepressant drug treatment – neurobiological and psychometric assessment of course. J Psychiatr Res 1994; 28: 381–99.
40 Yamada, N, Martin-Iverson, MT, Daimon, K, Tsujimoto, T, Takahashi, S. Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol Psychiatry 1995; 37: 866–73.
41 Prasko, J, Horacek, J, Klaschka, J, Kosova, J, Ondrackova, I, Sipek, J. Bright light therapy and/or imipramine for inpatients with recurrent non-seasonal depression. Neuroendocrinol Lett 2002; 23: 109–13.
42 Benedetti, F, Colombo, C, Serretti, A, Lorenzi, C, Pontiggia, A, Barbini, B, et al. Antidepressant effects of light therapy combined with sleep deprivation are influenced by a functional polymorphism within the promoter of the serotonin transporter gene. Biol Psychiatry 2003; 54: 687–92.
43 Tsai, YF, Wong, TK, Juang, YY, Tsai, HH. The effects of light therapy on depressed elders. Int J Geriatr Psychiatry 2004; 19: 545–8.
44 McEnany, GW, Lee, KA. Effects of light therapy on sleep, mood, and temperature in women with nonseasonal major depression. Issues Ment Health Nurs 2005; 26: 781–94.
45 Loving, RT, Kripke, DF, Shuchter, SR. Bright light augments antidepressant effects of medication and wake therapy. Depress Anxiety 2002; 16: 13.
46 Higgins, JP, Green, S. CochraneHandbook for Systematic Reviews of Interventions. Wiley Online Library, 2008.
47 Sun, X, Briel, M, Walter, SD, Guyatt, GH. Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. BMJ 2010; 340: c117.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Perera et al. supplementary material
Supplementary Material

 PDF (280 KB)
280 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 15
Total number of PDF views: 160 *
Loading metrics...

Abstract views

Total abstract views: 488 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 17th August 2018. This data will be updated every 24 hours.

Light therapy for non-seasonal depression: systematic review and meta-analysis

  • Stefan Perera (a1), Rebecca Eisen (a2), Meha Bhatt (a1), Neera Bhatnagar (a3), Russell de Souza (a1) (a4), Lehana Thabane (a5) (a6) and Zainab Samaan (a1) (a6) (a7)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *