Morning vs Evening Light Treatment of Patients With Winter Depression

Morning vs Evening Light Treatment of Patients With Winter Depression

BACKGROUND According to the phase-shift hypothesis for winter depression, morning light (which causes a circadian phase advance) should be more antidepressant than evening light (which causes a delay). Although no studies have shown evening light to be more antidepressant than morning light, investi...

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Bibliographic Details
Published in:Archives of general psychiatry Vol. 55; no. 10; pp. 890 - 896
Main Authors: Lewy, Alfred J, Bauer, Vance K, Cutler, Neil L, Sack, Robert L, Ahmed, Saeeduddin, Thomas, Katherine H, Blood, Mary L, Latham Jackson, Jeanne M
Format: Journal Article
Language:English
Published: Chicago, IL American Medical Association 01-10-1998
Subjects:
Adult
Biological and medical sciences
Circadian Rhythm
Cross-Over Studies
Female
Humans
Male
Medical sciences
Melatonin - blood
Middle Aged
Miscellaneous
Photoperiod
Phototherapy - methods
Psychiatric Status Rating Scales - statistics & numerical data
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Seasonal Affective Disorder - psychology
Seasonal Affective Disorder - therapy
Sleep - physiology
Treatment Outcome
Treatments
Mood disorder
Human
Treatment
Winter
Evening
Seasonal variation
Morning
Depression
Biological rhythm
Circadian rhythm
Light stimulus
Phototherapy
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Summary:BACKGROUND According to the phase-shift hypothesis for winter depression, morning light (which causes a circadian phase advance) should be more antidepressant than evening light (which causes a delay). Although no studies have shown evening light to be more antidepressant than morning light, investigations have shown either no difference or morning light to be superior. The present study assesses these light-exposure schedules in both crossover and parallel-group comparisons. METHODS Fifty-one patients and 49 matched controls were studied for 6 weeks. After a prebaseline assessment and a light/dark and sleep/wake adaptation baseline week, subjects were exposed to bright light at either 6 to 8 AM or 7 to 9 PM for 2 weeks. After a week of withdrawal from light treatment, they were crossed over to the other light schedule. Dim-light melatonin onsets were obtained 7 times during the study to assess circadian phase position. RESULTS Morning light phase-advanced the dim-light melatonin onset and was more antidepressant than evening light, which phase-delayed it. These findings were statistically significant for both crossover and parallel-group comparisons. Dim-light melatonin onsets were generally delayed in the patients compared with the controls. CONCLUSIONS These results should help establish the importance of circadian (morning or evening) time of light exposure in the treatment of winter depression. We recommend that bright-light exposure be scheduled immediately on awakening in the treatment of most patients with seasonal affective disorder.Arch Gen Psychiatry. 1998;55:890-896-->
Bibliography:ObjectType-Article-2
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ISSN:0003-990X
1538-3636
DOI:10.1001/archpsyc.55.10.890