Studie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health




НазваниеStudie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health
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Bright light treatment has limited effect in subjects over 55 years with mild early morning awakening.

Pallesen S, Nordhus IH, Skelton SH, Bjorvatn B, Skjerve A.

Department of Psychosocial Science, University of Bergen Norwegian Competence Center for Sleep Disorders.

31 subjects, age 55 yr. or older, suffering from mild early morning awakening were randomized to either a bright light (10,000 lux) or to a red dim light placebo condition (200 lux). Light exposure took place in the evening in the patients' homes, 60 to 30 min. before bedtime and lasted for 3 wk. The subjects kept a sleep diary for 2 wk. and wore an actigraph for 1 wk. both before treatment and at post-treatment. Of the eight sleep diary outcome variables, significant effects that could be attributed to the light treatment were only detected for time spent in bed after final morning awakening. None of the six actigraph outcome variables yielded any significant effect of the light therapy. Explanations for the limited therapeutic effects of bright light treatment obtained in the present study are discussed, such as the criteria defining early morning awakening, the selection procedure, problems with compliance, age of the sample, and the dose of light. The lack of an objective circadian marker in this study could represent a problem concerning the timing of the light exposure. Despite the limited success of bright light therapy in this study, bright light therapy should still be considered as a treatment option for early morning awakening.


Comparative Study

Randomized Controlled Trial

PMID: 16491678


46: Support Care Cancer. 2005 Dec;13(12):1010-7. Epub 2005 Apr 29.


The relationship between fatigue and light exposure during chemotherapy.

Liu L, Marler MR, Parker BA, Jones V, Johnson S, Cohen-Zion M, Fiorentino L, Sadler GR, Ancoli-Israel S.

Department of Psychiatry, University of California San Diego, San Diego, CA 92161, USA.

BACKGROUND: Fatigue is one of the most common and distressing complaints among cancer patients, not only during radiation and chemotherapy, but also for months to years after the completion of treatment. Fatigue interferes with patients' daily lives, reduces their quality of life, and is often a significant reason why patients discontinue treatment. We hypothesized that some of the fatigue may be related to disrupted circadian rhythms and low light exposure. The main objective of this study therefore was to investigate the association between fatigue and light exposure among patients with breast cancer. METHODS: As part of a larger, ongoing prospective study on fatigue, sleep, and circadian rhythms in patients with breast cancer, an analysis of 63 women newly diagnosed with stage I-IIIA breast cancer and scheduled to receive four cycles of adjuvant or neoadjuvant anthracycline-based chemotherapy was conducted. Data were collected before and during weeks 1, 2, and 3 of cycle 1 and cycle 4. Fatigue was assessed using the Short Form of Multidimensional Fatigue Symptom Inventory. Light exposure was recorded with a wrist actigraph. RESULTS: There were significant correlations between fatigue levels and light exposure (r=-0.28 to -0.45) within both cycle 1 and cycle 4, such that higher levels of fatigue were associated with less light exposure. There were also significant correlations between changes in light exposure and changes in fatigue within the first 2 weeks of each cycle (r=-0.28 to -0.52). CONCLUSIONS: Increased fatigue was significantly correlated with decreased light exposure among patients with breast cancer. Although the cause and effect of exacerbated fatigue and decreased light exposure cannot be confirmed by the current study, and lower light exposure may just in part be due to the fatigued patients spending less time outdoors in bright light, two hypotheses are proposed about the mechanisms by which light may alleviate the fatigue of patients with breast cancer. These results suggest the need for prospective intervention studies of light therapy for breast-cancer-related fatigue.


Research Support, N.I.H., Extramural

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15864659

47: BMC Psychiatry. 2005 Nov 9;5:42.


Bright green light treatment of depression for older adults [ISRCTN69400161].

Loving RT, Kripke DF, Knickerbocker NC, Grandner MA.

Department of Psychiatry, University of California, San Diego, USA. rloving@ucsd.edu

BACKGROUND: Bright white light has been successfully used for the treatment of depression. There is interest in identifying which spectral colors of light are the most efficient in the treatment of depression. It is theorized that green light could decrease the intensity duration of exposure needed. Late Wake Treatment (LWT), sleep deprivation for the last half of one night, is associated with rapid mood improvement which has been sustained by light treatment. Because spectral responsiveness may differ by age, we examined whether green light would provide efficient antidepressant treatment in an elder age group. METHODS: We contrasted one hour of bright green light (1,200 Lux) and one hour of dim red light placebo (<10 Lux) in a randomized treatment trial with depressed elders. Participants were observed in their homes with mood scales, wrist actigraphy and light monitoring. On the day prior to beginning treatment, the participants self-administered LWT. RESULTS: The protocol was completed by 33 subjects who were 59 to 80 years old. Mood improved on average 23% for all subjects, but there were no significant statistical differences between treatment and placebo groups. There were negligible adverse reactions to the bright green light, which was well tolerated. CONCLUSION: Bright green light was not shown to have an antidepressant effect in the age group of this study, but a larger trial with brighter green light might be of value.


Comparative Study

Randomized Controlled Trial

Research Support, N.I.H., Extramural

PMID: 16283926


48: BMC Psychiatry. 2005 Nov 9;5:41.


Bright light treatment of depression for older adults [ISRCTN55452501].

Loving RT, Kripke DF, Elliott JA, Knickerbocker NC, Grandner MA.

Department of Psychiatry, University of California, San Diego, USA. rloving@ucsd.edu

BACKGROUND: The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery. METHODS: In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (<10 Lux) light for one hour a day at three different times (morning, mid-wake and evening). A placebo response washout was used for the first week. Wake treatment was conducted prior to the initiation of treatment, to explore antidepressant response and the interaction with light treatment. Urine and saliva samples were collected during a 24-hour period both before and after treatment and assayed for aMT6s and melatonin respectively to observe any change in circadian timing. Subjects wore a wrist monitor to record light exposure and wrist activity. Daily log sheets and weekly mood (GDS) and physical symptom (SAFTEE) scales were administered. Each subject was given a SCID interview and each completed a mood questionnaire (SIGH-SAD-SR) before and after treatment. Also, Hamilton Depression Rating (SIGH-SAD version) interviews were conducted by a researcher who was blind to the treatment condition. A control group of healthy, age-matched, volunteers was studied for one day to obtain baseline data for comparison of actigraphy and hormone levels. RESULTS: Eighty-one volunteers, between 60 and 79 years old, completed the study. Both treatment and placebo groups experienced mood improvement. Average GDS scores improved 5 points, the Hamilton Depression Rating Scale (HDRS) 17 scores (extracted from the self-rated SIGH-SAD-SR) improved 6 points. There were no significant treatment effects or time-by-treatment interactions. No significant adverse reactions were observed in either treatment group. The assays of urine and saliva showed no significant differences between the treatment and placebo groups. The healthy control group was active earlier and slept earlier but received less light than the depressed group at baseline. CONCLUSION: Antidepressant response to bright light treatment in this age group was not statistically superior to placebo. Both treatment and placebo groups experienced a clinically significant overall improvement of 16%.


Comparative Study

Randomized Controlled Trial

Research Support, N.I.H., Extramural

PMID: 16283925


49: Cell Metab. 2005 Nov;2(5):297-307.


Comment in:

Cell Metab. 2005 Nov;2(5):278-81.

Light activates the adrenal gland: timing of gene expression and glucocorticoid release.

Ishida A, Mutoh T, Ueyama T, Bando H, Masubuchi S, Nakahara D, Tsujimoto G, Okamura H.

Division of Molecular Brain Science, Department of Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan.

Light is a powerful synchronizer of the circadian rhythms, and bright light therapy is known to improve metabolic and hormonal status of circadian rhythm sleep disorders, although its mechanism is poorly understood. In the present study, we revealed that light induces gene expression in the adrenal gland via the suprachiasmatic nucleus (SCN)-sympathetic nervous system. Moreover, this gene expression accompanies the surge of plasma and brain corticosterone levels without accompanying activation of the hypothalamo-adenohypophysial axis. The abolishment after SCN lesioning, and the day-night difference of light-induced adrenal gene expression and corticosterone release, clearly indicate that this phenomenon is closely linked to the circadian clock. The magnitude of corticostereone response is dose dependently correlated with the light intensity. The light-induced clock-dependent secretion of glucocorticoids adjusts cellular metabolisms to the new light-on environment.


Research Support, Non-U.S. Gov't

PMID: 16271530


50: ACP J Club. 2005 Sep-Oct;143(2):48.


Comment on:

Am J Psychiatry. 2005 Apr;162(4):656-62.

Review: bright light therapy and dawn simulation reduce symptom severity in seasonal affective disorder.

Simon G.

Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA.


Comment

PMID: 16134922 [PubMed]


51: Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):658-61.


The effect of bright light therapy on depression associated with premenstrual dysphoric disorder.

Krasnik C, Montori VM, Guyatt GH, Heels-Ansdell D, Busse JW; Medically Unexplained Syndromes Study Group.

Department of Medical Science, Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.

OBJECTIVE: This systematic review summarizes the evidence from randomized clinical trials of bright light therapy for treatment of premenstrual dysphoric disorder. STUDY DESIGN: The authors performed a systematic review and meta-analysis of randomized clinical trials. They searched MEDLINE, AMED, CINAHL, Digital Dissertations, EMBASE, and the Cochrane Central Register of Controlled Trials. The main outcome measure was the change in depressive symptom scores as measured by the Hamilton Depression Rating Scale and the Beck Depression Inventory. RESULTS: Four crossover trials studying a total of 55 participants met inclusion criteria. Three trials showed similar results; one fully unblinded trial showed a much larger effect. The pooled effect size from the random-effects model of the 3 higher quality trials was -0.20 (95% CI -0.48 to 0.07). CONCLUSION: The small size of trials and correspondingly wide confidence limits, and methodologic limitations of the trials, leaves the impact of bright light therapy for relief of premenstrual depressive symptoms uncertain. The current evidence justifies neither enthusiastic dissemination nor confident rejection of this therapeutic modality.


Meta-Analysis

Research Support, Non-U.S. Gov't

Review

PMID: 16150256


52: J Sleep Res. 2005 Sep;14(3):221-7.


Weak relationships between suppression of melatonin and suppression of sleepiness/fatigue in response to light exposure.

Rüger M, Gordijn MC, Beersma DG, de Vries B, Daan S.

Department of Chronobiology, University of Groningen, Groningen, The Netherlands.

m.rueger@rug.nl

In this paper we examine the relationship between melatonin suppression and reduction of sleepiness through light by comparing three different data sets. In total 36 subjects participated in three studies and received 4 h of bright light either from midnight till 4:00 hours (experiments A and B) or from noon till 16:00 hours (experiment C). In experiment A (night-time light, partial illumination of the retina, pupil dilated) subjects were exposed to either 100 lx of ocular light on the temporal, 100 lx on the nasal part of the retina, or <10 lx of dim light on the whole retina. In experiments B (night-time light, whole retina, pupil not dilated) and C (daytime light, whole retina, pupil not dilated) subjects were exposed either to bright (5000 lx) or to dim light (<10 lx). Subjective sleepiness/fatigue and melatonin concentrations in saliva were assessed hourly in all three experiments. For experiment A, a significant suppression of melatonin due to nasal and temporal illumination of the retina was found, that was not accompanied by a detectable reduction of subjective sleepiness/fatigue. For experiment B we found a suppression of melatonin that was paralleled with a significant reduction in subjective sleepiness, but not in fatigue. During experiment C we found no melatonin suppression but a reduction of subjective sleepiness, but also no effect on fatigue. From these data we conclude that the effects of light on sleepiness/fatigue are not mediated by melatonin and that the influence of endogenous melatonin concentration on sleepiness/fatigue is restricted.


Research Support, Non-U.S. Gov't

PMID: 16120096


53: Biol Psychiatry. 2005 Aug 15;58(4):331-6.


Actigraphy in patients with seasonal affective disorder and healthy control subjects treated with light therapy.

Winkler D, Pjrek E, Praschak-Rieder N, Willeit M, Pezawas L, Konstantinidis A, Stastny J, Kasper S.

Department of General Psychiatry, Medical University of Vienna, Vienna, Austria.

dietmar.winkler@meduniwien.ac.at

BACKGROUND: Abnormalities of the circadian rest-activity cycle are hypothesized to accompany the clinical picture of seasonal affective disorder (SAD). The purpose of this study was to investigate if bright light therapy (BLT) is able to reverse these disturbances. METHODS: Seventeen SAD outpatients and 17 sex- and age-matched healthy control subjects were treated with BLT administered in the morning for 4 weeks. Activity levels were measured with wrist actigraphy. RESULTS: SAD patients had 33% lower total (p = .031) and 43% lower daylight activity (p = .006) in week 1 compared with control subjects. The relative amplitude of the sleep-wake cycle was attenuated by 6% in patients (p = .025); they were phase delayed by 55 minutes (p = .023) and had significantly lower sleep efficiency (p = .030). Total (p = .002) and daylight activity (p = .001) increased after 4 weeks of treatment in SAD patients. Moreover, BLT led to increase of relative amplitude (p = .005), advance of delayed rhythms (p = .036), and improved sleep efficiency (p = .011) in patients. Intradaily stability, measuring the strength of coupling of the rhythm to external zeitgebers, increased by 9% both in patients and healthy control subjects (p = .032). CONCLUSIONS: Treatment with BLT normalizes disturbed activity patterns and restores circadian rhythms in SAD patients. BLT might also stabilize the circadian rhythm in nondepressed individuals during the fall-winter season.
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