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Objective: The authors sought to compare the degree of mood improvement after light
treatment with mood improvement in the subsequent summer in patients with seasonal affective disorder. Method: By using the Seasonal Affective Disorder Version of the Hamilton
Depression Rating Scale, the authors rated 15 patients with seasonal affective disorder on
three occasions: during winter when the patients were depressed, during winter following
2 weeks of light therapy, and during the following summer. They compared the three conditions by using Friedmans analysis of variance and the Wilcoxon signed ranks test. Results: The patients scores on the depression scale were significantly higher after 2 weeks
of light therapy in winter than during the following summer. Conclusions: Light treatment
for 2 weeks in winter is only partially effective when compared to summer. Further studies
will be necessary to assess if summers light or other factors are the main contributors to
this difference.
(Am J Psychiatry 1998; 155:16141616)
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of at least 14 or a minimum typical score of 12 with a total depressive score of at least 20 on the Hamilton Depression Rating Scale,
Seasonal Affective Disorder Version (4). We excluded patients if they
had comorbid axis I psychiatric conditions or medical problems or
were taking psychotropic medication. Twenty-two patients were eligible, of whom 15 were enrolled in this study (two patients required
antidepressants when they did not respond to light, one underwent
surgery, and four were unavailable for follow-up). Patients signed informed consent forms. Their mean age was 44.2 years (SD=10.6).
Eleven (73.3%) were women and four (26.7%) were men. Nine patients (60%) had unipolar depression, and six (40%) had bipolar
disorder.
We rated mood by administering the Hamilton Depression Rating
Scale, Seasonal Affective Disorder Version (4), once during winter
when the patients were depressed, once during winter after 2 weeks
of light therapy, and once during the following summer. Response to
light was defined as at least a 50% decrease in baseline score and a
total posttreatment score of 7 or lower on the Seasonal Affective
Disorder Version of the Hamilton depression scale (5). Eight of 15
patients responded to 2 weeks of light treatment, and 13 of 15 patients responded in summer (difference not significant by McNemar
test for significance of changes, with Yatess correction for continuity: 2=2.29, df=1, 0.10<p<0.20).
Light treatment consisted of a standard regimen of 10,000-lux
cool-white fluorescent light therapy for 45 minutes twice daily. After
2 weeks of the standard regimen, the treatment was individually customized and gradually tapered in spring.
We initially analyzed the patients scores on the depression scale
by using the Friedmans two-way analysis of variance with conditions (depressed, light-treated, and summer) as factors. We then
compared typical, atypical, and total depression scores across lighttreated and summer conditions by using the Wilcoxon signed ranks
BRIEF REPORTS
test. The criterion alpha (two-tailed) was set at 0.015, with a Bonferroni correction for multiple comparisons.
RESULTS
The Friedman analysis for total scores on the depression scale showed a significant effect for condition
(Friedman test statistic=26.3, df=2, p<0.001). Similarly, we found a main effect for condition when we
applied the analysis to typical (Friedman test statistic=
24.4, df=2, p<0.001) and to atypical (Friedman test
statistic=26.23, df=2, p<0.001) scores.
Further Wilcoxon signed ranks test comparisons of
light-treated and summer conditions showed that depressive scores were significantly lower in the summer
than after light therapy (figure 1). The median total depression score (30 in depressed state) fell from 7 in the
light-treated condition to 3 in the summer (T=5, N=14,
p<0.01) The median typical depression score (16 in depressed state) fell from 5 in light-treated condition to 2
in the summer (T=16, N=15, p<0.01). The median
atypical depression score (10 in depressed state) decreased from 4 in light-treated condition to 1 in the
summer (T=4, N=14, p<0.01).
DISCUSSION
a =Median
depression score. Significant condition effect (Friedman test statistic=24.4, df=2, p<0.001). Significant difference between light-treated and summer (Wilcoxon T=16, N=15, p<0.01).
b Significant condition effect (Friedman test statistic=26.23, df=2,
p<0.001). Significant difference between light-treated and summer (Wilcoxon T=4, N=14, p<0.01).
c Significant condition effect (Friedman test statistic=26.3, df=2,
p<0.001). Significant difference between light-treated and summer (Wilcoxon T=5, N=14, p<0.01).
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BRIEF REPORTS
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REFERENCES
1. Rosenthal NE, Sack DA, Gillin CJ, Lewy AJ, Goodwin FK,
Davenport Y, Mueller PS, Newsome, DA, Wehr TA: Seasonal
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affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41:
7280
Terman M, Terman JS: A multi-year controlled trial of bright
light and negative ions, in Abstracts of the 8th Annual Meeting
of the Society for Light Treatment and Biological Rhythms.
Wheat Ridge, Colo, Society for Light Treatment and Biological
Rhythms, 1996, p 1
Eastman CI, Young MA, Fogg LF, Lui L: Light therapy for winter depression is more than a placebo. Ibid, p 5
Williams JBW, Link MJ, Rosenthal NE, Terman M: Structured
Interview Guide for the Hamilton Depression Rating Scale,
Seasonal Affective Disorder Version (SIGH-SAD). New York,
New York State Psychiatric Institute, 1988
Terman M, Terman JS, Quitkin F, McGrath P, Stewart J, Rafferty B: Light treatment for seasonal affective disorder: a review of efficacy. Neuropsychopharmacology 1989; 2:122
Magnusson A, Kristbjarnarson H: Treatment of seasonal affective disorder with high-intensity light: a phototherapy study
with an Icelandic group of patients. J Affect Disord 1991; 21:
141147
Bauer MS, Kurtz JW, Rubin LB, Marcus JG: Mood and behavioral effects of four-week light treatment in winter depressives
and controls. J Psychiatr Res 1994; 28:135145
Terman M, Amira L, Terman JS, Ross DC: Predictors of response and nonresponse to light treatment for winter depression. Am J Psychiatry 1996; 153:14231429
Campbell SS, Murphy PJ: Extraocular circadian phototransduction in humans. Science 1998; 279:396399