Terman M, Terman J S
Department of Psychiatry, Columbia University, New York, NY, USA.
J Clin Psychiatry. 1999 Nov;60(11):799-808; quiz 809.
Bright light therapy has been established for treatment of winter depression, or seasonal affective disorder (SAD). Analysis of side effects most often have focused on a narrow set of suspected symptoms, based on clinical observation (e.g., headache, eyestrain, nausea, insomnia, and hyperactivity). This study broadens the purview to a set of 88 physical and subjective symptoms that might emerge, remit, or remain unchanged relative to baseline, thus reducing bias toward assessment of presumed side effects.
Eighty-three patients with SAD (DSM-III-R criteria for mood disorders with seasonal pattern [winter type] and National Institute of Mental Health criteria for SAD) received bright light therapy at 10,000 lux for 30 minutes daily in the morning or evening for 10 to 14 days. They completed a questionnaire (Systematic Assessment for Treatment Emergent Effects), rating symptom severity before and after treatment. Results were compared for morning or evening treatment and for responders and nonresponders.
Several side effects emerged--mostly mildly--including jumpiness/jitteriness (8.8%), headache (8.4%), and nausea (15.9%), mirroring findings of past studies with a less inclusive scope. In most cases, remission rate equalled or exceeded emergence rate. Several nondepressive symptoms also showed large improvement, including poor vision and skin rash/itch/irritation. Being overactive/excited/elated showed greater emergence under morning light and greater remission under evening light. Emergence of nausea was greater than remission in responders.
The dominant effect of light treatment was improvement in bothersome symptoms. Although patients should be advised of side effects and guided in dose manipulations to reduce them, attention also should be drawn to the substantial benefit-to-risk ratio. Improvement of symptoms outside the depressive cluster, seen in both responders and nonresponders, may point to new therapeutic uses of light therapy.
强光疗法已被确立用于治疗冬季抑郁症或季节性情感障碍（SAD）。基于临床观察，对副作用的分析通常集中在一小部分疑似症状上（例如，头痛、眼疲劳、恶心、失眠和多动）。本研究将范围扩大到一组88种可能出现、缓解或相对于基线保持不变的身体和主观症状，从而减少了对假定副作用评估的偏差。
83名季节性情感障碍患者（符合《精神疾病诊断与统计手册》第三版修订版中季节性模式[冬季型]情绪障碍的标准以及美国国立精神卫生研究所季节性情感障碍的标准）接受了10000勒克斯的强光疗法，每天早晨或晚上照射30分钟，持续10至14天。他们完成了一份问卷（治疗突发效应系统评估），对治疗前后的症状严重程度进行评分。比较了早晨或晚上治疗以及应答者和非应答者的结果。
出现了几种副作用——大多为轻度——包括神经过敏/紧张不安（8.8%）、头痛（8.4%）和恶心（15.9%），这与过去范围较窄的研究结果一致。在大多数情况下，缓解率等于或超过出现率。几种非抑郁症状也有显著改善，包括视力不佳和皮疹/瘙痒/刺激。多动/兴奋/欣喜在早晨光照下出现的情况更多，而在晚上光照下缓解的情况更多。应答者中恶心的出现率大于缓解率。
光照治疗的主要效果是改善令人烦恼的症状。虽然应告知患者副作用，并指导其进行剂量调整以减少副作用，但也应注意其显著的效益风险比。应答者和非应答者中均出现的抑郁症状群之外的症状改善，可能指向光照疗法的新治疗用途。
