Midday Bright Light Therapy Improves Mood in Bipolar Depressed Patients

In a six-week, double-blind study, Dr. Sit and collaborators randomly assigned adults with bipolar depression to treatment with either 7,000-lux bright white light or 50-lux dim red placebo light (23 patients in each group). The treatment was administered midday because bright light exposure at that time “can phase-advance and increase the amplitude of nocturnal melatonin production in healthy subjects and in elderly patients with insomnia.” It can also improve “decreased awake time at night, increased sleep efficiency, and reduced wake time after sleep onset.” The duration of light therapy started at 15 minutes per session between 12:00 p.m. and 2:30 p.m, increased by 15 minutes weekly up to 60 minutes by week 4. The authors found higher remission rates (68.2% vs. 22.2%) and lower depression scores with bright light therapy compared to placebo light. There were not mood polarity switches. Bright light therapy had a large effect between week 4 and week 6 of treatment. The results of this study are important given the limited treatment options for depression in bipolar disorder. In their conclusion, the authors stated “given its efficacy, ease of use, and tolerability, midday light therapy is ideally suited for depressed patients with bipolar disorder, and it may eventually gain widened acceptance with improved practitioner awareness.”

Continuing Antidepressants Lowers the Risk of Relapse in Patients Treated for Anxiety Disorders

Dr. Batelaan and colleagues systematically reviewed relapse prevention trials in patients with anxiety disorders who responded to antidepressants. They focused on patients treated for a variety of anxiety disorders, including panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and specific phobias. They included 28 double-blind studies with a maximum follow-up of one year. There were 2625 patients in the antidepressant group and 2608 in the placebo group. All patients responded to antidepressants and were randomly assigned to either continue the antidepressant or switch to placebo. The authors found that relapse rates were higher and time to relapse was shorter when antidepressants were discontinued. The authors conclude that the risk of relapse increases up to one year after discontinuation of antidepressants. In their discussion of the results, they emphasize that the recommendation to continue treatment for a year “should not be interpreted as advice to taper drugs after this period. [..] In addition to relapse, patients’ preferences and adverse effects should be taken into account when deciding whether to continue or discontinue antidepressants.”

Deficits in Memory after an Episode of Depression May Improve with Modafinil

After an episode of depression, almost half of the patients have impaired cognition (executive functioning, memory, attention), which results in poorer functioning and higher risk of relapse. in a study published in Biological Psychiatry CNNI, Muzaffer Kaser and colleagues suggest that modafinil improves memory in those patients. Modafinil is a a wake-promoting agent approved by the FDA for the treatment of narcolepsy and shift work sleep disorder. In a double-blind, randomized study, they compared two groups patients in remitted depression (30 who took a single-dose of 200 mg modafinil vs. 30 who took a single dose of placebo) for cognition and fatigue .

They found that modafinil improves episodic and working memory but has no effect on attention, planning, or fatigue. They hypothesize that patients recovering from depression have a dysfunction in the hippocampal areas of the brain. Modafinil could improve memory by releasing the neurotransmitter glutamate in the hippoccampus.

Bright Light Therapy for Non-Seasonal Depression

Bright light therapy is a safe and effective treatment for seasonal affective disorder, a depression characterized by depressed mood and vegetative symptoms (increased sleep and appetite, decreased energy and motivation) during winter months. Two recent studies suggest that bright light therapy can also be used in the treatment of non-seasonal depression. In a study published in 2015 in the Journal of Clinical Psychiatry, Dr. Özdemir and collaborators conducted an 8-week study comparing 150 mg venlafaxine Extended Release (ER) with (25 patients) or without (25 patients) light therapy (60-minute light of 7000 lux the initial week of clinical management (venlafaxine + bright light therapy) daily at 7:00 AM) in non-seasonal major depressive disorder. They found that venlafaxine+light therapy is more effective and works more quickly than venlafaxine alone to improve mood. In a more recent study published in 2016 in JAMA Psychiatry, Dr. Lam and collaborators conducted a randomized, double-blind, placebo-controlled study in patients with non-seasonal depression treated with either light therapy alone (32 patients), light therapy combined with 20 mg of  fluoxetine (29 patients), fluoxetine alone (31 patients) or placebo (30 patients). The light therapy consisted of 8-week, 30-minutes (if possible bewteen 7 and 8 am), daily exposure to a 10,000-lux fluorescent white light box light box. Patients treated with light monotherapy or light combined with fluoxetine had more improvement in depressive symptoms than patients treated with fluoxetine alone or placebo. Thus, both studies suggest that light therapy is well tolerated and more effective than an antidepressant alone for the treatment of non-seasonal depression. Larger studies will be necessary to corroborate these results.