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March 12, 2019; 92 (11) Article

Bright light therapy for depression in Parkinson disease

A randomized controlled trial

View ORCID ProfileSonja Rutten, Chris Vriend, Jan H. Smit, Henk W. Berendse, Eus J.W. van Someren, Adriaan W. Hoogendoorn, Jos W. R. Twisk, Ysbrand D. van der Werf, Odile A. van den Heuvel
First published February 15, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007090
Sonja Rutten
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Chris Vriend
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Jan H. Smit
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Henk W. Berendse
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Eus J.W. van Someren
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Adriaan W. Hoogendoorn
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Jos W. R. Twisk
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Ysbrand D. van der Werf
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Odile A. van den Heuvel
From Amsterdam UMC (S.R., C.V., J.H.S., E.J.W.v.S., A.W.H., O.A.v.d.H.), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience; Department of Research and Innovation (S.R., J.H.S., A.W.H., O.A.v.d.H.), GGZ InGeest; Amsterdam UMC (C.V., H.W.B., Y.D.v.d.W.), Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience; Amsterdam UMC (H.W.B.), Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam Neuroscience; Department of Sleep and Cognition (E.J.W.v.S., Y.D.v.d.W.), Netherlands Institute for Neuroscience; Department of Integrative Neurophysiology (E.J.W.v.S.), Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University; and Amsterdam UMC (J.W.T.), Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands.
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Citation
Bright light therapy for depression in Parkinson disease
A randomized controlled trial
Sonja Rutten, Chris Vriend, Jan H. Smit, Henk W. Berendse, Eus J.W. van Someren, Adriaan W. Hoogendoorn, Jos W. R. Twisk, Ysbrand D. van der Werf, Odile A. van den Heuvel
Neurology Mar 2019, 92 (11) e1145-e1156; DOI: 10.1212/WNL.0000000000007090

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Abstract

Objective To assess the efficacy of bright light therapy (BLT) in reducing depressive symptoms in patients with Parkinson disease (PD) and major depressive disorder (MDD) compared to a control light.

Methods In this double-blind controlled trial, we randomized patients with PD and MDD to treatment with BLT (±10,000 lux) or a control light (±200 lux). Participants were treated for 3 months, followed by a 6-month naturalistic follow-up. The primary outcome of the study was the Hamilton Depression Rating Scale (HDRS) score. Secondary outcomes were objective and subjective sleep measures and salivary melatonin and cortisol concentrations. Assessments were repeated halfway, at the end of treatment, and 1, 3, and 6 months after treatment. Data were analyzed with a linear mixed-model analysis.

Results We enrolled 83 participants. HDRS scores decreased in both groups without a significant between-group difference at the end of treatment. Subjective sleep quality improved in both groups, with a larger improvement in the BLT group (B [SE] = 0.32 [0.16], p = 0.04). Total salivary cortisol secretion decreased in the BLT group, while it increased in the control group (B [SE] = −8.11 [3.93], p = 0.04).

Conclusion BLT was not more effective in reducing depressive symptoms than a control light. Mood and subjective sleep improved in both groups. BLT was more effective in improving subjective sleep quality than control light, possibly through a BLT-induced decrease in cortisol levels.

ClinicalTrials.gov identifier: NCT01604876.

Classification of evidence This study provides Class I evidence that BLT is not superior to a control light device in reducing depressive symptoms in patients with PD with MDD.

Glossary

AUCG=
area under the curve with respect to the ground;
AUCI=
area under the curve with respect to the index of salivary cortisol change over time;
BLT=
bright light therapy;
CSD=
Consensus Sleep Diary;
DLMO=
dim-light melatonin onset;
DSM-IV-TR=
Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision;
HDRS=
Hamilton Depression Rating Scale;
MDD=
major depressive disorder;
MEQ=
Morningness-Eveningness Questionnaire;
mITT=
modified intention-to-treat;
PD=
Parkinson disease;
RCT=
randomized controlled trial

Footnotes

  • ↵* These authors contributed equally to this work.

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 499

  • Class of Evidence: NPub.org/coe

  • CME Course: NPub.org/cmelist

  • Received May 20, 2018.
  • Accepted in final form November 5, 2018.
  • © 2019 American Academy of Neurology
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