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Bright light monotherapy, combination effective for nonseasonal MDD

Results from a randomized, double-blind, placebo-and-sham-controlled trial indicated efficacy of bright light treatment, both as monotherapy and in combination with fluoxetine, for nonseasonal major depressive disorder.

“Light therapy, an effective treatment for seasonal affective disorder (SAD), may also be appropriate for [major depressive disorder (MDD)]. Bright light is a safe, well-tolerated, nonpharmacological treatment that can be used alone or combined with medications. Light can correct disturbed circadian rhythms, which have been implicated in the pathophysiology of MDD,” Raymond W. Lam, MD, of the University of British Columbia, Vancouver, Canada, and colleagues wrote. “Previous meta-analyses of light therapy for nonseasonal MDD, however, have yielded only equivocal and conflicting evidence for efficacy.”

To determine efficacy of light treatment, as monotherapy and in combination with fluoxetine hydrochloride, researchers randomly assigned 122 adults with at least moderately severe MDD to light monotherapy (n = 32), 20 mg/day of fluoxetine monotherapy (n = 31), combination therapy (n = 29) or placebo (n = 30) for 8 weeks. Light therapy consisted of active 10,000-lux fluorescent white light box for 30 minutes/day in the morning. Researchers measured change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to 8 weeks.

Mean changes in MADRS scores were 13.4 among participants in the light monotherapy group, 8.8 among those in the fluoxetine monotherapy group, 16.9 in the combination therapy group, and 6.5 in the placebo group.

MADRS score changes for combination therapy and light monotherapy were significantly superior to placebo, while score change for fluoxetine monotherapy was not superior to placebo.

Compared with placebo (33.3%), 29% of participants who received fluoxetine monotherapy, 50% of those who received light monotherapy and 75.9% of those who received combination therapy achieved response at end point.

Remission was achieved by 19.4% of participants in the fluoxetine monotherapy group, 43.8% of the light monotherapy group, 58.6% of the combination group and 30% of the placebo group.

Combination therapy achieved superior MADRS response compared with placebo, with numbers needed to treat of 2.4 (95% CI, 1.6-5.8) and 3.5 (95% CI, 2-29.9), respectively.

All treatments were generally well-tolerated, according to researchers.

“Light treatment, whether in monotherapy or particularly in combination with fluoxetine, is efficacious and well-tolerated in the treatment of nonseasonal MDD. The treatment effects were large and [numbers needed to treat] were clinically relevant. Further studies exploring mediators and moderators of response will be important,” the researchers concluded. – by Amanda Oldt

Disclosure: Lam reported receiving research funds from Brain Canada, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Coast Capital Savings, Lundbeck, Pfizer, St Jude Medical, University Health Network Foundation, and Vancouver Coastal Health Research Institute; serving as a consultant to and/or receiving speaker honoraria from AstraZeneca, Bristol-Myers Squibb, Canadian Psychiatric Association, Canadian Network for Mood and Anxiety Treatments, Eli Lilly and Co, Johnson and Johnson, Lundbeck, Lundbeck Institute, Mochida, Otsuka, Pfizer, Servier, and Takeda; receiving royalties from Cambridge University Press, Informa Press, and Oxford University Press; and holding a copyright on the Lam Employment Absence and Productivity Scale (LEAPS). Please see the full study for a list of all authors’ relevant financial disclosures.