From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
Neurology. 2019 Mar 12;92(11):e1145-e1156. doi: 10.1212/WNL.0000000000007090. Epub 2019 Feb 15.
To assess the efficacy of bright light therapy (BLT) in reducing depressive symptoms in patients with Parkinson disease (PD) and major depressive disorder (MDD) compared to a control light.
In this double-blind controlled trial, we randomized patients with PD and MDD to treatment with BLT (±10,000 lux) or a control light (±200 lux). Participants were treated for 3 months, followed by a 6-month naturalistic follow-up. The primary outcome of the study was the Hamilton Depression Rating Scale (HDRS) score. Secondary outcomes were objective and subjective sleep measures and salivary melatonin and cortisol concentrations. Assessments were repeated halfway, at the end of treatment, and 1, 3, and 6 months after treatment. Data were analyzed with a linear mixed-model analysis.
We enrolled 83 participants. HDRS scores decreased in both groups without a significant between-group difference at the end of treatment. Subjective sleep quality improved in both groups, with a larger improvement in the BLT group (B [SE] = 0.32 [0.16], = 0.04). Total salivary cortisol secretion decreased in the BLT group, while it increased in the control group (B [SE] = -8.11 [3.93], = 0.04).
BLT was not more effective in reducing depressive symptoms than a control light. Mood and subjective sleep improved in both groups. BLT was more effective in improving subjective sleep quality than control light, possibly through a BLT-induced decrease in cortisol levels.
NCT01604876.
This study provides Class I evidence that BLT is not superior to a control light device in reducing depressive symptoms in patients with PD with MDD.
评估强光疗法（BLT）在降低帕金森病（PD）和重度抑郁症（MDD）患者抑郁症状方面的疗效，与对照光相比。
在这项双盲对照试验中，我们将 PD 和 MDD 患者随机分为 BLT（±10,000 勒克斯）或对照光（±200 勒克斯）治疗组。参与者接受 3 个月的治疗，然后进行 6 个月的自然随访。研究的主要结果是汉密尔顿抑郁评定量表（HDRS）评分。次要结果是客观和主观睡眠测量以及唾液褪黑素和皮质醇浓度。评估在中途、治疗结束时以及治疗后 1、3 和 6 个月重复进行。数据采用线性混合模型分析进行分析。
我们共纳入了 83 名参与者。两组的 HDRS 评分均下降，但治疗结束时两组间无显著差异。两组的主观睡眠质量均有所改善，BLT 组的改善更为明显（B [SE] = 0.32 [0.16]， = 0.04）。BLT 组的总唾液皮质醇分泌减少，而对照组则增加（B [SE] = -8.11 [3.93]， = 0.04）。
BLT 在降低抑郁症状方面并不优于对照光。两组的情绪和主观睡眠均有所改善。BLT 在改善主观睡眠质量方面比对照光更有效，可能是通过 BLT 诱导的皮质醇水平降低所致。
临床试验.gov 标识符：NCT01604876。
本研究提供了 I 级证据，表明 BLT 并不优于对照光设备，无法降低伴发 MDD 的 PD 患者的抑郁症状。
