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Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive DisorderA Randomized Placebo-Controlled Trial
Ritsaert Lieverse, MD;
Eus J. W. Van Someren, PhD;
Marjan M. A. Nielen, PhD;
Bernard M. J. Uitdehaag, MD, PhD;
Jan H. Smit, PhD;
Witte J. G. Hoogendijk, MD, PhD
Arch Gen Psychiatry. 2011;68(1):61-70. doi:10.1001/archgenpsychiatry.2010.183
Context Major depressive disorder (MDD) in elderly individuals is prevalent and debilitating. It is accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus, the biological clock of the brain. Circadian rhythm disturbances are common in the elderly. Suprachiasmatic nucleus stimulation using bright light treatment (BLT) may, therefore, improve mood, sleep, and hormonal rhythms in elderly patients with MDD.
Objective To determine the efficacy of BLT in elderly patients with MDD.
Design Double-blind, placebo-controlled randomized clinical trial.
Setting Home-based treatment in patients recruited from outpatient clinics and from case-finding using general practitioners’ offices in the Amsterdam region.
Participants Eighty-nine outpatients 60 years or older who had MDD underwent assessment at baseline (T0), after 3 weeks of treatment (T1), and 3 weeks after the end of treatment (T2).
Intervention Three weeks of 1-hour early-morning BLT (pale blue, approximately 7500 lux) vs placebo (dim red light, approximately 50 lux).
Main Outcome Measures Mean improvement in Hamilton Scale for Depression scores at T1 and T2 using parameters of sleep and cortisol and melatonin levels.
Results Intention-to-treat analysis showed Hamilton Scale for Depression scores to improve with BLT more than placebo from T0 to T1 (7%; 95% confidence interval, 4%-23%; P = .03) and from T0 to T2 (21%; 7%-31%; P = .001). At T1 relative to T0, get-up time after final awakening in the BLT group advanced by 7% (P < .001), sleep efficiency increased by 2% (P = .01), and the steepness of the rise in evening melatonin levels increased by 81% (P = .03) compared with the placebo group. At T2 relative to T0, get-up time was still advanced by 3% (P = .001) and the 24-hour urinary free cortisol level was 37% lower (P = .003) compared with the placebo group. The evening salivary cortisol level had decreased by 34% in the BLT group compared with an increase of 7% in the placebo group (P = .02).
Conclusions In elderly patients with MDD, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment.
Trial Registration clinicaltrials.gov Identifier NCT00332670
Author Affiliations: Departments of Psychiatry (Drs Lieverse, Nielen, Smit, and Hoogendijk), Integrative Neurophysiology (Dr Van Someren), and Neurology (Dr Uitdehaag) and GGZ inGeest (Drs Lieverse, Nielen, Smit, and Hoogendijk), Neuroscience Campus, and Department of Epidemiology and Biostatistics (Dr Uitdehaag), VU University Medical Center, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (Dr Van Someren), and Center for Neurogenomics and Cognitive Research, VU University (Dr Hoogendijk), Amsterdam; AmaCura, Limburg (Dr Lieverse); Leiden Institute for the Clinical and Experimental Neuroscience of Sleep, Department of Neurology, Leiden University Medical Center, Leiden (Dr Van Someren); and Department of Psychiatry, Erasmus University Medical Center, Rotterdam (Dr Hoogendijk), the Netherlands.
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