Light Therapy for Elderly Depression

NCT ID: NCT00332670

Last Updated: 2008-08-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

89 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-01-31

Study Completion Date

2007-06-30

Brief Summary

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The purpose of this study is to investigate the following two hypotheses:

1. Treatment with bright light improves their sleep, mood, concentration and self-sufficiency of elderly depressed subjects. This clinical improvement is accompanied by decreases in cortisol/DHEA ratio and increases in melatonin concentration in urine and saliva.
2. The eventual beneficial effect of bright light treatment can be predicted by the presence of sleep-wake rhythm disturbances as found using muscle activity registration, and by cortisol/DHEA and melatonin concentrations in saliva and urine over the day and the night.

Detailed Description

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Background: Depression frequently occurs in the elderly. In normal aging, and in depression, the functioning of the suprachiasmatic nucleus (SCN) is impaired, as evidenced by an increased prevalence of day-night rhythm perturbations, e.g. sleeping disorders. Also, the normal inhibition of SCN neurons on corticotrophin-releasing hormone (CRH) producing cells is decreased, which could be responsible for the hyperactive hypothalamus-pituitary adrenocortical axis (HPA-axis). This raises the question whether elderly patients with depression have more impaired SCN activity and whether HPA-activity is enhanced. Using bright light therapy (BLT) the SCN can be stimulated. And, the beneficial effects of BLT on seasonal depressive disorders are well accepted. Nevertheless, the effects of BLT in aged depressed patients have never been studied, as yet.

Aims: The aim of this study is to test the hypothesis that BLT improves sleep, mood, concentration and self-efficacy of older people with depression and this improvement is accompanied by a normalization of HPA-indices.

Methods: Randomised double blind placebo controlled trial in 120 subjects of 60 years and older with a diagnosis of major depressive disorder (DSM-IV/SCID-I). Subjects are recruited through referrals of psychiatric outpatient clinics and from case-finding from databases of general practitioners and old-people homes in the Amsterdam region. After inclusion subjects are randomly allocated to bright blue light vs. dim red light groups using two Philips Bright Light Energy boxes type HF 3304 per subject from which the light bulbs have been covered with bright blue or dim red light permitting filters. Criteria for stratification are the use of SSRIs. Prior to treatment a 1-week run-in period without treatment will be used as a baseline condition. At three time points several endocrinological, psychophysiological, psychometrically, neuropsychological, and neuroimaging measures are performed: just before start of light therapy (T0), after completion of the three week light therapy period (T1), and three weeks thereafter (T2).

Relevance: This study is designed to show whether light therapy can reduce depressive symptoms of elderly patients with a major depressive disorder. If this is the case, then additional lightning may easily be installed in the homes of patients to serve as a maintenance treatment. Also, if our data support the role of a dysfunctional biological clock in depressed elderly subjects, such a finding may guide the further development of drugs that inhibit the HPA axis.

Conditions

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Major Depressive Disorder

Keywords

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(Non-seasonal) Depression bright light therapy randomized controlled trial suprachiasmatic nucleus HPA-axis DHEA melatonin actigraphy elderly self-efficacy social support

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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1

10.000lux bright blue light 1hour every morning 1 hour after wake-up time during three weeks

Group Type ACTIVE_COMPARATOR

10.000lux blue 1 hour every day during three weeks

Intervention Type PROCEDURE

10.000lux during 60 minutes, starting 1 hour after wake-up, during 3 weeks

2

50lux dim red light 1 hour every morning 1 hr after wake-up time during 3 weeks

Group Type PLACEBO_COMPARATOR

50lux dim red 1 hour every day during three weeks

Intervention Type PROCEDURE

50 lux red light, 60 minutes every morning, starting 1 hour after wake-up, during three weeks

Interventions

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10.000lux blue 1 hour every day during three weeks

10.000lux during 60 minutes, starting 1 hour after wake-up, during 3 weeks

Intervention Type PROCEDURE

50lux dim red 1 hour every day during three weeks

50 lux red light, 60 minutes every morning, starting 1 hour after wake-up, during three weeks

Intervention Type PROCEDURE

Other Intervention Names

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Bright light Dim red light

Eligibility Criteria

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Inclusion Criteria

* Understanding and speaking Dutch language
* 60 years of age or older
* Presence of a Major Depressive Disorder according to DSM-IV (SCID-based)
* When under treatment of an ophthalmologist, his / her approval for participation.

Exclusion Criteria

* Progressive eye diseases, glaucoma or cataract for which an operation is scheduled in near future, aphakia, retinopathies like maculopathy, retinitis pigmentosa or ablatio retina.
* Physical problems or disorders which require specific medical treatment like Lupus, untreated diabetes, malignancies, organic brain disorders, chronic infections, thyroid disorders not adequately treated, thyroid associated ophthalmopathies, M. Parkinson.
* Presence of any concurrent substance abuse problem
* Presence of other actual axis-I disorders like bipolar disorder, dementias, delirium, all psychotic disorders, Posttraumatic stress disorder.
* Use of tricyclic antidepressants, MAOIs.
* Use of corticosteroids.
* Use of tetracyclic antibiotics.
* Treatment with antidepressants shorter than 2 months
* Use of oral contraceptives.
* Treatment with light therapy in the past.
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Netherlands Institute for Brain Research, Amsterdam, The Netherlands.

UNKNOWN

Sponsor Role collaborator

GGZ Buitenamstel

OTHER

Sponsor Role lead

Responsible Party

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GGZBuitenamstel

Principal Investigators

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Witte JG Hoogendijk, prof. dr.

Role: STUDY_DIRECTOR

Center for Neurogenomics and Cognitive Research, Free University, Amsterdam, the Netherlands; Department of Psychiatry VU University Medical Center, Amsterdam, The Netherlands; GGZ Buitenamstel, Amsterdam, The Netherlands

Eus van Someren, PhD

Role: STUDY_CHAIR

Netherlands Institute for Brain Research, Amsterdam, The Netherlands; VU University Medical Center, Amsterdam, The Netherlands

Marjan MA Nielen, PhD

Role: STUDY_CHAIR

Center for Neurogenomics and Cognitive Research, Free University, Amsterdam, the Netherlands; Department of Psychiatry VU University Medical Center, Amsterdam, The Netherlands; GGZ Buitenamstel, Amsterdam, The Netherlands

Ritsaert Lieverse, MD

Role: PRINCIPAL_INVESTIGATOR

Center for Neurogenomics and Cognitive Research, Free University, Amsterdam, the Netherlands; Department of Psychiatry VU University Medical Center, Amsterdam, The Netherlands; GGZ Buitenamstel, Amsterdam, The Netherlands

Locations

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GGZ Buitenamstel

Amsterdam, North Holland, Netherlands

Site Status

Countries

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Netherlands

References

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Hoogendijk WJ, van Someren EJ, Mirmiran M, Hofman MA, Lucassen PJ, Zhou JN, Swaab DF. Circadian rhythm-related behavioral disturbances and structural hypothalamic changes in Alzheimer's disease. Int Psychogeriatr. 1996;8 Suppl 3:245-52; discussion 269-72. doi: 10.1017/s1041610297003426. No abstract available.

Reference Type BACKGROUND
PMID: 9154571 (View on PubMed)

Beekman AT, Penninx BW, Deeg DJ, Ormel J, Braam AW, van Tilburg W. Depression and physical health in later life: results from the Longitudinal Aging Study Amsterdam (LASA). J Affect Disord. 1997 Dec;46(3):219-31. doi: 10.1016/s0165-0327(97)00145-6.

Reference Type BACKGROUND
PMID: 9547118 (View on PubMed)

Deuschle M, Gotthardt U, Schweiger U, Weber B, Korner A, Schmider J, Standhardt H, Lammers CH, Heuser I. With aging in humans the activity of the hypothalamus-pituitary-adrenal system increases and its diurnal amplitude flattens. Life Sci. 1997;61(22):2239-46. doi: 10.1016/s0024-3205(97)00926-0.

Reference Type BACKGROUND
PMID: 9393943 (View on PubMed)

Kripke DF, Tuunainen A, Endo T. Benefits of light treatment for depression. Am J Psychiatry. 2006 Jan;163(1):162-3; author reply 163. doi: 10.1176/appi.ajp.163.1.162-b. No abstract available.

Reference Type BACKGROUND
PMID: 16390913 (View on PubMed)

Kripke DF. Light treatment for nonseasonal depression: speed, efficacy, and combined treatment. J Affect Disord. 1998 May;49(2):109-17. doi: 10.1016/s0165-0327(98)00005-6.

Reference Type BACKGROUND
PMID: 9609674 (View on PubMed)

Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry. 2005 Apr;162(4):656-62. doi: 10.1176/appi.ajp.162.4.656.

Reference Type BACKGROUND
PMID: 15800134 (View on PubMed)

Wirz-Justice A, Terman M, Oren DA, Goodwin FK, Kripke DF, Whybrow PC, Wisner KL, Wu JC, Lam RW, Berger M, Danilenko KV, Kasper S, Smeraldi E, Takahashi K, Thompson C, van den Hoofdakker RH. Brightening depression. Science. 2004 Jan 23;303(5657):467-9. doi: 10.1126/science.303.5657.467c. No abstract available.

Reference Type BACKGROUND
PMID: 14739440 (View on PubMed)

Wirz-Justice A, Benedetti F, Berger M, Lam RW, Martiny K, Terman M, Wu JC. Chronotherapeutics (light and wake therapy) in affective disorders. Psychol Med. 2005 Jul;35(7):939-44. doi: 10.1017/s003329170500437x.

Reference Type BACKGROUND
PMID: 16045060 (View on PubMed)

Martiny K, Lunde M, Unden M, Dam H, Bech P. Adjunctive bright light in non-seasonal major depression: results from clinician-rated depression scales. Acta Psychiatr Scand. 2005 Aug;112(2):117-25. doi: 10.1111/j.1600-0447.2005.00574.x.

Reference Type BACKGROUND
PMID: 15992393 (View on PubMed)

Martiny K, Lunde M, Unden M, Dam H, Bech P. Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and well-being scales. Acta Psychiatr Scand. 2005 Jun;111(6):453-9. doi: 10.1111/j.1600-0447.2005.00532.x.

Reference Type BACKGROUND
PMID: 15877712 (View on PubMed)

Gordijn MC, Beersma DG, Korte HJ, Van den Hoofdakker RH. Testing the hypothesis of a circadian phase disturbance underlying depressive mood in nonseasonal depression. J Biol Rhythms. 1998 Apr;13(2):132-47. doi: 10.1177/074873098128999989.

Reference Type BACKGROUND
PMID: 9554575 (View on PubMed)

Zhou JN, Riemersma RF, Unmehopa UA, Hoogendijk WJ, van Heerikhuize JJ, Hofman MA, Swaab DF. Alterations in arginine vasopressin neurons in the suprachiasmatic nucleus in depression. Arch Gen Psychiatry. 2001 Jul;58(7):655-62. doi: 10.1001/archpsyc.58.7.655.

Reference Type BACKGROUND
PMID: 11448372 (View on PubMed)

Lieverse R, Van Someren EJ, Nielen MM, Uitdehaag BM, Smit JH, Hoogendijk WJ. Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2011 Jan;68(1):61-70. doi: 10.1001/archgenpsychiatry.2010.183.

Reference Type DERIVED
PMID: 21199966 (View on PubMed)

Lieverse R, Nielen MM, Veltman DJ, Uitdehaag BM, van Someren EJ, Smit JH, Hoogendijk WJ. Bright light in elderly subjects with nonseasonal major depressive disorder: a double blind randomised clinical trial using early morning bright blue light comparing dim red light treatment. Trials. 2008 Jul 31;9:48. doi: 10.1186/1745-6215-9-48.

Reference Type DERIVED
PMID: 18671864 (View on PubMed)

Other Identifiers

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ZonMw SOW nr 014-91-049

Identifier Type: -

Identifier Source: secondary_id

ZonMw AGIKO nr 940-37-033

Identifier Type: -

Identifier Source: secondary_id

SOW 014-91-049

Identifier Type: -

Identifier Source: org_study_id