Dawn simulation and bright light in the treatment of SAD: a controlled study.

BACKGROUND: Some small controlled studies have found that dawn simulation is effective in treating seasonal affective disorder (SAD). With a larger sample size and a longer duration of treatment, we compared dawn simulation with bright light therapy and a placebo condition in patients with SAD. METHOD: Medication-free patients with SAD were randomly assigned to one of three conditions: bright light therapy (10,000 lux for 30 min, from 6:00 AM to 6:30 AM), dawn simulation (1.5 hour dawn signal from 4:30 AM to 6:00 AM peaking at 250 lux), and a placebo condition, a dim red light (1.5 hour dawn signal from 4:30 am to 6:00 AM peaking at 0.5 lux.) Over the subsequent 6 weeks, the subjects were blindly rated by a psychiatrist using the Structured Interview Guide for the Hamilton Depression Rating-Seasonal Affective Disorder Version (SIGH-SAD). We modeled the profiles of the remissions (SIGH-SAD < or = 8) and response (> or =50% decrease in SIGH-SAD) to treatment over time using Cox proportional hazards models. RESULTS: The sample consisted of 95 subjects who were randomized to the three conditions: bright light (n = 33), dawn simulation (n = 31) and placebo (n = 31). Dawn simulation was associated with greater remission (p <.05) and response (p <.001) rates compared to the placebo. Bright light did not differ significantly from the placebo. Dawn simulation was associated with greater remission (p <.01) and response (p <.001) rates compared to the bright light therapy. The mean daily hours of sunshine during the week before each visit were associated with a significant increase in likelihood of both remission (p <.001) and response (p <.001). CONCLUSIONS: Dawn simulation was associated with greater remission and response rates compared to the placebo and compared to bright light therapy. The hours of sunshine during the week before each assessment were associated with a positive clinical response.

Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure.

OBJECTIVE: Bright light therapy in seasonal affective disorder (SAD) has been studied extensively. However, little attention has been given to subsyndromal seasonal affective disorder (SSAD) or the use of bright light in the workplace. Many patients using bright light boxes complain of the inconvenience of use. Much of this inconvenience involves the often-recommended early timing of the bright light therapy. Patients, who already have difficulty awakening, often have difficulty using the bright light therapy soon after awakening before going to work. If bright light could be used effectively in the workplace, the treatment would be more convenient; the improved convenience would probably improve compliance. In this study, we studied the effectiveness of bright light therapy in subjects with SSAD in the workplace, comparing morning bright light with afternoon bright light. METHOD: Morning and afternoon bright light treatment (2500 lux) were compared in 30 subsyndromal seasonal affective disorder patients using the bright light therapy in the workplace. Hamilton Depression Ratings and subjective measures of mood, energy, alertness and productivity were assessed before and after 2 weeks of light therapy. RESULTS: Both morning and evening bright light significantly decreased the depression ratings and improved the subjective mood, energy, alertness and productivity scores. However, there were no significant differences between the two times of administration of the bright light treatment. Both bright light treatments were well tolerated. CONCLUSION: Bright light given in the workplace improves subjective ratings of mood, energy, alertness and productivity in SSAD subjects. Morning and afternoon bright lights resulted in similar levels of improvement.

Dawn simulation treatment of abstinent alcoholics with winter depression.

BACKGROUND: Recent data suggest that winter depression (seasonal affective disorder [SAD]) may be a subtype of affective disorder that is closely related to alcoholism. Dawn simulation has been shown in controlled trials to be effective in SAD. The present study examined the effectiveness of dawn simulation in abstinent alcoholics who met DSM-III-R criteria for major depression, or bipolar disorder, depressed with seasonal pattern. METHOD: All 12 subjects with winter depression had a history of either alcohol dependence or alcohol abuse according to DSM-III-R and had been abstinent from alcohol for at least 6 months. They also fulfilled criteria for SAD according to Rosenthal and were hypersomnic and drug free. After a 1-week baseline period, the subjects were randomly assigned to a 1-week treatment period at home with either a white 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 250 lux or a red 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 2 lux. The subjects were told that they would receive daily either a red or a white dawn reaching the same illuminance, an illuminance that would be much dimmer than standard bright light treatment. At the end of each week, the subjects were blindly assessed by a psychiatrist using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder version (SIGH-SAD). RESULTS: For the 6 subjects completing the white dawn treatment, the mean SIGH-SAD score decreased from 33.0 at baseline to 15.8 after treatment. For the 6 subjects completing the dim red dawn treatment, the mean SIGH-SAD score decreased from 34.3 to 32.7. The mean post-dawn SIGH-SAD score was significantly lower after the white dawn treatment than after the dim red dawn treatment (ANCOVA with baseline SIGH-SAD as the covariate, F = 12.95, p < .01). Superiority of the white dawn was also found by analogous analyses for the Hamilton Rating Scale for Depression (HAM-D) (p < .01) and the SAD Subscale (p < .05). CONCLUSION: The present study suggest that dawn simulation may be helpful in decreasing depression in abstinent alcoholics with SAD. Further study is necessary to confirm these preliminary findings and to determine whether dawn simulation might be helpful in preventing relapse in abstinent alcoholics who have SAD.

A psychiatrist-rated battery of measures for assessing the clinical status of psychiatric inpatients.

Despite the increasing demand for outcome assessment measures, no published reports have provided a standardized way to assess psychiatric inpatients that includes diagnosis and observer ratings of psychopathology. This paper reviews general principles for selecting outcome assessment measures, proposes a battery of instruments based on already available measures to assess clinical status in psychiatric inpatients, reviews methods of implementing the battery in an academic inpatient psychiatric setting, and presents preliminary data on its interrater reliability, construct validity, and range of response to acute hospitalization. Preliminary results suggest that the battery may be useful for resident and medical student education and for enhancing quality assurance and continuous quality improvement.

Dawn simulation compared with a dim red signal in the treatment of winter depression.

In a randomized, parallel design, 19 patients with winter depression were treated with either a week of a white 1.5-hr dawn simulation peaking at 250 lux or a week of a red, 1.5-hr dawn signal peaking at 2 lux. The subjects were told that they would receive either a white or red dawn reaching in intensity that would be dimmer than standard bright light treatment. At the end of both the baseline week and the treatment week subjects were blindly assessed with the Hamilton Rating Scale for Depression (HDRS). Analysis of covariance was used to compare the two dawn treatments. The white, 1.5-hr, 250 lux dawn simulation resulted in significantly (p < 0.05) lower HDRS scores compared to the red, 1.5-hr, 2 lux dawn. This is the second controlled study which indicates that dawn simulation is an effective treatment for winter depression.

Dawn simulation treatment of winter depression: a controlled study.

OBJECTIVE: This study sought to determine whether dawn simulation was superior to a shorter dimmer "placebo" dawn signal in treating winter depression. METHOD: In a randomized, parallel design, 22 patients with winter depression were treated with either 1 week of a 2-hour dawn simulation peaking at 250 lux or 1 week of a 30-minute dawn simulation peaking at 0.2 lux. The subjects were told that they would receive either a "gradual" dawn or a "rapid" dawn reaching an intensity that would be dimmer than standard bright light treatment. At the end of both the baseline week and the treatment week, subjects were assessed in a blind manner with the Hamilton Rating Scale for Depression. Analysis of covariance was used to compare the two dawn treatments. RESULTS: The 2-hour, 250-lux dawn simulation resulted in Hamilton depression scale scores that were significantly lower than scores after the 30-minute, 0.2-lux dawn simulation. CONCLUSIONS: This study indicates that dawn simulation is an effective treatment for winter depression.

Gradual versus rapid dawn simulation treatment of winter depression.

BACKGROUND: Bright light therapy has been shown to be effective in treating winter depression. Dawn simulation, a low-illuminance light that gradually increases in intensity while the person sleeps, decreased depression in an uncontrolled study. The present study compares a gradual dawn signal with a hypothesized placebo condition, a rapid dawn signal. METHOD: In a 4-week, randomized crossover design, nine patients with winter depression were treated with a gradual, 2.5-hour dawn simulation for 1 week and a rapid, 10-minute dawn simulation for 1 week. Both dawns had a maximum illuminance of 275 lux. At the end of each baseline week and treatment week, blind raters assessed the level of depression. RESULTS: Hamilton Rating Scale for Depression mean scores significantly decreased for both the gradual dawn (17.7 to 5.9, p < .05) and the rapid dawn (17.2 to 7.0, p < .05) condition. The improvement was similar for both treatments. Early morning awakening was significantly (p < .01) more common with the gradual dawn (7/9) than with the rapid dawn (1/9) condition. CONCLUSION: Depression decreased under both dawn simulations. Because the degree of improvement was similar, a placebo effect rather than the efficacy of dawn simulation might explain the results. However, a mere placebo effect is an unlikely explanation. The degree of improvement was similar to that shown in studies of bright light therapy and clearly superior to previous "placebo" control conditions. The side effects from the gradual dawn may have obscured a potential superiority of the gradual dawn over the rapid dawn.

Bright dawn simulation compared with bright morning light in the treatment of winter depression.

In a randomized cross-over design, 7 patients with winter depression were treated with a week of a bright (1700 lx) dawn simulation (0400 to 0600) and a week of standard bright (1700 lx) morning (0600 to 0800) light therapy. The Hamilton Rating Scale for Depression scores decreased significantly for the standard light therapy (18.9 to 6.6) but not for the bright dawn therapy (18.0 to 11.3). Early morning awakening was a frequent side effect with the bright dawn simulation. Although dawn simulation at a lower illuminance may be an effective treatment, the bright dawn used in this study showed only a nonsignificant trend to lower depression ratings. The illuminance of dawn simulation should be adjusted to minimize side effects.