Bright light for treatment of depression in the elderly

January 01, 0001

Bright light for treatment of depression in the elderly

Major depressive disorder (MDD) in elderly individuals is often accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus, the biological clock of the brain. Suprachiasmatic nucleus stimulation using bright light treatment (BLT) may, therefore, improve mood, sleep, and hormonal rhythms in elderly patients with MDD. These Dutch investigators conducted a double-blind, placebo-controlled randomized clinical trial among community-dwelling elderly to test this hypothesis. They entrolled 89 outpatients 60 years or older who had MDD underwent assessment at baseline (T0), after 3 weeks of treatment (T1), and 3 weeks after the end of treatment (T2). Intervention consisted of 1-hour early- morning BLT (pale blue, approximately 7500 lux) vs placebo (dim red light, approximately 50 lux).

They found: "Intention-to-treat analysis showed Hamilton Scale for Depression scores to improve with BLT more than placebo from T0 to T1 (7) and from T0 to T2 (21). At T1 relative to T0, get-up time after final awakening in the BLT group advanced by 7%, sleep efficiency increased by 2%, and the steepness of the rise in evening melatonin levels increased by 81% compared with the placebo group. At T2 relative to T0, get-up time was still advanced by 3% and the 24-hour urinary free cortisol level was 37% lower compared with the placebo group. The evening salivary cortisol level had decreased by 34% in the BLT group compared with an increase of 7% in the placebo group."

The authors concluded: "In elderly patients with MDD, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment."

This is a practical therapy with little or no associated risk.

For the full abstract, click here.

Arch Gen Psychiatry 68(1):61-70, January 2011
© 2011 to the American Medical Association
Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive Disorder-A Randomized Placebo-Controlled Trial. Ritsaert Lieverse, Eus J. W. Van Someren, Marjan M. A. Nielen, Bernard M. J. Uitdehaag, Jan H. Smit, Witte J. G. Hoogendijk. Correspondence to Dr. Lieverse: [email protected]

Category: P. Psychological, T. Endocrine/Metabolic/Nutritional. Keywords: major depressive disorder, MDD, elderly, bright light, sleep, melatonin, cortisol, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 18 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.