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Adjunctive bright light treatment with gradual advance in unipolar major depressive disorder with evening chronotype – A randomized controlled trial

Published online by Cambridge University Press:  14 September 2020

Joey WY Chan ,
SP Lam ,
Shirley X Li ,
Steven WH Chau ,
SY Chan ,
NY Chan ,
JH Zhang  and
YK Wing Open the ORCID record for YK Wing [Opens in a new window]
Joey WY Chan
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
SP Lam
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
Shirley X Li
Affiliation:
Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
Steven WH Chau
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
SY Chan
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
NY Chan
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
JH Zhang
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
YK Wing*
Affiliation:
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
*
Author for correspondence: Yun-Kwok Wing, Professor, Email: ykwing@cuhk.edu.hk
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Abstract

Background

Unipolar non-seasonal depressed patients with concomitant evening chronotype were associated with poor clinical outcomes and higher non-remission rate. This study aims to examine the efficacy of adjunctive bright light therapy with gradual timing advance in a randomized, assessor and prescriber-blinded controlled trial.

Method

Participants were randomly allocated to receive 5 weeks of either bright white light therapy (BLT) or dim red light (DRL) with the same advancement protocol. Participants were followed up till 5 months after treatment. Primary outcomes included (i) remission rate and (ii) the severity of depression. The analysis was conducted using Kaplan–Meier survival analysis, Cox proportional hazard analysis and linear mixed models.

Results

A total of 93 participants (46.4 ± 11.7 years old, 80% female) were randomized. The cumulative remission rate for the BLT and the DRL groups was 67.4% and 46.7%, respectively. Time to remission was shorter for the BLT group relative to the DRL group (log-rank test p = 0.024). Cox proportional hazard survival analysis showed that patients in the BLT group had a higher probability of achieving remission relative to patients in the DRL group [hazard ratio = 1.9 (95% CI = 1.1– 3.4), p = 0.026]. Further sensitivity analysis demonstrated greater improvement in 17-Hamilton Depression Score (group × time interaction, p = 0.04) in the BLT group for those who were adherent to light therapy.

Conclusions

The use of bright light therapy with gradual advance protocol is an effective adjunctive treatment resulting in quicker and a higher rate of remission of depression in patients with non-seasonal unipolar depression and evening-chronotype.

Keywords

Bright light therapynonseasonal depressionevening chronotype
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 8 , June 2022 , pp. 1448 - 1457
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Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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