Transcranial bright light treatment via the ear canals in seasonal affective disorder: a randomized, double-blind dose-response study

Heidi Jurvelin, Timo Takala, Juuso Nissilä, Markku Timonen, Melanie Rüger, Jari Jokelainen, Pirkko Räsänen, Heidi Jurvelin, Timo Takala, Juuso Nissilä, Markku Timonen, Melanie Rüger, Jari Jokelainen, Pirkko Räsänen

Abstract

Background: Bright light treatment is effective for seasonal affective disorder (SAD), although the mechanisms of action are still unknown. We investigated whether transcranial bright light via the ear canals has an antidepressant effect in the treatment of SAD.

Methods: During the four-week study period, 89 patients (67 females; 22 males, aged 22-65, mean ± SD age: 43.2 ± 10.9 years) suffering from SAD were randomized to receive a 12-min daily dose of photic energy of one of three intensities (1 lumen/0.72 mW/cm(2); 4 lumens/2.881 mW/cm(2); 9 lumens/6.482 mW/cm(2)) via the ear canals. The light was produced using light-emitting diodes. The severity of depressive symptoms was assessed with the Hamilton Depression Rating Scale - Seasonal Affective Disorder (SIGH-SAD), the Hamilton Anxiety Rating Scale (HAMA), and the Beck Depression Inventory (BDI). Cognitive performance was measured by the Trail Making Test (TMT). The within-group and between-group changes in these variables throughout the study were analysed with a repeated measures analysis of variance (ANOVA), whereas gender differences at baseline within the light groups were analysed using Student's t-tests.

Results: Patients in all three groups showed significant decreases in their BDI, HAMA, and SIGH-SAD scores. Response rates, i.e., an at least 50% decrease of symptoms as measured by the BDI, were 74%-79% in the three treatment groups. Corresponding variations for the SIGH-SAD and the HAMA were 35-45% and 47-62%, respectively. No intensity-based dose-response relationships in the improvement of anxiety and depressive symptoms or cognitive performance between treatment groups were observed. Approximately one in four patients experienced mild adverse effects, of which the most common were headache, insomnia, and nausea.

Conclusions: These results suggests that transcranial bright light treatment may have antidepressant and anxiolytic effect in SAD patients, as both self- and psychiatrist-rated depressive and anxiety symptoms decreased in all treatment groups. These improvements are comparable to findings of earlier bright light studies that used conventional devices. The lack of dose response may be due to a saturation effect above a certain light intensity threshold. Further studies on the effects of transcranial bright light with an adequate placebo condition are needed.

Trial registration: NCT01293409, ClinicalTrials.gov.

Figures

Figure 1
Figure 1
Randomized study procedures. A 12-minute bright light dose was administered transcranially via the ear canals daily after awakening. The intensity of the transcranial bright light (TBL) was 1, 4 and 9 lumens in treatment groups 1, 2, and 3, respectively. Depressive symptoms were evaluated using the SIGH-SAD, HAMA, and BDI measurements. Cognitive performance was measured using the Trail-Making Test (TMT) part A and B.
Figure 2
Figure 2
Spectral power distribution of the bright light produced by the light-emitting diode (LED) of the randomly selected device.
Figure 3
Figure 3
Response rates measured by SIGH-SAD, HAMA and BDI. Response rates are defined as the percentage of patients who met the response criteria, i.e., a >50% decrease of symptom scores. Values are reported as% ± sem.
Figure 4
Figure 4
BDI sum scores during the four-week treatment period. Values are reported as the mean ± sem.

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