Comparison of antidepressant drug alone versus antidepressant drug plus bright light therapy combination for severe major depressive disorder

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Objective: Phototherapy, i.e., bright light therapy (BLT), is an effective and safe treatment of major depressive disorder (MDD). It exerts rapid mood-elevating activity, similar to antidepressant medications, most likely mediated through both monoaminergic and circadian system melatonergic mechanisms. We assessed the efficiency of BLT as an adjuvant treatment to antidepressant pharmacotherapy in severe MDD patients randomized by Hamilton Depression Rating (HAM-D) scale score either to: (i) 150 mg venlafaxine hydrochloride (VH) daily at 8 a.m. or (ii) 150 mg VH+BLT (30-minute full spectrum light of 10000 lux) daily at 8 a.m. Methods: 50 severe MDD inpatients of the Psychiatry Clinic of Yuzuncu Yil University Training and Education Hospital participated. Mood states were assessed by the HAM-D, Profile of Mood States (POMS), and Beck Depression Inventory (BDI) instruments before and at 1, 2, 4, and 8 weeks of treatment. Results: Based on the HAM-D score as the primary outcome variable, both strategies significantly improved depression and negative mood states already at the 1st treatment week. Therapeutic effects were more remarkable at the 2nd treatment week, with beneficial effects improving until trial conclusion. However, those treated with VH+BLT evidenced significantly lower HAM-D depression and also POMS and BDI negative mood states scores. This more favorable effect of the combination VH+BLT strategy, signified by reduction of the mean score of the HAM-D and other assessment instruments, generally became more remarkable at the 2nd week of the trial and was sustained. At week 4 of the trial, 19 of the 25 (76%) VH+BLT patients vs. just 11 of the 25 (44%) VH patients attained the target goal of treatment, a HAM-D score less than 13 indicative of mild depression, and at week 8, 76% of VH+BLT patients vs. just 64% of the VH ones experienced complete remission of their depression (HAM-D score less than 7). Conclusion: Both VH and VH+BLT treatment strategies significantly reversed the depressive mood of severe MDD patients; however, the latter induced significantly stronger beneficial effects and more rapidly. Future longer-term studies of large sample size, nonetheless, are required to confirm and generalize these results to both severe and mild MDD patients of diverse ethnicities and cultures.