Morning Light Therapy Augments Citalopram Treatment in Major Depression

Laurie Barclay, MD

September 22, 2003

Sept. 22, 2003 — Morning light therapy helps augment therapy with citalopram for inpatients with major depression, according to a presentation on Sept. 22 at the European College of Neuropsychopharmacology meeting held in Prague, the Czech Republic. Treatment with 400 lux green light for 30 minutes was effective compared with placebo and was devoid of adverse effects.

"The study was aimed at speeding up response to selective serotonin reuptake inhibitors (SSRIs) with a chronobiological technique. We phase-advanced exposure to morning light of about two hours, by individually timing the exposure to a lamp," coauthor Francesco Benedetti, MD, from the Università Vita-Salute San Raffaele in Milan, Italy, told Medscape. "This peculiar timing was chosen based on the studies of Prof. Terman at Columbia and of Prof. Wehr at the NIMH, who showed respectively that light timed in this way is highly effective, and that winter depression is associated with changes in phase and period of melatonin of about two hours."

In this study, which has also been published in the Journal of Clinical Psychiatry, 30 consecutive inpatients admitted for a major depressive episode were treated with citalopram 40 mg. During the first two weeks of drug treatment, they were randomized 3:2 to treatment with 30 minutes of 400 lux green light in the morning or to placebo exposure to a deactivated negative ion generator. Outcome measures were the Hamilton and Zung depression rating scales (HDRS and ZDRS) and the visual analog scale.

At the end of treatment, 50% reduction of HDRS scores occurred in 77.7% of patients in the light therapy group and in 41.6% of patients in the placebo group (P = .044). Survival analysis for all outcome measures revealed a better pattern of response for patients in the light therapy group (P = .038). The benefits of light therapy began during the first days of treatment and continued throughout the four weeks of the study, with no adverse effects noted.

"To our surprise, the subjective evaluations of the patients showed that the first signs of amelioration were evident as soon as the third day of treatment. In this respect, the rapidity of action of this techique is similar to that of other chronobiological antidepressant treatments, such as sleep deprivation and phase advance," Dr. Benedetti said. "If these results [are] confirmed in an independent sample, this new strategy is likely to change common clinical practice: there's plenty of light on the earth, and light exposure is quite inexpensive and — properly controlled — devoid of side effects."

One of the authors has served as a consultant for Janssen-Silag and Schering. The other authors report no financial disclosures.

16th ECNP: Abstract P.1.117. 2003. Presented Sept. 22, 2003.
J Clin Psychiatry. 2003;64:648-653

Reviewed by Gary D. Vogin, MD