Avery D H, Bolte M A, Ries R
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104-2499, USA.
J Clin Psychiatry. 1998 Jan;59(1):36-42; quiz 43-4. doi: 10.4088/jcp.v59n0109.
Recent data suggest that winter depression (seasonal affective disorder [SAD]) may be a subtype of affective disorder that is closely related to alcoholism. Dawn simulation has been shown in controlled trials to be effective in SAD. The present study examined the effectiveness of dawn simulation in abstinent alcoholics who met DSM-III-R criteria for major depression, or bipolar disorder, depressed with seasonal pattern.
All 12 subjects with winter depression had a history of either alcohol dependence or alcohol abuse according to DSM-III-R and had been abstinent from alcohol for at least 6 months. They also fulfilled criteria for SAD according to Rosenthal and were hypersomnic and drug free. After a 1-week baseline period, the subjects were randomly assigned to a 1-week treatment period at home with either a white 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 250 lux or a red 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 2 lux. The subjects were told that they would receive daily either a red or a white dawn reaching the same illuminance, an illuminance that would be much dimmer than standard bright light treatment. At the end of each week, the subjects were blindly assessed by a psychiatrist using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder version (SIGH-SAD).
For the 6 subjects completing the white dawn treatment, the mean SIGH-SAD score decreased from 33.0 at baseline to 15.8 after treatment. For the 6 subjects completing the dim red dawn treatment, the mean SIGH-SAD score decreased from 34.3 to 32.7. The mean post-dawn SIGH-SAD score was significantly lower after the white dawn treatment than after the dim red dawn treatment (ANCOVA with baseline SIGH-SAD as the covariate, F = 12.95, p < .01). Superiority of the white dawn was also found by analogous analyses for the Hamilton Rating Scale for Depression (HAM-D) (p < .01) and the SAD Subscale (p < .05).
The present study suggest that dawn simulation may be helpful in decreasing depression in abstinent alcoholics with SAD. Further study is necessary to confirm these preliminary findings and to determine whether dawn simulation might be helpful in preventing relapse in abstinent alcoholics who have SAD.
近期数据表明，冬季抑郁症（季节性情感障碍[SAD]）可能是一种与酒精中毒密切相关的情感障碍亚型。在对照试验中已证明黎明模拟疗法对季节性情感障碍有效。本研究探讨了黎明模拟疗法对符合《精神疾病诊断与统计手册第三版修订版》（DSM-III-R）中重度抑郁症或双相情感障碍伴季节性发作抑郁标准的戒酒者的疗效。
所有12名患有冬季抑郁症的受试者根据DSM-III-R均有酒精依赖或酒精滥用史，且已戒酒至少6个月。他们还符合罗森塔尔提出的季节性情感障碍标准，有嗜睡症状且未服用药物。在为期1周的基线期后，受试者被随机分配到在家进行为期1周的治疗期，接受两种治疗之一：一种是从凌晨4:30至6:00的1.5小时白色黎明模拟，光照强度在250勒克斯达到峰值；另一种是从凌晨4:30至6:00的1.5小时红色黎明模拟，光照强度在2勒克斯达到峰值。受试者被告知他们每天会接受红色或白色的黎明模拟，达到相同的光照强度，且该光照强度比标准强光疗法要暗得多。在每周结束时，由一名精神科医生使用汉密尔顿抑郁量表季节性情感障碍版（SIGH-SAD）的结构化访谈指南对受试者进行盲法评估。
对于完成白色黎明模拟治疗的6名受试者，SIGH-SAD平均得分从基线时的33.0降至治疗后的15.8。对于完成暗红色黎明模拟治疗的6名受试者，SIGH-SAD平均得分从34.3降至32.7。以基线SIGH-SAD作为协变量进行协方差分析（ANCOVA），结果显示白色黎明模拟治疗后的黎明后SIGH-SAD平均得分显著低于暗红色黎明模拟治疗后（F = 12.95，p <.01）。通过对汉密尔顿抑郁量表（HAM-D）（p <.01）和季节性情感障碍分量表（p <.05）的类似分析，也发现了白色黎明模拟疗法的优越性。
本研究表明，黎明模拟疗法可能有助于减轻患有季节性情感障碍的戒酒者的抑郁症状。需要进一步研究以证实这些初步发现，并确定黎明模拟疗法是否有助于预防患有季节性情感障碍的戒酒者复发。
