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11 May 2006
Light therapy and fluoxetine appear to have comparable efficacy for the treatment of seasonal affective disorder, research shows.
The only significant differences were an earlier response onset and lower rate of some adverse events with light treatment than with fluoxetine.
"This study supports the effectiveness and tolerability of both treatments for seasonal affective disorders and suggests that other factors including patient preference, should guide selection of first-line treatment," say Raymond Lam (University of British Columbia, Vancouver, Canada) and colleagues.
The researchers compared the efficacy of light therapy and fluoxetine treatment in 96 patients who were randomly assigned to receive 10,000-lux light treatment and a placebo capsule or 100-lux light treatment (placebo) and 20 mg/day of fluoxetine for 8 weeks.
Light treatment was applied for 30 minutes every morning with a fluorescent white-light box, while placebo light boxes used neutral density filters.
Overall, there were no differences between the two treatment groups with regard to clinical response rates, defined as a 50% or greater reduction in Hamilton Depression Rating Scale scores, at 67% for each group.
There was also no significant difference in rates of remission, classified as a clinical response plus a Hamilton Depression Rating Scale score of 8 points or less, at 50% for patients receiving active light therapy and 54% for patients taking fluoxetine.
The investigators note in the American Journal of Psychiatry that patients treated with light therapy showed a greater improvement at 1 week than those taking fluoxetine, but not at other time points.
Both treatments were generally well tolerated, with no difference in the overall number of adverse events or in drop-out rates due to side effects. However, fluoxetine was associated with a greater frequency of some treatment-emergent effects, including agitation, sleep disturbance, and palpitations.
Concluding that fluoxetine and light therapy have comparable efficacy for seasonal affective disorder, Lam et al comment: "In the absence of clear superiority for either treatment, patient preference should be a major factor in treatment selection."
They add: "Predictive factors (symptoms, personality traits, circadian measures) of response to light or medication, and differences in quality of life and cost-benefit of treatment, also should be of interest."
Source: Am J Psychiatry 2006; 163: 805-812
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