Chan Joey Wy, Lam S P, Li Shirley X, Chau Steven Wh, Chan S Y, Chan N Y, Zhang J H, Wing Y K
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
Psychol Med. 2022 Jun;52(8):1448-1457. doi: 10.1017/S0033291720003232. Epub 2020 Sep 14.
Unipolar non-seasonal depressed patients with concomitant evening chronotype were associated with poor clinical outcomes and higher non-remission rate. This study aims to examine the efficacy of adjunctive bright light therapy with gradual timing advance in a randomized, assessor and prescriber-blinded controlled trial.
Participants were randomly allocated to receive 5 weeks of either bright white light therapy (BLT) or dim red light (DRL) with the same advancement protocol. Participants were followed up till 5 months after treatment. Primary outcomes included (i) remission rate and (ii) the severity of depression. The analysis was conducted using Kaplan-Meier survival analysis, Cox proportional hazard analysis and linear mixed models.
A total of 93 participants (46.4 ± 11.7 years old, 80% female) were randomized. The cumulative remission rate for the BLT and the DRL groups was 67.4% and 46.7%, respectively. Time to remission was shorter for the BLT group relative to the DRL group (log-rank test = 0.024). Cox proportional hazard survival analysis showed that patients in the BLT group had a higher probability of achieving remission relative to patients in the DRL group [hazard ratio = 1.9 (95% CI = 1.1- 3.4), = 0.026]. Further sensitivity analysis demonstrated greater improvement in 17-Hamilton Depression Score (group × time interaction, = 0.04) in the BLT group for those who were adherent to light therapy.
The use of bright light therapy with gradual advance protocol is an effective adjunctive treatment resulting in quicker and a higher rate of remission of depression in patients with non-seasonal unipolar depression and evening-chronotype.
伴有晚睡型昼夜节律的单相非季节性抑郁症患者临床预后较差，缓解率较低。本研究旨在通过一项随机、评估者和处方者双盲对照试验，检验辅助明亮光疗法并逐步提前光照时间的疗效。
参与者被随机分配接受为期5周的明亮白光疗法（BLT）或暗光疗法（DRL），两种疗法的光照时间提前方案相同。对参与者随访至治疗后5个月。主要结局包括：（i）缓解率；（ii）抑郁严重程度。采用Kaplan-Meier生存分析、Cox比例风险分析和线性混合模型进行分析。
共有93名参与者（年龄46.4±11.7岁，80%为女性）被随机分组。BLT组和DRL组的累积缓解率分别为67.4%和46.7%。BLT组的缓解时间短于DRL组（对数秩检验P = 0.024）。Cox比例风险生存分析显示，相对于DRL组患者，BLT组患者达到缓解的概率更高[风险比=1.9（95%CI=1.1-3.4），P = 0.026]。进一步的敏感性分析表明，坚持光照疗法的患者中，BLT组的17项汉密尔顿抑郁量表评分改善更明显（组×时间交互作用，P = 0.04）。
采用逐步提前方案的明亮光疗法是一种有效的辅助治疗方法，可使非季节性单相抑郁症且为晚睡型昼夜节律的患者更快缓解抑郁，缓解率更高。
