Bright Light Therapy May Boost Odds of Remission of Nonseasonal Depression

Participants who received add-on bright light therapy for nonseasonal depression, either unipolar or bipolar, were more likely to respond and reach remission than those who did not receive it, according to a systematic review and meta-analysis issued by JAMA Psychiatry.

“Bright light therapy has been studied as a potential adjunctive treatment for major depressive disorder, as light exposure is well understood to affect human mood and cognitive function,” wrote Artur Menegaz de Almeida, M.S., of the Federal University of Mato Grosso in Sinop, Brazil, and colleagues. However, they noted the efficacy of bright light therapy is only established for seasonal depression.

Menegaz de Almeida and colleagues combined data from 11 randomized trials involving 858 participants who had nonseasonal major depressive disorder or bipolar depression and used bright light therapy as adjunctive treatment to their medication. Bright light therapy was defined as using a fluorescent light box that produces white light for at least 30 minutes, with the commonly used range of 10,000 lux; the treatment length ranged from one to six weeks. All studies compared outcomes to a control group who received either an air ionizer or dim red light. Studies were published between 2000 and March 25, 2024.

In total, 60.4% of participants receiving bright light therapy responded to treatment (typically defined as a 50% or greater reduction in depressive symptoms), compared with just 38.6% of those in the control groups. Participants treated with bright light therapy also had a significantly higher remission rate than the control group (40.7% versus 23.5%, respectively). Menegaz de Almeida and colleagues also found that bright light therapy increased the likelihood that individuals could achieve a response or remission within four weeks or less.

“The primary supportive argument in favor of using bright light as an adjunctive treatment is the cost,” the authors wrote. “Even though outpatient treatment costs with antidepressants are widely variable, exposure to external light generally involves no costs or limitations, which reinforces the need to firm [bright light therapy] as an efficient adjunctive treatment for nonseasonal depressive disorders.”

For related information, see the Psychiatric Research and Clinical Practice article "Commercially Available Phototherapy Devices for Treatment of Depression: Physical Characteristics of Emitted Light."

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Mood Disorders in Parents May Increase Risk of Anxiety Disorders in Offspring

Children who have a parent with a mood disorder appear to be at an elevated risk of a several anxiety disorders, suggests a report in the Journal of the American Academy of Child and Adolescent Psychiatry. The findings, which were based on a meta-analysis of 35 studies, suggest that children may be particularly at risk for panic disorder.

“Although we know that there is an overall increased risk for anxiety disorder in general among offspring of parents with mood disorders, little is understood about the risks of specific anxiety disorders and whether the risks differ between parental mood disorder subtypes,” wrote lead author En-Nien Tu, M.D., of the University of Oxford and colleagues.

To begin to answer these risks, Tu and colleagues sought out peer-reviewed studies that examined the risk of anxiety in the offspring of parents with mood disorders (at-risk group) and the offspring of parents who did not have these conditions (control group). The researchers identified 35 studies that fit their criteria that were published between 1994 and January 2023. Of these, 13 were cross-sectional studies, three were baseline data from cohort studies, and 19 were cohort follow-up studies. The majority of the studies included children under the age of 19 and most of the study participants were White and from high-income Western countries, the authors noted.

Anxiety disorders in the analysis included seasonal affective disorder (SAD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and agoraphobia.

Overall, 36.0% of children in the at-risk group experienced anxiety disorders during their lifetime, compared with 20.4% in the control group. Lifetime rates of anxiety disorders between the at-risk group vs. the control group were 20.4% vs. 10.0% for SAD, 14.5% vs. 7.16% for GAD, 15.6% vs 9.32% for social phobia, 20.2% vs. 12.1% for specific phobia, and 5.96% vs. 1.58% for panic disorder, and 4.17% vs. 4.40% for agoraphobia.

Compared with the control group, those who had parents with mood disorders were at 1.82 times higher risk of any anxiety disorder, except for agoraphobia; they also had more than a 3-fold greater risk of panic disorder compared with children who did not have a parent with a mood disorder.

When Tu and colleagues compared the offspring of parents with bipolar disorder with those of parents with unipolar depression, they found no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder versus unipolar depression.

The findings point to the importance of proactive prevention, early identification, and treatment strategies to reduce the risk of anxiety disorders in children of parents with mood disorders, the researchers noted. “An understanding of the mechanism underlying the increased rates of anxiety disorders in the offspring of parents with mood disorders may help identify important targets for intervention,” they wrote.

For related information, see the Psychiatric News Alert “One-Third of Teens Have Parent With Anxiety or Depression, Survey Suggests” and the Psychiatric News article “Childhood Anxiety Can Be Treated, the Challenge is to Recognize It.”

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Nearly 4 in 10 Americans Experience Declining Mood in Winter, APA Poll Finds

Declining mood affects 38% of Americans in the winter, APA’s November Healthy Minds Monthly Poll has found. The poll also found that 24% of Americans feel generally depressed in winter. APA’s Healthy Minds Monthly tracks timely mental health issues throughout the year.

The November Healthy Minds Monthly Poll, conducted online by Morning Consult from October 19 to October 21, asked 2,211 adults about the state of their mental health during the winter and found the following:

• 66% of participants noted behavioral changes during winter.
• 33% said they sleep more.
• 28% said they feel fatigued in the winter months.
• 21% said they become moody.
• 20% said they lose interest in the things they liked doing.
• 19% said they eat more sweets in the winter months.
• 17% said they had difficulty sleeping.

The poll also found that women and mothers were more likely than men and fathers to say their mood declined in the winter. Participants who lived in rural areas were more likely to report declining mood in winter compared with people who lived in suburban or urban areas. Furthermore, participants who lived in the Northeast and Midwest were more likely to say their mood worsened in the winter compared with those who lived in the South and West.

The survey also identified situations that improved participants’ mood during the winter; 44% of participants reported looking forward to spending time with friends and family during the holidays, and 49% said that enjoying good food improves their mood.

“Cold, dark weather can have a real impact on our mood,” APA President Rebecca W. Brendel, M.D., J.D., said in a statement. “Especially in northern areas of the country, where winter lasts for several months, it’s important to keep tabs on our mood and to seek help if sadness or other symptoms become overwhelming. It’s also a great time to remember that there are winter traditions and activities that can bring us joy and lift our moods.”

When asked about daylight savings time, 57% of participants said that the time change didn’t affect their mental health, 25% said it had a negative impact, and 18% said it had a positive impact. Parents were more likely to report a positive impact than nonparents.

The poll also examined awareness of seasonal affective disorder (SAD), a form of depression with symptoms that emerge in the fall or winter and typically resolve in the spring. Women were more likely to be familiar with it than men, and White and Latinx participants were more likely to be aware of it than Black participants. Among all participants, roughly half reported having heard or read about SAD. Slightly more than half gauged the symptoms of SAD as serious as depression, and just over a third said the symptoms are less serious. Men were more likely than women to consider the symptoms as less serious.

“Seasonal affective disorder is more than just the winter blues, and people need to be aware that if they’re having depression symptoms specifically during these months, it’s a medical disorder for which they can get help,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “It’s important to get the word out, especially in communities that have been historically underserved by medicine, that this disorder exists and that help is available.”

For related information, see the Psychiatric News article “CBT, Light Therapy Found Comparable for Seasonal Affective Disorder.”

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Bipolar II Disorder Associated With Higher Prevalence of Seasonal Affective Disorder

Patients with early-onset bipolar II disorder may be more likely to experience seasonal affective disorder (SAD) than those with other mood disorders, according to a study published in Depression and Anxiety.

“SAD can co-occur with several psychiatric disorders, including mood disorders,” wrote Heon-Jeong Lee, M.D., Ph.D., of the Korea University College of Medicine, and colleagues. They noted that although there have been debates on separating SAD as an independent diagnosis, DSM-5 recognizes seasonality as a specifier of major depressive disorder, bipolar I disorder, and bipolar II disorder.

The authors recruited 378 participants from the Mood Disorder Cohort Research Consortium study, a multicenter observational study of individuals with early-onset mood disorders including major depressive disorder, bipolar I disorder, and bipolar II disorder. The participants had to be either under 25 years old or under 35 years old and treated for a mood disorder for less than two years. Participants completed the Korean language version of the Seasonal Pattern Assessment Questionnaire to determine overall seasonal impairment and the Mood Disorder Questionnaire to identify bipolarity. The authors also recruited 235 health control subjects.

Of the participants, 138 were diagnosed with major depressive disorder, 101 were diagnosed with bipolar I disorder, and 139 were diagnosed with bipolar II disorder. Participants with mood disorders had higher overall seasonal impairment than the healthy controls. About 10% of participants with major depressive disorder and bipolar I disorder also had SAD, compared with 23% of those with bipolar II disorder and only 6% of the controls. Participants with bipolar I disorder had the highest proportion of winter-associated SAD, while those with major depressive disorder had the highest proportion of summer-associated SAD. Participants with bipolar II disorder were between two and three times more likely to experience SAD compared with those with major depressive disorder.

Additionally, the authors noted that previous studies have shown that SAD is more common in females than males. Their study, however, did not identify sex as a risk factor for SAD, which they hypothesized may be due to the younger age of the study sample and suggests that risk factors for seasonality in patients with early-onset mood disorder may differ between age groups.

“It remains unclear and needs further investigation to understand why [bipolar II disorder] has the highest seasonality among the mood disorders,” the authors wrote. “Considering the close relationship between [bipolar II disorder] and SAD, it may be helpful for clinicians to screen for seasonality in [bipolar II disorder] and bipolarity in those suspected to have SAD.”

For related information, see the Psychiatric News article “This Winter, Pandemic May Intensify Seasonal Depression.”

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Bright Light Therapy Found To Be Effective in Treating Adults With MDD

Bright light therapy has been shown to be effective in people with seasonal affective disorder (SAD), but a new study published today in JAMA Psychiatry shows that this therapy may also serve as an effective treatment for nonseasonal major depressive disorder (MDD).

To examine the efficacy of light treatment alone or in combination with antidepressants for the treatment of MDD, Raymond Lam, M.D., a professor of psychiatry at the University of British Columbia, and colleagues conducted an eight-week randomized, placebo-controlled trial of adults aged 19 to 60.

A total of 122 patients with MDD were randomly assigned to one of four groups: light therapy (active white light box for 30 minutes in early morning plus placebo pill each day); antidepressant therapy (inactive negative ion generator plus fluoxetine hydrochloride (20 mg) each day; combination light and antidepressant treatment; or placebo (inactive negative ion generator plus placebo pill). The primary outcome measure was a reduction in score on the Montgomery Åsberg Depression Rating Scale (MADRS), from baseline to endpoint. Secondary outcome measures included response (greater than 50% reduction in MADRS score) and remission (MADRS score less than 10 at end point).

The results showed that light monotherapy and combined therapy was statistically superior to placebo as it relates to reduction in MADRS scores; there was no statistical difference between fluoxetine monotherapy and placebo. For the respective placebo, fluoxetine, light, and combination groups at the end point, response was achieved by 33.3%, 29.0%, 50.0%, and 75.9% and remission was achieved by 30.0%, 19.4%, 43.8%, and 58.6%.

“Bright light treatment, both as monotherapy and in combination with fluoxetine, was efficacious and well tolerated in the treatment of adults with nonseasonal MDD. The combination treatment had the most consistent effects,” noted the researchers. “Further studies exploring mediators and moderators of response will be important.”

To read more about therapies for seasonal affective disorder, see the AJP in Advance article “Outcomes One and Two Winters Following Cognitive-BehavioralTherapy or Light Therapy for Seasonal Affective Disorder.”

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SAMHSA Seeks Chief Medical Officer to Address MH Issues at Federal Level

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CBT May Be More Durable Treatment for SAD Than Light Therapy

Six weeks of cognitive-behavioral therapy sessions tailored for seasonal affective disorder (CBT-SAD) may lead to longer-lasting effects than those seen with light therapy, according to a recent study in AJP in Advance.

Light therapy is a proven approach to treat acute SAD, but previous studies show that most patients fail to reinitiate light therapy in subsequent winters—leaving them vulnerable to the recurrence of depression. A recent analysis found CBT-SAD to be as effective as light therapy in alleviating depression associated with SAD, but it was unknown how long lasting these effects might be.

In the current study, researchers examined outcomes for 177 participants with SAD who were randomly assigned to receive CBT-SAD (two 90-minute sessions a week) or light therapy (30 minutes each morning) for six weeks. The participants were then assessed one and two winters later. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version.

In the first follow-up winter, recurrence of SAD was the same in the two groups (28.9% for CBT and 24.9% for light therapy). At the second winter, CBT-SAD had a 27.3% recurrence rate compared with 45.6% for light therapy. Participants treated with CBT-SAD also reported less severe symptoms and showed a higher rate of remission, as measured by the Beck Depression Inventory-Second Edition scores.

“Light therapy remains an important treatment for SAD, but this study shows the value of educating people about their illness and behaviors that can help manage it,” said Norman Rosenthal, M.D., a clinical professor of psychiatry at Georgetown University School of Medicine. Rosenthal, an expert on SAD, was not involved in the study.

For more on the effectiveness of CBT and light therapy for SAD, see the Psychiatric News article “CBT, Light Therapy Found Comparable for Seasonal Affective Disorder.”

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CBT Comparable to Light Therapy for Seasonal Affective Disorder, Study Finds

Cognitive behavioral therapy (CBT) is just as effective as light therapy for treating seasonal affective disorder (SAD), according to a study published online in AJP in Advance, “Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes.”

While it is known that many people with SAD respond to light therapy, few studies have examined the effectiveness of other therapies. In the current study, Kelly Rohan, Ph.D., a professor of psychology at the University of Vermont, and colleagues assigned 177 adults with an episode of major depression recurrent with a seasonal pattern to receive six weeks of CBT (two 90 minute sessions per week) or light therapy (30 minute session each morning). Depression severity was measured throughout the study by two different methods: the Structured Interview Guide for the Hamilton Rating Scale for Depression–SAD Version (SIGH-SAD) and Beck Depression Inventory–Second Edition (BDI-II).

The researchers found that both treatments produced a significant and comparable response, with about half of the patients in each treatment arm reaching criteria for remission.

"These findings suggest that CBT-SAD and light therapy are comparably effective treatment modalities for targeting acute SAD," the study authors write. "Accordingly, CBT-SAD should be disseminated into practice and considered as a viable alternative to light therapy in treatment decision making."

To read about how CBT can be effective in the treatment of childhood anxiety disorder, see the Psychiatric News article, “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”

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