From the Department of Psychiatry and Behavioral Sciences and the Department of Preventive Medicine-Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh; the Epidemiological Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the Department of Statistics, Carnegie Mellon University, Pittsburgh; and the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York.
Am J Psychiatry. 2018 Feb 1;175(2):131-139. doi: 10.1176/appi.ajp.2017.16101200. Epub 2017 Oct 3.
Patients with bipolar disorder have recurrent major depression, residual mood symptoms, and limited treatment options. Building on promising pilot data, the authors conducted a 6-week randomized double-blind placebo-controlled trial to investigate the efficacy of adjunctive bright light therapy at midday for bipolar depression. The aims were to determine remission rate, depression symptom level, and rate of mood polarity switch, as well as to explore sleep quality.
The study enrolled depressed adults with bipolar I or II disorder who were receiving stable dosages of antimanic medication (excluding patients with hypomania or mania, mixed symptoms, or rapid cycling). Patients were randomly assigned to treatment with either 7,000-lux bright white light or 50-lux dim red placebo light (N=23 for each group). Symptoms were assessed weekly with the Structured Interview Guide for the Hamilton Depression Scale With Atypical Depression Supplement (SIGH-ADS), the Mania Rating Scale, and the Pittsburgh Sleep Quality Index. Remission was defined as having a SIGH-ADS score of 8 or less.
At baseline, both groups had moderate depression and no hypomanic or manic symptoms. Compared with the placebo light group, the group treated with bright white light experienced a significantly higher remission rate (68.2% compared with 22.2%; adjusted odds ratio=12.6) at weeks 4-6 and significantly lower depression scores (9.2 [SD=6.6] compared with 14.9 [SD=9.2]; adjusted β=-5.91) at the endpoint visit. No mood polarity switches were observed. Sleep quality improved in both groups and did not differ significantly between them.
The data from this study provide robust evidence that supports the efficacy of midday bright light therapy for bipolar depression.
双相情感障碍患者存在反复发作的重度抑郁症、残留的情绪症状和有限的治疗选择。基于有前景的初步数据，作者进行了一项为期 6 周的随机双盲安慰剂对照试验，以研究午间辅助强光疗法治疗双相抑郁症的疗效。目的是确定缓解率、抑郁症状水平和情绪极性转换率，并探讨睡眠质量。
该研究纳入了正在接受稳定剂量抗躁狂药物治疗（不包括轻躁狂或躁狂、混合症状或快速循环的患者）的双相 I 或 II 型障碍的抑郁成人患者。患者被随机分配接受 7000 勒克斯的强光或 50 勒克斯的弱红光治疗（每组 23 例）。每周使用 Hamilton 抑郁量表伴有非典型抑郁补充版（SIGH-ADS）、躁狂评定量表和匹兹堡睡眠质量指数评估症状。缓解定义为 SIGH-ADS 评分为 8 或更低。
在基线时，两组均有中度抑郁，无轻躁狂或躁狂症状。与弱红光安慰剂组相比，强光治疗组在第 4-6 周的缓解率显著更高（68.2%比 22.2%；调整后的优势比=12.6），终点时的抑郁评分显著更低（9.2[SD=6.6]比 14.9[SD=9.2]；调整后的β=-5.91）。未观察到情绪极性转换。两组的睡眠质量均有所改善，且两组之间无显著差异。
这项研究的数据提供了有力的证据，支持午间强光疗法治疗双相抑郁症的疗效。
