Light therapy in patients with depression and
Light therapy in patients with depression and
Abstract
Degree Project Thesis, Programme in Medicine. TITLE: Light therapy in patients with depression and insomnia in Department of Psychiatry 363 in
Gothenburg. Abstract
Introduction
Depression and different anxiety disorders belong to the most common public health problems in the world today. At least 25 % of all woman and 15 % of all men will at least once during their lifetime seek treatment for a depressive episode. The treatment alternatives are many and vary depending on the severity and precipitating circumstances; everything from consolidating interview, psychotherapy, anti-depressive medicines to electro-convulsive therapy. Several of them are very effective, however, not all patients respond to antidepressants and there may be considerable side effects.
A relatively recent form of treatment is chronobiology, where the organic circadian rhythm is pre-dominantly manipulated to treat mental symptoms. Previous studies have shown results suggesting that bright light therapy could be an adjuvant treatment to other antidepressants, not only in seasonal affective disorder but also in major depression. The Swedish National Board of Health and Welfare (Socialstyrelsen), however, has called for more evidence from scientific research before recommending light therapy.
Aim
The aim of this thesis was to evaluate the role of the most common chronobiological method, bright light therapy, as adjuvant treatment in patients with affective disorder and contribute to the knowledge of light therapy and its possible impact on depression, insomnia and medication needed.
Methods
Bright light therapy was introduced as an adjuvant therapy and offered to suitable patients admitted to Department 363 Sahlgrenska University Hospital/Östra in October 2013. Patient records were collected prospectively for those receiving bright light therapy as adjunctive treatment and retrospectively for historical controls. The first 18 consecutive patients who completed the adjuvant bright light therapy were included. For each of the 18 patients two patients admitted up to three years previously were included as controls. The controls had to: a) be same sex, b) be at a similar age at admission (within one to two years) and c) meet the criteria for bright light therapy without it being available.
The patient records included results from the two questionnaires: The Insomnia Severity Index (ISI) and the self-rating version of Montgomery–Åsberg Depression Rating Scale (MADRS-S). ISI is a diagnostic questionnaire used to evaluate the severity of insomnia and MADRS-S is a diagnostic questionnaire used to evaluate the severity of depressive disorders in affective patients.
Results The mean age in the bright light therapy group was 39.1 years compared to 38.8 in the control group and in each group there were more woman, 72 %. The mean length of stay was 16 days for the light therapy group and 19 for the control group - a 3-day shorter stay for the those who had received bright light therapy. The mean MADRSs end score was 27 points for the light therapy group and 23 for the control group - a 4-point higher score for the patients who had received light therapy. The total accumulated dose of diazepam equivalent of benzodiazepine for the whole hospital stay for the control group was 100 mg and 75 for the light therapy group. Patients did not experience severe side effects and no patient switched to a manic state. The daily average dosage was 4.8 respectively 4.3 mg/day. However, these results did not reach statistical significance.
Discussion and conclusion This study did not find a significantly more rapid improvement in depressive self-scoring and insomnia which might be due to too small groups. Though, it provides support to continue studying light therapy in patients with affective disorder as the results point in the direction that light therapy possibly could shorten the length of stay and reduce the consumption of diazepam Also there were few to no side effects and light therapy could be a valuable alternative for hard-to-treat patients. A randomized controlled trial with a higher number of patients would be necessary for achieving high statistical power. It would also be interesting if such a study looked further into the use of benzodiazepines and if it would be possible to decrease the use of these highly dependence producing medications with light therapy.
Degree
Student essay
Collections
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Date
2016-02-11Author
Hantelius, Victor
Keywords
Light therapy
depression
insomnia
Language
eng